Journal of Neuro-Oncology

, Volume 72, Issue 2, pp 169–177 | Cite as

Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients

  • Wilhelm Küker
  • Thomas Nägele
  • Agnieska Korfel
  • Stefan Heckl
  • Eckhard Thiel
  • Michael Bamberg
  • Michael Weller
  • Ulrich Herrlinger
Clinical Study

Abstract

To avoid an unnecessary extend of surgery in primary central nervous system lymphoma (PCNSL), the diagnosis should be suspected after MRI.

Pre-treatment MRI examinations of 100 immunologically competent patients with biopsy-proven PCNSL were evaluated. All patients had T2- and T1-weighted images with contrast enhancement. Diffusion-weighted MRI (DW-MRI) was available in 15, proton-MR-spectroscopy (1H-MRS) in four patients.

The number of lesions ranged from one (n=65 patients) to eight (n=1) with a mean of 1.7. The most frequent locations were the cerebral hemispheres (n=66), the basal ganglia (n=27) and the corpus callosum (n=24). In the 65 patients with a solitary lesion, hemispheric lesions were most frequent (n=23) followed by corpus callosum (n=18). Contrast enhancement was found in all but one patient. 1H-MRS revealed a uniformly pathologic pattern of metabolite concentrations in all patients.

Characteristic imaging features of PCNSL are contrast-enhancing lesions with a diameter of at least 15 mm in contact with the subarachnoid space. DW-MRI and proton spectroscopy may aid in differential diagnosis.

Keywords

brain neoplasm DW-MRI lymphoma MRI PCNSL spectroscopy 

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References

  1. 1.
    Bailey, P 1929Intracranial sarcomatous tumors of leptomeningeal originArch Surg1813591402Google Scholar
  2. 2.
    Larocca, LM, Capello, D, Rinelli, A, Nori, S, Antinori, A, Gloghini, A, Cingolani, A, Migliazza, A, Saglio, G, Cammilleri-Broet, S, Raphael, M, Carbone, A, Gaidano, G 1998The molecular and phenotypic profile of primary central nervous system lymphoma identifies distinct categories of the disease and is consistent with histogenetic derivation from germinal center-related B cellsBlood9210111019PubMedGoogle Scholar
  3. 3.
    Peterson, K, Gordon, KB, Heinemann, MH, DeAngelis, LM 1993The clinical spectrum of ocular lymphomaCancer72843849PubMedGoogle Scholar
  4. 4.
    Ling, SM, Roach, M,3rd, Larson, DA, Wara, WM 1994Radiotherapy of primary central nervous system lymphoma in patients with and without human immunodeficiency virusTen years of treatment experience at the University of California San Francisco. Cancer7325702582Google Scholar
  5. 5.
    Jellinger, KA, Paulus, W 1992Primary central nervous system lymphomas – an updateJ Cancer Res Clin Oncol119727CrossRefPubMedGoogle Scholar
  6. 6.
    Kadan-Lottick, NS, Skluzacek, MC, Gurney, JG 2002Decreasing incidence rates of primary central nervous system lymphomaCancer95193202CrossRefPubMedGoogle Scholar
  7. 7.
    Lanfermann, H, Heindel, W, Schaper, J, Schroder, R, Hansmann, ML, Lehrke, R, Ernestus, RI, Lackner, K 1997CT and MR imaging in primary cerebral non-Hodgkin’s lymphomaActa Radiol38259267PubMedGoogle Scholar
  8. 8.
    DeAngelis, LM 1999Primary CNS lymphoma: treatment with combined chemotherapy and radiotherapyJ Neurooncol43249257CrossRefPubMedGoogle Scholar
  9. 9.
    Roman Goldstein, SM, Goldman, DL, Howieson, J, Belkin, R, Neuwelt, EA 1992MR of primary CNS lymphoma in immunologically normal patientsAJNR Am J Neuroradiol1312071213PubMedGoogle Scholar
  10. 10.
    Bühring, U, Herrlinger, U, Krings, T, Thiex, R, Weller, M, Küker, W 2001MRI features of primary central nervous system lymphomas (PCNSL) at presentationNeurology57393396PubMedGoogle Scholar
  11. 11.
    Herrlinger, U, Schabet, M, Brugger, W, Kortmann, RD, Kuker, W, Deckert, M, Engel, C, Schmeck-Lindenau, HJ, Mergenthaler, HG, Krauseneck, P, Benohr, C, Meisner, C, Wiestler, OD, Dichgans, J, Kanz, L, Bamberg, M, Weller, M 2002German Cancer Society Neuro-Oncology Working Group NOA-03 multicenter trial of single-agent high-dose methotrexate for primary central nervous system lymphomaAnn Neurol51247252CrossRefPubMedGoogle Scholar
  12. 12.
    Kuker, W, Herrlinger, U, Gronewaller, E, Rohrbach, JM, Weller, M 2002Ocular manifestation of primary nervous system lymphoma: what can be expected from imaging?J Neurol24917131716CrossRefPubMedGoogle Scholar
  13. 13.
    Seeger, U, Mader, I, Nagele, T, Grodd, W, Lutz, O, Klose, U 2001Reliable detection of macromolecules in single-volume 1H NMR spectra of the human brainMagn Reson Med45948954CrossRefPubMedGoogle Scholar
  14. 14.
    Klose, U 1990In vivo proton spectroscopy in presence of eddy currentsMagn Reson Med142630PubMedGoogle Scholar
  15. 15.
    Seeger, U, Klose, U, Mader, I, Grodd, W, Nagele, T 2003Parameterized evaluation of macromolecules and lipids in proton MR spectroscopy of brain diseasesMagn Reson Med491928CrossRefPubMedGoogle Scholar
  16. 16.
    Song, DK, Boulis, NM, McKeever, PE, Quint, DJ 2002Angiotropic large cell lymphoma with imaging characteristics of CNS vasculitisAJNR Am J Neuroradiol23239242PubMedGoogle Scholar
  17. 17.
    Williams, RL, Meltzer, CC, Smirniotopoulos, JG, Fukui, MB, Inman, M 1998Cerebral MR imaging in intravascular lymphomatosisAJNR Am J Neuroradiol19427431PubMedGoogle Scholar
  18. 18.
    Nakahara, T, Saito, T, Muroi, A, Sugiura, Y, Ogata, M, Sugiyama, Y, Yamamoto, T 1999Intravascular lymphomatosis presenting as an ascending cauda equina: conus medullaris syndrome: remission after biweekly CHOP therapyJ Neurol Neurosurg Psychiatr67403406PubMedGoogle Scholar
  19. 19.
    Ayuso-Peralta, L, Orti-Pareja, M, Zurdo-Hernandez, M, Jimenez-Jimenez, FJ, Tejeiro-Martinez, J, Ricoy, JR, Lama, A, Bernardo, AI 2001Cerebral lymphoma presenting as a leukoencephalopathyJ Neurol Neurosurg Psychiatr71243246CrossRefPubMedGoogle Scholar
  20. 20.
    Moulignier, A, Galicier, L, Mikol, J, Masson, H, Molho, M, Thiebaut, JB 2003Primary cerebral lymphoma presenting as diffuse leukoencephalopathyAids1711111113CrossRefPubMedGoogle Scholar
  21. 21.
    Pramstaller, PP, Salerno, A, Bhatia, KP, Prugger, M, Marsden, CD 1999Primary central nervous system lymphoma presenting with a parkinsonian syndrome of pure akinesiaJ Neurol246934938CrossRefPubMedGoogle Scholar
  22. 22.
    Herrlinger, U, Weller, M, Küker, W 2002Primary CNS lymhoma in the spinal cord: clinical symptoms may precede MRI detectabilityNeuroradiology44239244CrossRefPubMedGoogle Scholar
  23. 23.
    Mader, I, Seeger, U, Weissert, R, Klose, U, Naegele, T, Melms, A, Grodd, W 2001Proton MR spectroscopy with metabolite-nulling reveals elevated macromolecules in acute multiple sclerosisBrain124953961CrossRefPubMedGoogle Scholar
  24. 24.
    Naegele, T, Grodd, W, Viebahn, R, Seeger, U, Klose, U, Seitz, D, Kaiser, S, Mader, I, Mayer, J, Lauchart, W, Gregor, M, Voigt, K 2000MR imaging and (1)H spectroscopy of brain metabolites in hepatic encephalopathy: time-course of renormalization after liver transplantationRadiology216683691PubMedGoogle Scholar
  25. 25.
    Kaminogo, M, Ishimaru, H, Morikawa, M, Ochi, M, Ushijima, R, Tani, M, Matsuo, Y, Kawakubo, J, Shibata, S 2001Diagnostic potential of short echo time MR spectroscopy of gliomas with single-voxel and point-resolved spatially localised proton spectroscopy of brainNeuroradiology43353363CrossRefPubMedGoogle Scholar
  26. 26.
    Hartmann, M, Heiland, S, Harting, I, Tronnier, VM, Sommer, C, Ludwig, R, Sartor, K 2003Distinguishing of primary cerebral lymphoma from high-grade glioma with perfusion-weighted magnetic resonance imagingNeurosci Lett338119122CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Wilhelm Küker
    • 1
    • 2
    • 6
  • Thomas Nägele
    • 1
  • Agnieska Korfel
    • 5
  • Stefan Heckl
    • 1
  • Eckhard Thiel
    • 5
  • Michael Bamberg
    • 4
  • Michael Weller
    • 3
  • Ulrich Herrlinger
    • 3
  1. 1.Department of Neuroradiology, Medical SchoolUniversity of TübingenTübingenGermany
  2. 2.Department of NeuroradiologyRadcliffe InfirmaryOxfordUK
  3. 3.Dep-artment of Neurology, Medical SchoolUniversity of TübingenTübingenGermany
  4. 4.Department of Radiation Oncology, Medical SchoolUniversity of TübingenTübingenGermany
  5. 5.Department of Hematology and OncologyUniversity Hospital Benjamin FranklinBerlinGermany
  6. 6.Department of NeuroradiologyThe Radcliffe InfirmaryOxfordUK

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