Zur neuroradiologischen Diagnostik von primären Non-Hodgkin-Lymphomen des Zentralnervensystems

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Abstract
The incidence of primary cerebral lymphomas has risen continuously during the past years. The neuroradiological signs, which are decisive for the differential diagnosis of cerebral lymphomas, are worked up and discussed in this study. Thirty CT and 27 MR investigations of a total of 32 patients (14 males, 18 females, age 60 +/- 15 years) with histopathologically proven cerebral lymphomas were analysed retrospectively. Multiple cerebral lymphomas were detected in 10/32 patients (31%). The cerebral lymphomas appeared on CT scans as hyperdense masses in 28/30 cases (93%). On T2-weighted MR scans 14/27 (52%) lymphomas were slightly hyperintense compared to white matter and 9/27 (33%) inhomogeneously isointense to poorly hyperintense. These were clearly T2-hypointense compared to T2-hyperintense perifocal oedema. In these cases CT density and T2-weighted signal intensity looked like grey matter. All cerebral lymphomas except one case took up contrast medium. An ependymal infiltration or a contact to the ventricle's wall were found in 24/32 cases and an infiltration or a contact to the leptomeningeal space in 15/32 cases. One should consider a cerebral lymphoma as a possible differential diagnosis when a cerebral mass shows the following signs: (1) in CT scans as a hyperdense mass, and on T2-weighted MR images hyperintense compared to white matter and hypointense compared to perifocal edema; (2) clear contrast enhancement and (3) infiltration or broad contact with the ependyma and/or the leptomeningeal space.

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