| CNS PTLD | AIDS CNS Lymphoma | PCNS lymphoma |
---|---|---|---|
Clinical | Status post-transplant of solid organ, stem cell, or bone marrow | HIV positive patient | Elderly patient, Wiskott-Aldrich syndrome, ataxia-telangiectasia, severe-combined or common-variable immunodeficiency, rheumatoid arthritis, and systemic lupus erythematosus |
Lesion number | Multifocal more common than unifocal | Multifocal | Unifocal more common than multifocal |
Lesion location | Lobar predominantly, numerous basal ganglia and thalamic lesions, less commonly abuts CSF surface | Basal ganglia and corpus callosum | Periventricular, abutting CSF surface |
Enhancement pattern | Ring | Ring | Solid |
Enhancement | Heterogeneous | Heterogeneous | Homogeneous |
Margin of enhancement | Irregular/Ill-defined | Irregular | Well-defined |
ADC | Elevated compared to lymphoma, will still have focal areas of restricted diffusion | Slightly elevated compared to normal white matter but lower than in toxoplasmosis | Lower and more homogeneous |
Perfusion | Limited data, likely overall low (Fig. 2) | Not reported | Low to mildly elevated, leakage pattern very suggestive |
Spectroscopy | Increased choline, lipid and lactate Decreased NAA | Increased choline Decreased NAA, Cr | Increased choline, lipid and lactateDecreased NAA, Cr |
Intratumoral susceptibility signal | Peripheral pattern of punctate hypointensities, tendency to bleed | Not reported, there is a tendency to bleed more than PCNS lymphoma | Minimal signal changes |