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Type:
Educational Exhibit
Keywords:
CNS, MR, Decision analysis, Tissue characterisation
Authors:
T. Buende Tchokouako, H. Nejadhamzeeigilani, J. L. Nix, I. Craven, D. J. Warren, J. Macmullen-Price, S. Currie; Leeds/UK
DOI:
10.1594/ecr2017/C-2264
Background
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 standard for the diagnosis,
often the diagnosis of neurosarcoidosis must be made indirectly through clinical history,
radiological findings and blood tests (in particular the serum angiotensin converting enzyme level which has been reported to be elevated in patient with neurosarcoidosis in 5-50% of cases).
Virtually any structure of the central and peripheral nervous system can be affected although the most common location is the leptomeninges,
especially around the brain base.
Other structures commonly involved are the pituitary and the cranial nerves (especially the facial and optic nerves).
Less commonly,
neurosarcoidosis can present as solitary or multiple dural-based lesions.
Additionally,
non-specific unenhancing T2 hyperintensities involving the brain and,
less commonly,
the spinal cord may be encountered.
The MRI features of the most common patterns of involvement of neurosarcoidosis scanned at a large tertiary neuroscience centre are reviewed and discussed along with the differential diagnosis.