Objective: Primary central nervous system lymphomas (PCNS) are relatively rare tumors, accounting for about 4% of all brain tumors. On neuroimaging, they are characterized by a low MR signal in T1, isointense in T2, bright uniform contrast enhancement, and diffusion restriction. The aim of this study is to note the lack of effectiveness of the MR/CT perfusion technique in complex multiparametric imaging in the differential diagnosis of primary lymphomas of the central nervous system in comparison with highly malignant gliomas and brain metastases. Materials and Methods: This prospective study included 80 patients with CNS tumors examined/operated at the Federal Center for Neurosurgery (Tyumen, Russia) from 2018 to 2021. The patients were divided into 4 groups: group 1 consisted of 33 cases with primary CNS lymphomas (10 cases with atypical manifestations according to perfusion parameters and 23 cases of classic CNS lymphomas), group 2 with anaplastic astrocytomas—14 cases, group 3—23 cases with glioblastomas and group 4—10 cases with solitary metastatic lesions. The study was carried out on a General Electric Discovery W750 3T magnetic resonance tomograph, a Canon Aquilion One multispiral X-ray computed tomograph (Gadovist 7.5 ml, Yomeron 400 mg−50 ml). Additionally, immunohistochemical analysis was carried out with the following markers: CD3, CD20, CD34, Ki-67, VEGF. Results: It has been established that MR/CT perfusion is not a highly sensitive method for visualizing primary CNS lymphomas, as previously thought, but at the same time, the method has a number of undeniable advantages that make it indispensable in the algorithm of a complex multiparametric diagnostic approach for this type of tumor. Nevertheless, PLCNS is characterized by an atypical manifestation, which is an exception to the rule. Conclusions: The possibilities of neuroimaging of primary lymphomas, even with the use of improved techniques for collecting MR/CT data, are limited and do not always allow reliable differentiation from other neoplasms.