Value of Multimodal Imaging Approach to Diagnosis of Neurosarcoidosis
Background: Neurosarcoidosis is a highly variable condition with many clinical and radiological manifestations, that can lead to difficult identification of isolated central nervous system (CNS) forms, because it could mimic inflammatory, infective or neoplastic disorders. Conventional magnetic reso...
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doaj-fc8fa86dfa464b428dfacf3c6b086ecc2020-11-25T01:32:43ZengMDPI AGBrain Sciences2076-34252019-09-0191024310.3390/brainsci9100243brainsci9100243Value of Multimodal Imaging Approach to Diagnosis of NeurosarcoidosisIlaria Sammarra0Gaetano Barbagallo1Angelo Labate2Baldassare Mondello3Giuseppe Albonico4Maurizio Maisano5Giuseppe Lucio Cascini6Aldo Quattrone7Antonio Gambardella8Institute of Neurology, Magna Græcia University, 88100 Catanzaro, ItalyInstitute of Neurology, Magna Græcia University, 88100 Catanzaro, ItalyInstitute of Neurology, Magna Græcia University, 88100 Catanzaro, ItalyUnit of Thoracic Surgery, Grande Ospedale Metropolitano di Reggio Calabria, 89124 Reggio Calabria, ItalyUnit of Anatomical Pathology, Grande Ospedale Metropolitano di Reggio Calabria, 89124 Reggio Calabria, ItalyUnit of Anatomical Pathology, Grande Ospedale Metropolitano di Reggio Calabria, 89124 Reggio Calabria, ItalyInstitute of Radiology, Nuclear Medicine Unit, Magna Graecia University, 88100 Catanzaro, ItalyNeuroimaging Research Unit, IBFM, National Research Council, 88100 Catanzaro, ItalyInstitute of Neurology, Magna Græcia University, 88100 Catanzaro, ItalyBackground: Neurosarcoidosis is a highly variable condition with many clinical and radiological manifestations, that can lead to difficult identification of isolated central nervous system (CNS) forms, because it could mimic inflammatory, infective or neoplastic disorders. Conventional magnetic resonance imaging (MRI) is gold standard to evaluate CNS involvement in neurosarcoidosis, despite the reported high sensitivity but low specificity in the diagnosis. Case presentation: Here, we describe a 52-year-old man that presented to our hospital with a 10-year history of focal seizures, progressive cognitive decline and motor impairment. Neurological examination revealed ataxic gait, bilateral telekinetic and postural tremor, brisk reflexes, left extensor plantar response and hypoesthesia to the right side of body. Brain 3T-magnetic resonance imaging (MRI) showed a leukoencephalopathy with multifocal nodular lesions hyperintense on T2/ fluid attenuated inversion recovery (FLAIR) weighted images involving basal ganglia, periventricular and deep white matter. The interpretation of this pattern on conventional MRI was unclear, opening a challenge on the differential diagnosis between inflammatory, infective or neoplastic disorders. Thus, to better understand the nature of these nodules, single-voxel <sup>1</sup>H-magnetic resonance spectroscopy (<sup>1</sup>H-MRS), contrast enhanced computed tomography (CT) scan and fluorine-18-fluorodeoxyglucose-positron emission tomography (<sup>18</sup>F-FDG-PET)/3T-MRI were performed. The parenchymal multifocal lesions exhibited slight <i>N</i>-acetyl-aspartate/creatine reduction without abnormal peaks on <sup>1</sup>H-MRS, enhancement after the administration of contrast agent on CT and hypermetabolism on <sup>18</sup>F-FDG-PET/3T-MRI. All these findings excluded primary neoplasms, metastasis, neurotuberculosis, neurocysticercosis and brain abscess, strongly suggesting a diagnosis of neurosarcoidosis. Therefore, a whole-body <sup>18</sup>F-FDG-PET/CT was performed in order to identify subclinical extraneural sarcoidosis localizations, and a hypermetabolic nodule of the left lung upper lobe was found. Subsequently, a biopsy documented the presence of systemic sarcoidosis, supporting a diagnosis of probable neurosarcoidosis. Conclusions: This case demonstrated that a multimodal neuroimaging approach can provide different but complementary evidences to suspect sarcoidosis, especially in apparently CNS isolated forms.https://www.mdpi.com/2076-3425/9/10/243neurosarcoidosismultimodal imagingmagnetic resonance imagingcomputed tomographymagnetic resonance spectroscopypositron emission tomography |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ilaria Sammarra Gaetano Barbagallo Angelo Labate Baldassare Mondello Giuseppe Albonico Maurizio Maisano Giuseppe Lucio Cascini Aldo Quattrone Antonio Gambardella |
spellingShingle |
Ilaria Sammarra Gaetano Barbagallo Angelo Labate Baldassare Mondello Giuseppe Albonico Maurizio Maisano Giuseppe Lucio Cascini Aldo Quattrone Antonio Gambardella Value of Multimodal Imaging Approach to Diagnosis of Neurosarcoidosis Brain Sciences neurosarcoidosis multimodal imaging magnetic resonance imaging computed tomography magnetic resonance spectroscopy positron emission tomography |
author_facet |
Ilaria Sammarra Gaetano Barbagallo Angelo Labate Baldassare Mondello Giuseppe Albonico Maurizio Maisano Giuseppe Lucio Cascini Aldo Quattrone Antonio Gambardella |
author_sort |
Ilaria Sammarra |
title |
Value of Multimodal Imaging Approach to Diagnosis of Neurosarcoidosis |
title_short |
Value of Multimodal Imaging Approach to Diagnosis of Neurosarcoidosis |
title_full |
Value of Multimodal Imaging Approach to Diagnosis of Neurosarcoidosis |
title_fullStr |
Value of Multimodal Imaging Approach to Diagnosis of Neurosarcoidosis |
title_full_unstemmed |
Value of Multimodal Imaging Approach to Diagnosis of Neurosarcoidosis |
title_sort |
value of multimodal imaging approach to diagnosis of neurosarcoidosis |
publisher |
MDPI AG |
series |
Brain Sciences |
issn |
2076-3425 |
publishDate |
2019-09-01 |
description |
Background: Neurosarcoidosis is a highly variable condition with many clinical and radiological manifestations, that can lead to difficult identification of isolated central nervous system (CNS) forms, because it could mimic inflammatory, infective or neoplastic disorders. Conventional magnetic resonance imaging (MRI) is gold standard to evaluate CNS involvement in neurosarcoidosis, despite the reported high sensitivity but low specificity in the diagnosis. Case presentation: Here, we describe a 52-year-old man that presented to our hospital with a 10-year history of focal seizures, progressive cognitive decline and motor impairment. Neurological examination revealed ataxic gait, bilateral telekinetic and postural tremor, brisk reflexes, left extensor plantar response and hypoesthesia to the right side of body. Brain 3T-magnetic resonance imaging (MRI) showed a leukoencephalopathy with multifocal nodular lesions hyperintense on T2/ fluid attenuated inversion recovery (FLAIR) weighted images involving basal ganglia, periventricular and deep white matter. The interpretation of this pattern on conventional MRI was unclear, opening a challenge on the differential diagnosis between inflammatory, infective or neoplastic disorders. Thus, to better understand the nature of these nodules, single-voxel <sup>1</sup>H-magnetic resonance spectroscopy (<sup>1</sup>H-MRS), contrast enhanced computed tomography (CT) scan and fluorine-18-fluorodeoxyglucose-positron emission tomography (<sup>18</sup>F-FDG-PET)/3T-MRI were performed. The parenchymal multifocal lesions exhibited slight <i>N</i>-acetyl-aspartate/creatine reduction without abnormal peaks on <sup>1</sup>H-MRS, enhancement after the administration of contrast agent on CT and hypermetabolism on <sup>18</sup>F-FDG-PET/3T-MRI. All these findings excluded primary neoplasms, metastasis, neurotuberculosis, neurocysticercosis and brain abscess, strongly suggesting a diagnosis of neurosarcoidosis. Therefore, a whole-body <sup>18</sup>F-FDG-PET/CT was performed in order to identify subclinical extraneural sarcoidosis localizations, and a hypermetabolic nodule of the left lung upper lobe was found. Subsequently, a biopsy documented the presence of systemic sarcoidosis, supporting a diagnosis of probable neurosarcoidosis. Conclusions: This case demonstrated that a multimodal neuroimaging approach can provide different but complementary evidences to suspect sarcoidosis, especially in apparently CNS isolated forms. |
topic |
neurosarcoidosis multimodal imaging magnetic resonance imaging computed tomography magnetic resonance spectroscopy positron emission tomography |
url |
https://www.mdpi.com/2076-3425/9/10/243 |
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