Atypical Imaging Features of Epstein-Barr Virus–Positive Primary Central Nervous System Lymphomas in Patients without AIDS

Abstract

BACKGROUND AND PURPOSE:Recent clinical experience with EBV-positive PCNSL in patients without acquired immune deficiency syndrome showed that they tended to have atypical features seen on conventional MR imaging. The purpose of our study was to evaluate the MR imaging features of EBV-positive PCNSL in patients without AIDS and to compare these imaging findings with those of EBV-negative PCNSL.

Primary Central Nervous System Lymphoma and Atypical Glioblastoma: Multiparametric Differentiation by Using Diffusion-, Perfusion-, and Susceptibility-weighted MR Imaging

“…In the present study, we focused on atypical, solid enhancing glioblastomas, which usually are not distinguishable from PCNSL with standard MR imaging sequences. Additional evaluation of atypical PCNSL with visible necrosis and comparison with typical glioblastoma was not performed, because atypical appearance of PCNSL in immunocompetent patients (ie, visible necrosis on MR images) is predominant among patients who are positive for Epstein-Barr virus (9), which is infrequent among patients in Europe and North America (10) and reflects the imaging appearance of the present P reoperative differentiation of primary central nervous system lymphomas (PCNSLs) and glioblastomas is of high clinical relevance because treatment strategies for glioblastoma and PCNSL vary substantially. In patients with glioblastoma, gross total resection followed by radiation therapy and chemotherapy with temozolomide is the treatment of choice, whereas patients with PCNSL usually undergo stereotactic biopsy followed by highdose methotrexate-based chemotherapy (1,2).…”

Necrotic Primary Central Nervous System Lymphoma in an Immunocompetent Patient: A Case Report and Literature Review

“…The serial follow-up MRI exams performed in this patient who refused biopsy and surgical treatment also demonstrated an increasingly necrotic appearance of the tumor on T2-weighted imaging with internal areas of hyperintense signal intensity within the corpus callosum and biparietal deep white matter. This imaging appearance on MRI has been observed in AIDS-related PCNSL with many of the lesions exhibiting necrotic regions and more commonly a multifocal or disseminated appearance [1,5,9]. Subsequent MRI exams also demonstrated a peripheral “leading edge” of enhancement.…”

“…Atypical MRI appearance of PCNSL (eg necrosis, irregular or peripheral enhancement) in an immunocompetent patient is rare in the USA. This presentation is more common among patient with tumors who are positive for EBV [9-10]. EBV-positive PCNSL is more common in males and patients > 60 years old who are immunocompromised due to conditions such as HIV, chronic alcoholism, and several collagen vascular diseases.…”

Primary central nervous system lymphoma: is absence of intratumoral hemorrhage a characteristic finding on MRI?

“…Lee et al, recently demonstrated that Epstein-Barr virus -positive PCNSL cases showed intratumoral necrosis or hemorrhage more frequently than cases with Epstein-Barr virus -negative PCNSL, even in the absence of HIV infection. 38 No description of Epstein-Barr virus infection status has been available in previous studies on ITSS 13 – 15 , and this was also the case for this study. PCNSL with GITH or ITSS could potentially be related to Epstein-Barr virus infection, but no conclusion can be drawn within this study.…”