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Radiologic Differentiation of Primary CNS Posttransplant Lymphoproliferative Disorder From Brain Metastasis
Matthew L White1, Yan Zhang1, Justin Cramer1
1Department of Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE 68198-1045.
AJR. American Journal of Roentgenology
|April 30, 2020
Summary
Primary CNS posttransplant lymphoproliferative disorder (PTLD) and brain metastases share imaging traits but differ in location and diffusion/perfusion. Distinguishing these CNS lesions is crucial for accurate diagnosis and treatment.
Area of Science:
- Neuroradiology
- Oncology
- Transplant Medicine
Background:
- Primary central nervous system (CNS) posttransplant lymphoproliferative disorder (PTLD) can mimic brain metastases on imaging.
- Accurate differentiation is vital for appropriate patient management.
Purpose of the Study:
- To identify distinct radiologic features differentiating primary CNS PTLD from brain metastases.
Main Methods:
- Retrospective review of 51 primary CNS PTLD lesions and 156 brain metastases.
- Analysis of lesion characteristics including size, location, enhancement, necrosis, edema, diffusion, and perfusion.
- Statistical comparison using chi-square or Fisher exact tests.
Main Results:
- Primary CNS PTLD lesions showed a predilection for deep gray matter and periventricular locations, unlike brain metastases.
- Primary CNS PTLD lesions exhibited less frequent hemorrhage, more restricted diffusion, and lower perfusion compared to metastases.
- No significant differences were found in lesion size, multifocality, necrosis, or edema.
Conclusions:
- While imaging characteristics overlap, lesion location, diffusion, perfusion, and hemorrhage patterns can help distinguish primary CNS PTLD from brain metastases.
- These findings aid in the differential diagnosis of intraaxial brain lesions in transplant recipients.
