A Case of Primary T-Cell Central Nervous System Lymphoma: MR Imaging and MR Spectroscopy Assessment

Abstract

Primary central nervous system lymphomas (PCNSLs) are mainly B-cells lymphomas. A risk factor for the development of PCNSL is immunodeficiency, which includes congenital disorders, iatrogenic immunosuppression, and HIV. The clinical course is rapidly fatal; these patients usually present signs of increased intracranial pressure, nausea, papilledema, vomiting, and neurological and neuropsychiatric symptoms. PCNSL may have a characteristic appearance on CT and MR imaging. DWI sequences and MR spectroscopy may help to differentiate CNS lymphomas from other brain lesions. In this paper, we report a case of a 23-year-old man with T-primary central nervous system lymphoma presenting with a mass in the right frontotemporal lobe. We describe clinical, CT, and MRI findings. Diagnosis was confirmed by stereotactic biopsy of the lesion.

Figure 1

Axial CT acquisition (a)-(b) with sagittal (c) and coronal (d) multiplanar reformatted images showing a mild hyperdense complex lobulated mass in the right frontotemporal region associated with oedema and a similar smaller lesion in the right cerebellar lobe.

Figure 2

Isotropic diffusion weighted images (DWI) showing signal restriction associated with the fronto-temporal lesion.

Figure 3

Axial and coronal T2-weighted images showing inhomogeneous hyperintensity of the cerebellar and fronto-temporal right lobe lesions associated with ovalar hyperintensities and perilesional oedema.

Figure 4

Gadolinium-DTPA enhanced T1-weighted multiplanar images (a), (b), and (c) reveal heterogenous enhancement throughout the fronto-temporal mass; single-voxel H MR spectroscopy (d) shows a lactate/lipid peak, increase of Choline/creatine ratio, and depression of N-acetylaspartate/creatine ratio in the fronto-temporal lesion.