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Table 1 MR imaging features CNS PTLD vs AIDS CNS Lymphoma and PCNS lymphoma

From: Primary central nervous system post-transplant lymphoproliferative disorders: the spectrum of imaging appearances and differential

 

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