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Punctate and curvilinear gadolinium enhancing lesions in the brain: a practical approach

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Abstract

Introduction

Cerebral punctate and curvilinear gadolinium enhancements (PCGE) correspond to opacification of small vessel lumen or its perivascular areas in case of blood-brain barrier (BBB) disruption. We will discuss the possible causes of intra-parenchymal central nervous system PCGE.

Methods

Our review is based on French database including patients presenting with central nervous system PCGE and literature search using PubMed database with the following keywords: punctate enhancement, linear enhancement, and curvilinear enhancement. Disorders which displayed linear leptomeningeal or periventricular enhancements without intra-parenchymal PCGE are excluded of this review.

Results

Among our 39 patients with PCGE, 16 different diagnoses were established. After combining our PCGE causes with those described in the literature, we propose a practical approach. Besides physiologic post-contrast enhancement of small vessels, three pathologic conditions may exhibit PCGE: (1) small collateral artery network seen in Moyamoya syndrome, (2) small veins congestions related to developmental or acquired venous outflow disturbance, and (3) disorders causing small vessels BBB disruption indicated by T2 and FLAIR hyperintensities in the corresponding areas of PCGE. Disruption of the BBB could be caused by a direct injury of the endothelial cell, as in posterior reversible encephalopathy syndrome, Susac syndrome, and radiochemotherapy-induced injuries, or by an angiocentric cellular infiltrate, as in inflammatory disorders, demyelinating diseases, host immune responses fighting against infections, prelymphoma states, lymphoma, and in CLIPPERS.

Conclusion

PCGE may conceal several causes, including physiological and pathological conditions. Nevertheless, a practical approach could improve its management and limit the indications of brain biopsy to very specific situations.

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Abbreviations

DWI:

Diffusion-weighted images with increased

ADC:

Apparent diffusion coefficient

BBB:

Blood-brain barrier

MRI:

Magnetic resonance imaging

PCGE:

Punctate and curvilinear gadolinium enhancements

SWI:

Susceptibility-weighted imaging

T1WI:

T1-weighted images

T2WI:

T2-weighted images

PRES:

Posterior reversible encephalopathy syndrome

SLE:

Systemic lupus erythematosus

LCH:

Langerhans cell histiocytosis

NLCH:

Non-Langerhans cell histiocytosis

PCACNS:

Primary arteritis of the CNS

ADEM:

Acute demyelinating encephalomyelitis\

MS:

Multiple sclerosis

NMOSD:

Neuromyelitis optica spectrum disorders

IRIS:

Immune reconstitution inflammatory syndrome

PML:

Progressive multifocal leukoencephalopathy

PCNSL:

Primary CNS lymphoma

LYG:

Lymphomatoid granulomatosis

IVL:

Intravascular lymphoma

CLIPPERS:

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids

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Acknowledgments

We want to especially thank Mr Benjamin Taieb for his help in figure design.

Author information

Authors and Affiliations

  1. Department of Neurology, CHU Montpellier, Hopital Guy de Chauliac, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France

    Guillaume Taieb, Thibaut Allou & Pierre Labauge

  2. Department of Neurology, Mazarin, Goupe Hospitalier Pitié Salpêtrière, Paris, France

    Alberto Duran-Peña & Khe Hoang-Xuan

  3. Department of Neuroradiology, CHU Montpellier, Hopital Guy de Chauliac, Montpellier, France

    Nicolas Menjot de Chamfleur

  4. Department of Neurology, Fondation Rothschild, Paris, France

    Antoine Moulignier

  5. Department of Neurology, CHU Nîmes, Hôpital Caremeau, Nîmes, France

    Eric Thouvenot

  6. Department of Neurology, CHU De Lille, Lille, France

    Arnaud Lacour

  7. APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France

    Jean Pelletier

Authors
  1. Guillaume Taieb
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  2. Alberto Duran-Peña
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Corresponding author

Correspondence to Guillaume Taieb.

Ethics declarations

We declare that this manuscript does not contain clinical studies. Anonymized data with a number were used to develop a practical approach.

Conflict of interest

We declare that we have no conflict of interest.

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Taieb, G., Duran-Peña, A., de Chamfleur, N.M. et al. Punctate and curvilinear gadolinium enhancing lesions in the brain: a practical approach. Neuroradiology 58, 221–235 (2016). https://doi.org/10.1007/s00234-015-1629-y

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  • DOI: https://doi.org/10.1007/s00234-015-1629-y

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