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Imaging Manifestations of Neurosarcoidosis

¹ All authors: Department of Radiology, University of North Carolina School of Medicine, CB# 7510, Chapel Hill, NC 27599-7510.

View larger version (145K): [in a new window]   Fig. 1. —T1-weighted parasagittal MRI of 31-year-old man with neurosarcoidosis obtained after contrast administration shows enhancing lesion (arrow) in brain parenchyma, arising from spread of sarcoidosis granuloma along perivascular spaces.

View larger version (149K): [in a new window]   Fig. 2. —Leptomeningeal sarcoidosis of brain in 45-year-old woman. T1-weighted axial image obtained after contrast administration shows enhancement involving basilar cisterns, Sylvian fissures, and cortical sulci (arrows).

View larger version (135K): [in a new window]   Fig. 3. —Contrast-enhanced T1-weighted coronal image shows enhancement and thickening of pituitary infundibulum (arrows) in 37-year-old woman.

View larger version (155K): [in a new window]   Fig. 4A. —Optic nerve sarcoidosis. Contrast-enhanced fat-saturated T1-weighted axial image of 35-year-old woman shows enhancement of entire visible portions of both optic nerves in orbit and optic canals (arrowheads). Enhancement of extraocular muscles is normal finding.

View larger version (161K): [in a new window]   Fig. 4B. —Optic nerve sarcoidosis. Contrast-enhanced fat-saturated T1-weighted coronal image of 26-year-old woman with rapid vision loss shows enhancement and thickening of both optic nerves in prechiasmatic segment (arrows).

View larger version (159K): [in a new window]   Fig. 5. —Cranial nerve sarcoidosis in 43-year-old man with diffuse sarcoidosis. Contrast-enhanced T1-weighted parasagittal image shows enhancing lesion causing thickening and enhancement of cisternal segment of third cranial nerve (arrowheads). Note enhancing suprasellar mass (m) and diffuse leptomeningeal enhancement (arrows).

View larger version (131K): [in a new window]   Fig. 6A. —Hydrocephalus associated with neurosarcoidosis in 31-year-old man with neurosarcoidosis (same patient as in Fig. 1). Contrast-enhanced T1-weighted axial image shows enlargement of lateral ventricles and enhancement in and adjacent to wall of left lateral ventricle.

View larger version (129K): [in a new window]   Fig. 6B. —Hydrocephalus associated with neurosarcoidosis in 31-year-old man with neurosarcoidosis (same patient as in Fig. 1). Fluid-attenuated inversion recovery MRI obtained at same level as A shows different signal intensity in left and right lateral ventricles, presumably due to elevated protein concentration within left lateral ventricle (L), which is isolated from rest of ventricular system.

View larger version (136K): [in a new window]   Fig. 7A. —Focal masses in 31-year-old woman with dural sarcoidosis. Contrast-enhanced T1-weighted axial image shows bilateral extraaxial enhancing masses of dura (arrows).

View larger version (127K): [in a new window]   Fig. 7B. —Focal masses in 31-year-old woman with dural sarcoidosis. Fat-saturated T2-weighted axial image shows dural masses to be low signal intensity (arrows), with some high signal of adjacent brain parenchyma, most likely vasogenic edema.

View larger version (114K): [in a new window]   Fig. 8. —Diffuse disease in 58-year-old woman with dural sarcoidosis. Contrast-enhanced T1-weighted axial image shows diffuse thickening and enhancement of dura (arrows).

View larger version (93K): [in a new window]   Fig. 9A. —Skull lesions of sarcoidosis. Axial CT image with bone window settings in 46-year-old man with sarcoidosis shows well-circumscribed lytic lesion involving inner and outer tables of calvarium, with sharp, nonsclerotic margins (arrow).

View larger version (131K): [in a new window]   Fig. 9B. —Skull lesions of sarcoidosis. Contrast-enhanced T1-weighted coronal image in 38-year-old woman with diffuse sarcoidosis shows enhancing lesion on patient's right that thins inner and outer tables of skull, expanding diploic space (straight arrow). Second lesion on patient's left involves only inner table (curved arrow).

View larger version (88K): [in a new window]   Fig. 10. —Spinal cord intramedullary sarcoidosis in 47-year-old man with upper and lower extremity weakness. Contrast-enhanced sagittal T1-weighted image shows enhancing lesion in spinal cord (arrows). Note abnormal linear leptomeningeal enhancement (arrowheads).

View larger version (125K): [in a new window]   Fig. 11. —51-year-old man with spinal leptomeningeal sarcoidosis. Contrast-enhanced sagittal T1-weighted images show multiple nodular enhancing lesions along surface of spinal cord and on spinal nerve roots (arrows).

View larger version (86K): [in a new window]   Fig. 12. —42-year-old woman with spinal dural sarcoidosis. Contrast-enhanced T1-weighted sagittal image shows dural-based mass (m), diffuse nodular thickening, and enhancement of dura (arrows).

View larger version (114K): [in a new window]   Fig. 13. —37-year-old man with spinal vertebral sarcoidosis. Contrast-enhanced fat-saturated sagittal T1-weighted image shows multiple enhancing lesions in bodies and spinous processes of lumbar vertebrae (straight arrows). Note diffuse leptomeningeal disease with nodular thickening and enhancement of lumbar nerve roots (curved arrows).

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