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MRI of Sarcoidosis Patients with Musculoskeletal Symptoms

¹ Department of Radiology (Musculoskeletal), NYU Medical Center, 560 First Ave., New York, NY 10016.
² Department of Pulmonary and Critical Care Medicine, Mount Sinai Medical Center, New York, NY.

View larger version (114K): [in a new window]   Fig. 1 —38-year-old woman with pulmonary sarcoidosis and hand and foot deformities. Axial proton density-weighted image (TR/TE 4,016/15) shows diffuse, poorly marginated marrow infiltration of both calcanei. Patient also had MRI findings of tendinosis and tenosynovitis of ankle (not shown).

View larger version (168K): [in a new window]   Fig. 2A —58-year-old woman with sarcoidosis and pelvic pain. Anteroposterior radiograph of pelvis was interpreted as normal. Coronal images of pelvis and hips obtained with T1-weighting (TR/TE 550/8) in A, and proton density weighting with fat saturation in B (3,600/22) show innumerable discrete subcentimeric lesions infiltrating marrow.

View larger version (152K): [in a new window]   Fig. 2B —58-year-old woman with sarcoidosis and pelvic pain. Anteroposterior radiograph of pelvis was interpreted as normal. Coronal images of pelvis and hips obtained with T1-weighting (TR/TE 550/8) in A, and proton density weighting with fat saturation in B (3,600/22) show innumerable discrete subcentimeric lesions infiltrating marrow.

View larger version (165K): [in a new window]   Fig. 2C —58-year-old woman with sarcoidosis and pelvic pain. Anteroposterior radiograph of pelvis was interpreted as normal. Coronal detail of sacrum, coronal proton density fat-saturated (TR/TE 3,600/22) image shows innumerable high-signal discretely marginated round lesions, most 1 cm or smaller. Although patient had sarcoidosis and no known primary tumor, clinical assumption was metastases and patient underwent deep bone biopsy that revealed noncaseating granulomas.

View larger version (138K): [in a new window]   Fig. 3 —55-year-old woman with hip pain. T1-weighted axial image (TR/TE 550/9) obtained through upper pelvis. Low signal lesion in left ilium does not violate cortex (black arrow). Apparent asymmetry of iliac bones is due to positioning.

View larger version (102K): [in a new window]   Fig. 4 —52-year-old woman with wrist "mass." T1-weighted (TR/TE 500/10) axial image performed with fat saturation after administration of IV gadolinium chelate shows tenosynovitis of extensor compartment with marked thickening and enhancement of synovium. Synovial biopsy showed noncaseating granulomas.

View larger version (83K): [in a new window]   Fig. 5 —55-year-old woman with sarcoidosis and leg weakness. Patient was treated with steroids. Coronal T1-weighted image (TR/TE 550/8) shows fatty replacement of right gluteal and bilateral hamstring muscles. Biopsy of gastrocnemius muscle showed noncaseating granulomas.

View larger version (126K): [in a new window]   Fig. 6A —51-year-old woman with painful palpable calf nodules. T1-weighted axial image of right calf (TR/TE 550/9) shows donut-shaped lesion, nearly isointense with muscle, with low signal intensity centrally (white arrow).

View larger version (113K): [in a new window]   Fig. 6B —51-year-old woman with painful palpable calf nodules. T2-weighted axial image (4,550/54), same level. Lesion showed mild increase in signal intensity compared with surrounding muscle, with low signal intensity centrally but not as bright as fluid (white arrow).

View larger version (108K): [in a new window]   Fig. 6C —51-year-old woman with painful palpable calf nodules. T1-weighted axial image (616/9) with fat saturation after IV administration of gadopentetate dimeglumine. Periphery of lesion enhances (white arrow), but central "dark star" does not.

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