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Vol. 60. Issue 4.
Pages 280-289 (July - August 2018)
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Vol. 60. Issue 4.
Pages 280-289 (July - August 2018)
Update in Radiology
DOI: 10.1016/j.rxeng.2018.04.003
Primary central nervous system lymphoma in immunocompetent patients: Spectrum of findings and differential characteristics
Linfoma cerebral primario en pacientes inmunocompetentes: espectro de hallazgos y características diferenciales
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E. Gómez Roselló
Corresponding author
evagrosello@hotmail.com

Corresponding author.
, A.M. Quiles Granado, G. Laguillo Sala, S. Pedraza Gutiérrez
Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, Spain
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Table 1. Findings in conventional sequences.
Table 2. Findings in advanced sequences: differences among high-grade glial tumor, metastasis, and primary lymphoma of the central nervous system.
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Abstract

Primary central nervous system lymphomas (PCNSL) are rare and their management varies significantly from that of other malignant tumors involving the CNS. This article discusses how the imaging findings often suggest the diagnosis early in time. The typical findings in immunocompetent patients consist of one supratentorial intra-axial mass of homogeneous enhancement. Other findings that should be assessed include multifocality and incomplete ring enhancement. The differential diagnosis of PCNSL should mainly consider other malignant tumors of the CNS such as glioblastomas or metastases. PCNSLs tend to have less edema and less mass effect; they also tend to spare the adjacent cortex. Necrosis, hemorrhage, and calcification are rare in PCNSLs. Although the findings in the morphologic sequences are characteristic, they are not completely specific and atypical types can sometimes be found. Advanced imaging techniques such as diffusion-weighted images and, above all, perfusion-weighted images provide qualitative and quantitative data that play an important role in the differentiation of PCNSLs from other brain tumors.

Keywords:
Lymphoma
Central nervous system
Brain
Brain tumor
Magnetic resonance imaging
Perfusion
Diffusion
Resumen

El linfoma primario del sistema nervioso central (LPSNC) es infrecuente y su manejo difiere significativamente del resto de los tumores malignos de esta localización. El texto desarrolla cómo los hallazgos radiológicos a menudo sugieren el diagnóstico precozmente. La imagen típica en los pacientes inmunocompetentes es una masa intraaxial supratentorial con realce homogéneo. Otros hallazgos que deben valorarse son la multifocalidad y el realce en anillo incompleto. En el diagnóstico diferencial del LPSNC deben considerarse principalmente otros tumores malignos del SNC, como el glioblastoma y las metástasis. El LPSNC suele tener menor edema y efecto masa, y respeta el córtex adyacente, siendo infrecuentes la necrosis, la hemorragia y la calcificación. Aunque los hallazgos en secuencias morfológicas son típicos, no son por completo específicos y pueden encontrarse formas atípicas. Las técnicas avanzadas, como la difusión y sobre todo la perfusión, muestran valores cualitativos y cuantitativos que desempeñan un papel importante al diferenciar el LPSNC de otros tumores cerebrales.

Palabras clave:
Linfoma
Sistema nervioso central
Cerebro
Tumor cerebral
Resonancia magnética
Perfusión
Difusión

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