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结节病 中枢神经系统结节病（neurosarcoidosis） Neurosarcoidosispresenting as an isolated mass of the quadrigeminal plate Fig. 1Preoperative sagittal Tl-weighted MRI image showing a gadolinium enhancing massof the quadrigeminal plate compressing the aqueduct. Fig. 2Non-caseating granulomatous inflammation of the tectal plate.Centralaccumulation of epithelioid macrophages surrounded by a rim of lymphocytes andreactive gliosis H&E bar 30 gm). Fig. 3Postoperative sagittal Tl-weighted MRI image showing a free aqueduct and theresection cavity,
FIGURE 1. SingleMRI examination (Picker 1.5 T scanner,Conventional spin-echo, 220 3 256, FOV-23 cm, slice thickness:axial, 6mm; sagittal, 4mm). The right side of the image represents the rightside of the head. A well-circumscribed roundmass is noted in the suprasellarregion which lies in the midline and slightly to the right. The mass measures 3 cm left to right, 2.5 cm anterior to posterior, and 2.2 cm inferior to superior.(A)Non-contrast T1-weighted axial (TR/TE: 733/20).An isointense core isinterspersed with and surrounded by speckled and septated hyperintensities.Mass effect is noted on the ventral midbrain/diencephalon. (B,C) Post-contrast(gadoteridol,5minute delay) T1-weighted [(B) axial, TR/TE: 733/20; (C)sagittal, TR/TE: 500/20]. Intense, homogeneous enhancement of the mass isnoted. The lesion is clearly confined to the suprasellar region; the sellarcontents are separate from the mass and show normal enhancement.(D)Non-contrast T2-weighted axial (TR/TE: 2300/80). The mass is heterogeneousin appearance. It is largely hypointense,but contains intermixed isointenseregions. Peritumoral edema is noted involving the midbrain, diencephalon,andmedial temporal lobes. The Pitfall ofSilent Neurosarcoidosis Pediatr Neurol 1999;20:215-218.
Figure 1. Chestcomputed tomography scan revealing bilateral mediastinal and hilaradenomegalies associated with diffuse reticulonodular pulmonary infiltrates
Figure 2.Abdominal computed tomography scan revealing multiple enlarged lymph nodesalong the coeliomesenteric and aorticocaval areas with heterogeneous aspect ofthe spleen.
Figure 3. (A)Postgadolinium coronal reformatted images from threedimensional-fouriertransformed T1-weighted acquisition. Enhancement following the inferior part ofthe optic chiasm is observed. (B) Nodular enhanced lesions are scatteredthroughout the subarachnoid spaces at the level of the right lenticular nucleusfollowing the vascular distribution of the right middle cerebral artery. Mimics of BrainTumor on Neuroimaging: Part II RadiationMedicine: Vol. 22 No. 3, 135–142 p.p., 2004
Fig. 11. Pituitaryadenoma? A 62-year-old man complained of visual field defect. (Final diagnosiswith pathological confirmation:idiopathic lymphocytic hypophysitis) (withpermission from Shujunsha)55 a: Postcontrastcoronal T1-weighted (TR/TE=600/15) image shows an enhancing pituitary massextending into the suprasellar region(*). b: Postcontrastaxial T1-weighted (600/15) image shows enhancement and thickening of thebilateral tentorium cerebelli (arrows), as well as a suprasellar portion of thepituitary mass (*).
Fig. 12. Anteriorfalx meningioma or malignant lymphoma? A 27-year-old man presented with mildright hemiparesis. (Final diagnosis with pathological confirmation: sarcoidgranuloma) a: PostcontrastT1-weighted (460/9) image shows focal thickening and enhancement of theanterior falx with dural tail sign. Venous malformation is incidentallydemonstrated in the left parietal region. b: The lesion ismarkedly hypointense on isotropic diffusion-weighted image (EPI, TE 123 msec,b=1,000 sec/mm2).
Fig. 13.Meningioma? A 7-year-old girl with bilateral hearing loss underwent MRI. (Finaldiagnosis with pathological confirmation: sinus histiocytosis with massivelymphadenopathy or Rosai-Dorfman disease) Postcontrast coronal T1-weighted(400/15) image shows an enhancing dural mass (*) with dural tail sign.Bilateral maxillary sinuses are occupied by enhancing lesions ( ★ ). Neurosarcoidosispresenting with simple partial seizures and solitary enhancing mass: casereports and review of the literature Epilepsy &Behavior 6 (2005) 623–630
Fig. 1. EEG recordshowing seizure with left frontotemporal onset. The calibration bar represents90 lV, 1 second. High-frequency filter was 35 Hz.
Fig. 2. (A) ThisMRI image shows enlargement of left amygdala, hippocampal head, and adjacentneocortex on inversion recovery weighted T1 sequence. (B) Bright signal is seenwithin the abnormal structures on FLAIR. (C) Gadolinium produced patchyenhancement. Arrows identify the abnormal region.
Fig. 3. (A)Successive 3-mm T2-weighted images anterior (left) to posterior (right) showingenlarged amygdala and anterior hippocampus on the left(see arrow). (B)Corresponding PET scans are seen below with hypermetabolism in the abnormalregion.
Fig. 4. Confluentareas of granuloma within the amygdala consistent with sarcoidosis. Case Report /Epilepsy & Behavior 6 (2005) 623–630 625 Isolatedneurosarcoidosis presenting as anosmia and visual changes Otolaryngol HeadNeck Surg 1997;117:S183-S186.
Fig. 1, A,Gadolinium-enhanced Tl-weighted axial image demonstrates densely enhancingbilateral subfrontal mass that extends posteriorly to abut left aspect of opticchiasm, optic tract, and proximal middle cerebral artery. Hypointensevasogenice edema is seen in inferior frontal lobes.There is no definiteparanasal sinus invasion, B, More posterior gadolinium-enhanced Tl-weighted coronalimage demonstrates extension of mass into left aspect of optic chiasm andinferior left basal ganglia. Mass partially encases distal left internalcarotid artery. C, Gadoliniumenhanced Tl-weighted coronal image demonstratesdensely enhancing bilateral subfrontal mass. It extends into interhemisphericfissure. Spiculation is suggestive of brain invasion. Marked amount ofhypointense vasogenic edema is seen in frontal white matter bilaterally.
Fig. 2. A,Photomicrograph showing respiratory epithelium with submucosal noncaseating granulomata.(Hematoxylin-eosin stain; original magnification ×50.) B, Photomicrograph showingnoncaseating granulomata; epithelial histiocytes and surrounding lymphocytesare demonstrated. (Hematoxylin-eosin stain; original magnification ×125.) Clinical andMagnetic Resonance Imaging Manifestations of Neurosarcoidosis
Figure 1Contrast-enhanced magnetic resonance imaging of patient 1 in coronal (T1-weighted; A) and axial(Fluidattenuation inversion recovery; B) planes demonstrates a large,homogeneously enhancing mass in the left frontal lobe.There is significantsurrounding edema with resultant mass effect, causing midline shift andeffacement of adjacent cortical sulci. There is also an enhancing, nodularthickening of the dura and meninges overlying the convexity of the left frontallobe (short arrows) and encircling the left temporal pole (long arrows). Biopsyof the lesion (C) revealed multi-nucleated giant cells within extensivegranulomatous inflammation (hematoxylin and eosin; original magnification 20).Cultures and periodic acid-Schiff and silver stains were negative for fungi andacid-fast bacilli. Following biopsy and 3 months of corticosteroids, repeat MRI(D; T1-weighted, postcontrast, axial plane) shows the mass is reduced in sizewith resolution of midline shift and subfalcine herniation.Neurosarcoidosis 655
Figure 2Contrast-enhanced, T1-weighted magnetic resonance images in the sagittal planeof patient 16 demonstrate an intramedullary lesion within the lower cervicalspinal cord. The lesion spans several segments and exhibits homogeneouscontrast enhancement.A smaller plaque with similar MRI characteristics wasidentified at the T-12 spinal level (not shown). The patient significantlyimproved with intravenous dexamethasone and was able to ambulate independentlyin 2 days. He was discharged on prednisone and remains free of neurologicalcomplaints.
Figure 3 SaggitalMRI (T1-weighted) of the cervical spinal cord, postcontrast (patient 13)reveals several enhancing lesions within the cervico-medullary junction (shortarrow), pons, and upper cervical spinal cord. Note is also made of atrophy ofthe upper cervical spinal cord (long arrow).Neurosarcoidosis—Review of ImagingFindings
Neurosarcoidosis:a clinical dilemma the lancetNeurology Vol 3 July 2004
Figure 1. Left:enhanced lesion in a middle aged, white man with multisystem sarcoidosis. Abiopsy of the cerebellum showed noncaseating granuloma. Right: resolution ofthe lesion after combined prednisone and hydroxychloroquine therapy.
Figure 2. Left:unenhanced spinal cord lesion in a patient with sarcoidosis who developedmarked weakness of the lower extremities. Right:gadolinium-enhanced image. The patient responded to corticosteroid treatment. Neurosarcoidosis:a clinical dilemma the lancetNeurology Vol 3 July 2004
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