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Radiologic Differentiation of Primary CNS Posttransplant Lymphoproliferative Disorder From Brain Metastasis
Author(s) -
Matthew L. White,
Yan Zhang,
Justin A. Cramer,
Fang Yu,
Philip J. Bierman,
Timothy C. Greiner
Publication year - 2020
Publication title -
american journal of roentgenology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.294
H-Index - 196
eISSN - 1546-3141
pISSN - 0361-803X
DOI - 10.2214/ajr.19.22056
Subject(s) - medicine , metastasis , pathology , lymphoproliferative disorders , primary (astronomy) , brain metastasis , lymphoma , cancer , physics , astronomy
OBJECTIVE. Primary CNS posttransplant lymphoproliferative disorder (PTLD) may present as multiple contrast-enhancing intraaxial lesions, often with central necrosis and surrounding edema. This imaging appearance is similar to the pattern seen in brain metastases. The purpose of this study was to find differences in the radiologic features of primary CNS PTLD lesions and brain metastases. MATERIALS AND METHODS. We retrospectively reviewed the radiologic findings of 51 primary CNS PTLD lesions in 10 patients and 156 metastatic brain lesions in 25 patients. Lesion size, multifocality, location, necrosis, hemorrhage, perilesional vasogenic edema, contrast enhancement, and diffusion and perfusion features were evaluated. We used the chi-square test or Fisher exact test when appropriate to compare the findings between primary CNS PTLD lesions and brain metastases. RESULTS. Primary CNS PTLD lesions occur in the deep gray matter and periventricular locations more frequently than brain metastases ( p < 0.0001) and are not present at the gray and white matter junctions and vascular border zones as commonly as brain metastases are ( p < 0.0001). Primary CNS PTLD tends to have less frequent hemorrhage ( p < 0.0001), more restricted diffusion ( p = 0.001), and lower perfusion ( p = 0.002) than brain metastases. We did not find statistically significant differences between primary CNS PTLD and brain metastases for lesion size, multifocality, necrosis, and perilesional edema. CONCLUSION. The imaging characteristics of primary CNS PTLD overlap considerably with those of brain metastases, but there are significant differences between primary CNS PTLD lesions and brain metastases in lesion location, diffusion and perfusion features, and tendency to hemorrhage.

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