MR of CNS Sarcoidosis: Correlation of Imaging Features to Clinical Symptoms and Response to Treatment
Greg A. Christoforidis,a,
Eric M. Spicklera,
Maria V. Recioa and
Bharat M. Mehtaa
a From the Department of Radiology, Ohio State University Medical Center (G.A.C.), Columbus; and the Departments of Radiology (E.M.S., B.M.M.) and Ophthalmology (M.V.R.), Henry Ford Hospital, Detroit.
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FIG 1. 33-year-old white woman with chronic headache.
A–D, An extraaxial left parietal mass is hypointense on noncontrast T2-weighted MR image (2517/90/1 [TR/TE/excitations]) (A), enhances on contrast-enhanced T1-weighted (533/11/2) image (arrows, B), and is isointense with gray matter on noncontrast T1-weighted image (450/19/2) (arrows, C). Substantial fibrocollagenous material and noncaseating granulomas were seen at biopsy. The patient's symptoms resolved with steroids; however, a T1-weighted image (400/16/2) 28 months later showed only partial regression of the lesion (D).
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FIG 2. 33-year-old African-American woman with right-sided visual loss, panhypopituitarism, polydipsia, and polyuria (with normal ADH).
A and B, T1-weighted contrast-enhanced MR image (400/15/2) (A) shows basal meningeal enhancement and an enhancing pituitary mass involving both lobes, the infundibulum, and the right optic nerve (not shown). Pituitary and meningeal biopsy revealed noncaseating granulomas with negative AFB and fungal stains. The visual symptoms resolved with steroid treatment; however, 21 months later she returned with a left abducens palsy. A T1-weighted image (400/12/2) shows resolution of the pituitary lesion but new involvement of the left cavernous sinus (arrows, B).
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FIG 3. 52-year-old African-American man with seizure disorder. Imaging revealed hydrocephalus and a brain parenchymal lesion. His seizures gradually became more difficult to control.
A and B, Contrast-enhanced T1-weighted MR images obtained 9 (483/13/2) (A) and 11 (500/16/2) (B) years after seizure onset show interim progression of meningeal thickening (arrows, B) and enlargement and multiplication of enhancing foci (arrowheads, B).
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FIG 4. 34-year-old Arabic man with seizures, dysphagia, and lower extremity weakness.
A, T2-weighted MR image (2416/90/1) shows multiple hyperintense lesions in the brain stem and cerebellum as well as the cerebral hemispheres and basal ganglia (not shown), which demonstrated contrast enhancement.
B, Biopsy specimen shows atypical lymphoid tissue with noncaseating granulomatous plaques (arrow) and granulomatous perivasculitis (arrowheads) (hematoxylin-eosin). The symptoms and MR abnormalities disappeared 15 months after treatment with steroids and hydroxychloroquine sulfate.FIG 5. 36-year-old African-American man with lower extremity weakness, hypopituitarism, mild unilateral trigeminal dysesthesia, and anosmia. Contrast-enhanced T1-weighted MR image (700/19/2) shows enhancement of trigeminal oculomotor nerves and within both internal auditory canals. The patient's symptoms resolved with steroids but recurred upon tapering of the medication. The symptoms were never referable to any of the MR findings.
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FIG 6. 36-year-old African-American man with gradual onset of weakness, numbness, spasticity, and bowel and bladder dysfunction.
A–C, T1-weighted MR image (450/15/2) (A) shows intramedullary enhancement and enhancement along the surface of the cord, associated with cord signal abnormality and disk herniation on T2-weighted fast spin-echo image (B). The patient underwent surgical diskectomy and initially did worse. His symptoms and the findings on a T2-weighted fast spin-echo image (3000/102/2) (C) improved with steroids, but recurred 5 months later.
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