Radiographic findings in 37 cases of primary CNS lymphoma in immunocompetent patients

Abstract

Because of the increasing incidence of primary central nervous system lymphoma (PCNSL), it is essential to recognize this disease in order to start appropriate treatment. We present the characteristic CT and MRI features of this tumour. The findings of 32 CT and 31 MR of 37 immunocompetent patients with biopsy-proved PCNSL are reviewed. The main features are presented and analysed, and are discussed in comparison with proven literature data. Primary central nervous system lymphoma presents as supratentorial solitary lesions in approximately 80% of the patients and multiple lesions in 20%. In contrast to classical data, the lesions are located in deep structures only in one-third of the cases, and involve posterior fossa in 10% of cases. Most of the lesions are hyperdense or isodense (92%) on CT, hypointense or isointense on T1-weighted images, and only about 40% are hyperintense on T2-weighted images. Nearly all the lesions enhance, except after corticosteroid administration. They produce mild oedema and mass effect. Meningeal or ventricular enhancement are rare but suggestive. Calcification, haemorrhage or necrosis are scarce. Although PCNSL in immunocompetent patients have a variable CT and MR appearance, the imaging data often suggest the diagnosis.

Findings at presentation in primary CNS diffuse large B-cell lymphoma of the brain: A comparison of immunocompetent and immunodeficient patients

“…Most of the lesions were supratentorial, which agrees with the existing literature [4,9,12,13] , and predominantly affecting the frontal and parietal lobes (especially in immunodeficient patients). The posterior fossa has been reported to be a rare site for tumors in the literature [9,12] . However, in our study, we found lesions in the posterior fossa in up to a third of the patients.…”

“…In our present study, the time between the onset of symptoms and diagnosis was less than half of that reported in some other studies [6,7,9,10] . The interval was almost twice as long in immunocompetent patients when we compared the two groups.…”

Patterns of response and relapse in primary CNS lymphomas after first-line chemotherapy: imaging analysis of the ANOCEF-GOELAMS prospective randomized trial

“…Neuroimaging of PCNSL shows typical intense and homogeneously enhancing mass lesions that are likely located deep in periventricular areas. [2][3][4][5] However, the impact of baseline neuroimaging characteristics on patient outcome is unclear. The most commonly used response criteria are those published by the International PCNSL Collaborative Group (IPCG), which combines MRI findings, eye examination, cerebrospinal fluid (CSF) analysis, and steroid dose.…”

Increasing incidence and continued dismal outcome of primary central nervous system lymphoma in Norway 1989–2003

“…Common debut symptoms, such as personality changes and headache, 23 are unspecific, and findings on diagnostic imaging may be variable or inconclusive. [25][26][27] In a previous study, we observed that there was a considerable delay in the diagnosis of PCNSL. 28 However, considering the advances in diagnostic imaging technologies the last decades and the reported improvements in treatment for PCNSL, we hypothesized that there has been a reduction in diagnostic delay and that overall survival has improved for patients with PCNSL over time in Norway.…”