-Review-

Neuroimaging of Primary Central Nervous System Lymphoma in Immunocompetent Patients: Comparison of Recent and Previous Findings

Koji Adachi¹, Fumio Yamaguchi², Yoji Node³, Shiro Kobayashi⁴, Ryo Takagi⁵ and Akira Teramoto²

¹Department of Neurosurgery, Nippon Medical School Musashi Kosugi Hospital
²Department of Neurosurgery, Nippon Medical School
³Department of Neurosurgery, Nippon Medical School Tama Nagayama Hospital
⁴Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital
⁵Department of Radiology, Nippon Medical School

The typical neuroimaging features of primary central nervous system lymphoma (PCNSL) have been described as single or multiple intra-axial, homogenous, contrast-enhancing lesions with marked perilesional edema and restricted diffusion, usually contacting the cerebrospinal fluid surface. Necrosis, peripheral enhancement, hemorrhages, and calcifications are unusual. Recently, some of our patients with PCNSL have had atypical neuroimaging features even before treatment. In this article, we review the neuroimaging characteristics of PCNSL in immunocompetent patients and analyzed how imaging findings over the last 10 years differ from those from more than 10 years ago. Neuroimaging findings suggest that PCNSL is a disease that affects the entire brain. Although some imaging findings are characteristic of PCNSL, the frequency of atypical findings on conventional neuroimaging is increasing. Atypical neuroimaging findings do not rule out PCNSL, even in immunocompetent patients.

J Nippon Med Sch 2013; 80: 174-183

Keywords
primary central nervous system lymphoma, neuroimaging, atypical feature, diagnosis

Correspondence to
Koji Adachi, MD, DMSc, Department of Neurosurgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
adachi@nms.ac.jp

Received, May 12, 2012
Accepted, January 5, 2013