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Wegener granulomatosis: MR imaging findings in brain and meninges
J M Murphy1, B Gomez-Anson, J H Gillard
1Department of Radiology, Addenbrooke's Hospital, England. joemmurphy@hotmail.com
Purpose:
To determine the spectrum of intracranial magnetic resonance (MR) imaging appearances of Wegener granulomatosis.
Materials And Methods:
MR imaging studies in 19 patients with Wegener granulomatosis and possible central nervous system involvement were reviewed by two neuroradiologists. Intermediate-weighted and T2-weighted fast spin-echo MR images of the brain had been acquired in all patients, and spin-echo T1-weighted nonenhanced and gadolinium-enhanced images had been acquired in 18 patients.
Results:
MR imaging findings included diffuse linear dural thickening and enhancement (n = 6); focal dural thickening and enhancement contiguous with orbital, nasal, or paranasal disease (n = 5); infarcts (n = 4); nonspecific white matter areas of high signal intensity on intermediate-weighted and T2-weighted images (n = 10); enlarged pituitary gland with infundibular thickening and enhancement (n = 2); a discrete cerebellar lesion that was probably granulomatous in origin (n = 1); and cerebral (n = 8) and cerebellar atrophy (n = 2).
Conclusion:
MR imaging demonstrated the wide spectrum of findings of central nervous system involvement in patients with Wegener granulomatosis and was particularly useful for the evaluation of direct intracranial spread from orbital, nasal, or paranasal disease.
Insights
Magnetic resonance imaging (MRI) reveals diverse intracranial changes in Wegener granulomatosis, aiding diagnosis of central nervous system involvement. This imaging technique is crucial for assessing spread from head and neck regions.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Wegener granulomatosis is a rare autoimmune disorder.
- Central nervous system (CNS) involvement can occur but is challenging to diagnose.
- Intracranial manifestations require detailed imaging for accurate assessment.
Purpose of the Study:
- To characterize the spectrum of intracranial magnetic resonance (MR) imaging findings in Wegener granulomatosis.
- To evaluate the utility of MR imaging in detecting CNS involvement.
Main Methods:
- Retrospective review of MR imaging studies in 19 patients with Wegener granulomatosis and suspected CNS involvement.
- Acquisition of various MR sequences including intermediate-weighted, T2-weighted fast spin-echo, T1-weighted nonenhanced, and gadolinium-enhanced images.
Main Results:
- Observed findings included dural thickening/enhancement, infarcts, white matter abnormalities, pituitary enlargement, cerebellar lesions, and cerebral/cerebellar atrophy.
- Specific patterns like diffuse or focal dural thickening and enhancement were noted.
- MR imaging identified a wide range of intracranial abnormalities.
Conclusions:
- MR imaging effectively demonstrates the diverse intracranial manifestations of Wegener granulomatosis.
- It is particularly valuable for evaluating direct intracranial spread from contiguous orbital, nasal, or paranasal disease.