MRI findings of primary CNS lymphoma in 26 immunocompetent patients.
OBJECTIVE
To record the MR imaging features of primary central nervous system lymphoma (PCNSL) and compare these features in monofocal and multifocal disease.


METHODS
Twenty-one cases of monofocal disease were compared to five cases of multifocal disease. All patients were examined by non-enhanced and contrast-enhanced MRI. Tumor location, tumor size, signal intensity, enhancement characteristics, age distribution, peritumoral edema, cystic changes, and the presence of calcifications were assessed. The MRI features were compared between the monofocal and multifocal disease cases.


RESULTS
The 26 cases, including both the monofocal and multifocal cases, exhibited 37 lesions. Contrast-enhanced images showed variable enhancement patterns: homogeneous enhancement (33 lesions), ring-like enhancement (2), and 'open-ring-like' enhancement (2). The 'notch sign' was noted in four of 33 homogeneously enhancing lesions. One case of hemorrhage and three cases of cystic formation were observed. Intra-tumoral calcification was not found. The frontal lobe, the corpus callosum and the basal ganglia were commonly affected in both the monofocal and multifocal groups. Tumor size differed significantly between the two groups (t = 3.129, p < 0.01) and mildly or moderately enhanced lesions were more frequently found in the monofocal group (p < 0.05). There was no statistical difference between perifocal edema (p > 0.05) and the signal characteristics (p > 0.05) between the two groups.


CONCLUSIONS
Our data show that PCNSL has a variable enhancement pattern on MR images. We first reported two lesions with an 'open-ring' enhancement as well as four cases with a 'notch sign'. Monofocal PCNSL cases typically have larger sized tumors with mild or moderate enhancement.
Zhang
Dong
D
Department of Radiology, XinQiao Hospital, Third Military Medical University, ChongQing, P.R.China.
Hu
Liang-Bo
LB
Henning
Tobias D
TD
Ravarani
Elisabeth M
EM
Zou
Li-Guang
LG
Feng
Xiao-Yuan
XY
Wang
Wen-Xian
WX
Wen
Li
L
D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007121:Immunocompetence; D008223:Lymphoma / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D055815:Young Adult
D003287:Contrast Media; D019786:Gadolinium DTPA
AJNR Am J Neuroradiol. 1997 Mar;18(3):563-72
9090424
Clin Neurol Neurosurg. 2004 Dec;107(1):55-63
15567554
Neuroradiology. 1999 Nov;41(11):820-5
10602854
Neuroradiology. 2000 Oct;42(10):738-41
11110076
AJR Am J Roentgenol. 1986 Feb;146(2):271-6
3484575
J Neurooncol. 2005 Apr;72(2):169-77
15925998
J Neurooncol. 1999 Jul;43(3):199-201
10563423
Clin Radiol. 1982 May 3;33(3):331-6
7075140
AJR Am J Roentgenol. 2005 May;184(5):1679-85
15855138
Neuroradiology. 1992;34(1):36-42
1553036
J Neurooncol. 1999 Jul;43(3):219-26
10563426
J Neurosurg. 1988 Jun;68(6):835-53
3286832
J Neurosurg. 1995 Jan;82(1):77-82
7815138
Brain Tumor Pathol. 1999;16(1):29-35
10532421
AJR Am J Roentgenol. 1995 Sep;165(3):626
7645482
Clin Radiol. 1998 Jun;53(6):428-34
9651058
Neuroradiology. 1996 Jan;38(1):34-7
8773272
Neurology. 2000 Apr 11;54(7):1427-33
10751251
Eur Radiol. 2002 Feb;12(2):329-40
11870430
Radiology. 1995 Jan;194(1):271-6
7997566
Neurochirurgie. 1997;43(6):385-7
9706618
Clin Neurol Neurosurg. 2003 Apr;105(2):78-86
12691795
Ann Oncol. 1997 Mar;8(3):227-34
9137790
Ann Neurol. 1993 Mar;33(3):308-11
8498814
Neuroradiology. 1984;26(6):485-92
6504318
Clin Radiol. 1994 Oct;49(10):696-702
7955832
Cancer. 1994 Aug 15;74(4):1383-97
8055462
Radiology. 1988 Apr;167(1):211-5
3279454
J Neurosurg. 1986 Nov;65(5):592-9
3772444
AJR Am J Roentgenol. 2001 May;176(5):1319-26
11312202
Radiographics. 1997 Nov-Dec;17(6):1497-526
9397461