Magnetic resonance findings of primary central nervous system T-cell lymphoma in immunocompetent patients

Purpose: To describe the MR findings of primary central nervous system T-cell lymphoma (T-PCNSL) in immunocompetent patients. Material and Methods: Seven patients with pathologically proven T-PCNSL were included in our study. The number, location, shape, enhancement pattern, and signal intensity of the tumors were determined. Diffusion-weighted images (DWI) and perfusion-weighted images (PWI) were obtained in four and two patients, respectively. Apparent diffusion coefficients (ADCs) were generated, and regions of interest were defined in each lesion. Results: Four patients with T-PCNSL had a single mass, while the others had multiple lesions (four, three, and two lesions, respectively). All seven cases of T-PCNSL had a supratentorial location: 12 in the subcortical area and 1 in the thalamus. No leptomeningeal involvement was noted. All tumors showed iso- to low T1 and iso- to slightly high T2 signal intensity to the adjacent gray matter. Rim enhancement was seen in 5 of the 7 patients (71.4%), while heterogeneous and homogeneous enhancement was seen in each of two. On DWI and ADC maps, the enhancing lesions showed slight hyperintensity in three patients (mean ADC ratio, 0.92±0.06) and iso-intensity in the other (ADC ratio, 1.02±0.05). Cystic areas consistent with necrosis were noted in three patients. High-signal intensity area in the cortex was noted on T1-weighted images in three patients, suggesting hemorrhage. In two patients, the same signal intensity area was noted within the mass. The two masses on the relative cerebral blood volume (rCBV) map demonstrated either similar or slightly higher signal intensity than that of the contralateral white matter. The rCBV ratios of these two masses were 1.27±0.16 and 1.35±0.2, respectively. Conclusion: T-PCNSLs show a predilection for a subcortical location, a relatively high incidence of cortical or intratumoral hemorrhage, rim enhancement, or cystic areas consistent with necrosis on magnetic resonance imaging. The lower rCBV ratio of the tumor might be helpful in differentiating T-PCNSL from other brain tumors such as high-grade glioma.