MR of CNS sarcoidosis: correlation of imaging features to clinical symptoms and response to treatment.
OBJECTIVE
Sarcoidosis is an idiopathic systemic granulomatous disease, recognized in a patient when clinical and radiologic findings are confirmed by histopathologic analysis. The objective was to identify a relationship between MR imaging and clinical findings in CNS sarcoidosis.


METHODS
The clinical charts of 461 patients with biopsy-proved sarcoidosis were reviewed retrospectively. Criteria for including patients in the study included those with symptoms referable to the CNS, excluding those with another explanation for their symptoms, those with headaches or other subjective complaints without accompanying objective findings, and those with peripheral neuropathy other than cranial nerve involvement or myopathy without CNS manifestations. Thirty-four of 38 patients whose conditions met the criteria for CNS sarcoidosis underwent a total of 82 MR examinations. The positive imaging findings were divided into categories as follows: pachymeningeal, leptomeningeal, nonenhancing brain parenchymal, enhancing brain parenchymal, cranial nerve, and spinal cord and nerve root involvement. Treatment response, clinical symptomatology, and any available histopathologic studies were analyzed with respect to imaging manifestations in each of the categories.


RESULTS
Eighty-two percent of the patients with sarcoidosis with neurologic symptoms referable to the CNS had findings revealed by MR imaging. However, eight (40%) of 20 cranial nerve deficits seen at clinical examination of 13 patients were not seen at contrast-enhanced MR imaging, and 50% of the patients with symptoms referable to the pituitary axis had no abnormal findings on routine contrast-enhanced MR images. In contradistinction, 44% of 18 cranial nerves in nine patients with MR evidence of involvement had no symptoms referable to the involved cranial nerve. Clinical and radiologic deterioration occurred more commonly with leptomeningeal and enhancing brain parenchymal lesions.


CONCLUSIONS
MR imaging can be used to confirm clinical suspicion and to show subclinical disease and the response of pathologic lesions to treatment.
D000328:Adult; D001099:Arachnoid / Q000473:pathology; D001927:Brain Diseases / Q000188:drug therapy / Q000473:pathology*; D003287:Contrast Media; D003389:Cranial Nerve Diseases / Q000188:drug therapy / Q000473:pathology; D004388:Dura Mater / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008578:Meninges / Q000473:pathology; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy / Q000473:pathology; D010841:Pia Mater / Q000473:pathology; D010900:Pituitary Diseases / Q000188:drug therapy / Q000473:pathology; D012074:Remission Induction; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000188:drug therapy / Q000473:pathology*; D013118:Spinal Cord Diseases / Q000188:drug therapy / Q000473:pathology*; D013126:Spinal Nerve Roots / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome