Abstract
Primary central nervous system lymphomas (PCNSLs) and high-grade gliomas (HGGs) arising in the cerebellum is extremely low, making the differential diagnosis difficult or even impossible. The purpose of this study was to define the MR features of cerebellar PCNSL in immunocompetent patients, and to determine whether a combination of conventional MR and DW imaging can assist in the differentiation of PCNSLs and HGGs. Twelve PCNSLs and 15 HGGs confirmed by pathological analysis were retrospectively identified. The apparent diffusion coefficient (ADC) and conventional MRI parameters were compared for differences between PCNSL and HGG groups using the independent sample t test or chi-square test. Both ADCmin and ADCtotal values were lower in the PCNSL group than those in the HGG group (ADCmin: 0.53 × 10−3 vs. 0.83 × 10−3 mm2/sec, P < 0.001; ADCtotal: 0.66 × 10−3 vs. 0.98 × 10−3 mm2/sec, P = 0.001). As for conventional MR features, there were significant difference in the tumor size, enhancement patterns, the presence of cystic changes, edema degree and streak-like edema (all P < 0.01); but there were no significant difference in lesion type, the presence of bleeding, and involvement of brain surface between two groups (P = 0.554, 0.657 and 0.157, respectively). The results revealed that several conventional MR features, including enhancement patterns, branch-like enhancement and streak-like edema may be useful for the differentiation of PCNSL and HGG in cerebellum and, when combined with ADC values, further improve the discriminating ability.
Highlights
Primary central nervous system lymphomas (PCNSLs) are relatively rare, accounting for 1% of all intracranial tumors, and occurs in supra-tentorial location in majority of patients with posterior fossa as a location of tumor only in 7% of the cases[1]
We detected significant differences in apparent diffusion coefficient (ADC) values, tumor size, enhancement patterns, the presence of cystic changes and streak edema between PCNSL and high-grade gliomas (HGGs) patients. These findings highlight importance of combining conventional MR and DW imaging in diagnosing cerebellar PCNSL or HGG
ADC measurements are useful in the differentiation between lymphoma and GBM
Summary
Primary central nervous system lymphomas (PCNSLs) are relatively rare, accounting for 1% of all intracranial tumors, and occurs in supra-tentorial location in majority of patients with posterior fossa as a location of tumor only in 7% of the cases[1] Both PCNSLs and high grade gliomas (HGGs) are malignant tumors in adults and exceedingly rare in cerebellum[2]. Conventional magnetic resonance imaging (MRI) has shown considerable potential in the diagnosis and follow-up monitoring of brain tumors, the MRI features of PCNSLs and HGGs are changeable and overlapping. Due to their extreme rarity, it is sometimes difficult to differentiate them from other tumors in the cerebellum by conventional MRI. We retrospectively analyze the conventional MR and DW imaging characteristics of cerebellar PCNSLs and HGGs from adult group, and determine whether a combination of conventional MR and DW imaging can assist in the differentiation of PCNSLs and HGGs
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