Central nervous system sarcoidosis: follow-up at MR imaging during steroid therapy.
OBJECTIVE
To document the changes observed at sequential magnetic resonance (MR) imaging of sarcoidosis lesions of the central nervous system (CNS) during treatment with corticosteroids.


METHODS
The abnormalities detected in 24 patients (mean follow-up, 36 months) were compared before and after therapeutic periods (n = 75) that were divided into attack (high-dose), upkeep (decreased-dose), and minimal (low-dose) periods. Parenchymal lesions were classified as type 1 (enhanced with gadolinium), type 2 (demyelinating), or type 3 (lacunar) and were assessed as regressing, stable, or progressing.


RESULTS
Seven of the 24 patients had several types of lesions. Isolated type 3 lesions (six patients) were the only lesions not associated with neurologic deficit. Type 1 lesions (13 patients) regressed in 22 of 22 attack periods and progressed in nine of 27 upkeep and minimal periods. MR imaging depicted relapses in patients with multifocal CNS involvement or long-standing CNS impairment or in those who had previously received steroid therapy. Type 2 (seven patients) and type 3 (13 patients) lesions remained stable in 68 of 68 therapeutic periods. Type 1 lesions appeared in three patients with type 2 and type 3 lesions during two upkeep and three minimal periods. Findings at follow-up MR imaging contributed to the reintroduction of high-dose corticosteroid therapy in eight patients.


CONCLUSIONS
MR imaging can be used to differentiate between reversible and irreversible lesions in CNS sarcoidosis. MR imaging can be a useful tool for adjusting treatment to prevent irreversible CNS damage.
Dumas
J L
JL
Department of Radiology, Hôpital Avicenne, 125 route de Stalingrad, 93009 Bobigny, France.
Valeyre
D
D
Chapelon-Abric
C
C
Belin
C
C
Piette
J C
JC
Tandjaoui-Lambiotte
H
H
Brauner
M
M
Goldlust
D
D
D000328:Adult; D001921:Brain / Q000187:drug effects / Q000473:pathology; D001927:Brain Diseases / Q000145:classification / Q000188:drug therapy* / Q000473:pathology; D003287:Contrast Media; D003711:Demyelinating Diseases / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D012507:Sarcoidosis / Q000145:classification / Q000188:drug therapy* / Q000473:pathology; D013116:Spinal Cord / Q000187:drug effects / Q000473:pathology; D013118:Spinal Cord Diseases / Q000145:classification / Q000188:drug therapy* / Q000473:pathology
D003287:Contrast Media; D005938:Glucocorticoids; D018696:Neuroprotective Agents; D005682:Gadolinium; D011241:Prednisone; D008775:Methylprednisolone