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MR imaging of the brain in lymphomatoid granulomatosis
1Department of Radiology, Hokkaido University School of Medicine, N-15 W-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
Background And Purpose:
Clinical diagnosis of lymphomatoid granulomatosis (LG) of the brain, in patients without skin or chest lesions, usually is difficult because of the nonspecific neurologic manifestations, laboratory data, and CT appearance. Our aim was to characterize the MR appearance of LG of the brain.
Methods:
We retrospectively reviewed the MR images in four patients (35 to 72 years old) with histologically confirmed LG of the brain.
Results:
On T2-weighted images, we noted diffuse hyperintense lesions in the cerebral white matter bilaterally (n = 3), in the brain stem and cerebellar hemisphere (n = 1), and patchy hyperintense lesions the brain stem (n = 2). On contrast-enhanced T1-weighted images, we observed multiple punctate or linear enhancements residing along the perivascular space (n = 4), nodular enhancements (n = 2), ringlike enhancements (n = 1), and a large, enhanced mass (n = 1). All patients had multifocal lesions.
Conclusion:
Although the MR appearance of LG of the brain varies, multiple punctate or linear enhancements that reside along the perivascular space suggest LG.
Insights
Diagnosing brain lymphomatoid granulomatosis (LG) is challenging. Magnetic resonance (MR) imaging reveals characteristic punctate or linear enhancements along perivascular spaces, aiding diagnosis in patients without typical skin or chest lesions.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- Clinical diagnosis of brain lymphomatoid granulomatosis (LG) is often difficult due to nonspecific symptoms and imaging findings.
- Patients without skin or chest lesions present particular diagnostic challenges for LG of the brain.
Purpose of the Study:
- To characterize the magnetic resonance (MR) imaging appearance of lymphomatoid granulomatosis (LG) affecting the brain.
- To identify distinctive MR imaging features that can aid in the diagnosis of brain LG.
Main Methods:
- Retrospective review of MR images from four patients with histologically confirmed brain LG.
- Analysis of T2-weighted and contrast-enhanced T1-weighted MR images.
Main Results:
- Multifocal lesions were observed in all patients.
- T2-weighted images showed diffuse or patchy hyperintense lesions in various brain regions.
- Contrast-enhanced T1-weighted images revealed multiple punctate or linear perivascular enhancements, nodular enhancements, ringlike enhancements, and a large enhanced mass.
Conclusions:
- The MR imaging appearance of brain LG can be variable.
- Multiple punctate or linear enhancements along perivascular spaces on contrast-enhanced T1-weighted MR images are suggestive of LG.
- MR imaging plays a crucial role in the diagnosis of brain LG, especially when other clinical signs are absent.