Eccentric topic of the Week, Neuroradiology
Question 14:
The correct answer is B, primary CNS lymphoma lesions will enhance on MRI.
Before the introduction and widespread use of combination antiretroviral therapy, the incidence of Primary CNS lymphoma (PCNSL), which is strongly associated with Epstein-Barr virus (some strudies also suggest human herpesvirus 8 [HHV-8]), was increasing in patients with AIDS. One study found that the median CD4+ cell count at which AIDS related-PCNSL was diagnosed was 30/mL, but the CD4+ cell range in these patients was 0 to 279/mL. This finding is important because the CD4+ count at the high end of this range far exceeds the threshold CD4+ level at which clinicians routinely suspect AIDS related-PCNSL.
Stateme t A is false because single legions are typically seen at first, and statement C is incorrect because although Magnetic Resonance Spectroscopy is a valuable tool, brain biopsy remains the gold standard.
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