To review the most common Magnetic Resonance Imaging (MRI) features of neurosarcoidosis.

Sarcoidosis is an inflammatory multisystem disorder of unknown aetiology characterised by the presence of non-caseating granulomas in tissues. Practically, no organ is immune to sarcoidosis but it most commonly affects the lungs and lymph nodes. When sarcoidosis affects the brain it is termed neurosarcoidosis. Neurosarcoidosis is present in only approximately 5% of patients with sarcoidosis. Less than 1% of patients have isolated central nervous system (CNS) involvement. There are limitations of approaching the diagnostic confirmation of neurosarcoidosis. Although a tissue biopsy is considered the gold...

Leptomeningeal involvement Leptomeningeal involvement occurs with predilection for the basilar cisterns in about 40% of patients with neurosarcoidosis. Gadolinium enhancement can be diffuse or nodular on post-contrast T1 weighted MRI (Fig. 1). Hypothalamic-Pituitary involvement The pituitary gland, infundibulum, or hypothalamus are affected in about 18% of patients with neurosarcoidosis. The most common patterns of involvement on MRI are an enhancing mass or thickening and enhancement of the infundibulum. These findings may occur in isolation or in combination with basilar leptomeningeal involvement. Perivascular spread can be...

Neurosarcoidosis has a wide spectrum of imaging features that mimic both benign and malignant conditions. MRI is highly sensitive for detecting neurosarcoidosis, but is not specific. This pictorial review has highlighted salient features which should raise the suspicion of a potential diagnosis of neurosarcoidosis;the suggestion of which will facilitate prompt diagnosis andexpedient therapeutic intervention.

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