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Brain miliary enhancement
Joseph C J Bot1, Linda Mazzai2,3, Rogier E Hagenbeek4
1Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands. j.bot@amsterdamumc.nl.
Purpose:
Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted post-contrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes.
Methods:
An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1-weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement.
Results:
Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses.
Conclusion:
A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.
Insights
Miliary enhancement on brain MRI can indicate various conditions. Recognizing spread along perivascular spaces and specific MRI findings aids diagnosis, potentially reducing invasive procedures.
Area of Science:
- Neuroradiology
- Neuroimaging
- Differential Diagnosis
Background:
- Miliary enhancement on T1-weighted post-contrast MRI presents as multiple small, monomorphic enhancing foci.
- A broad differential diagnosis for miliary enhancement can lead to invasive procedures, including brain biopsy.
- Lack of clear clinical presentation complicates the diagnosis of miliary enhancement.
Purpose of the Study:
- To review diseases presenting with miliary enhancement on brain MRI.
- To summarize clinical and radiological findings associated with miliary enhancement.
- To categorize findings based on perivascular space involvement to aid diagnosis.
Main Methods:
- Comprehensive literature review of diseases causing miliary enhancement on T1-weighted brain MR images.
- Summarization of disease-specific clinical and radiological findings.
- Categorization of findings by perivascular space involvement.
Main Results:
- Miliary enhancement can result from inflammatory, infectious, nutritional, or neoplastic processes.
- Identifying perivascular space spread and specific MRI features (leptomeningeal enhancement, hemorrhage, spinal cord involvement) narrows differential diagnoses.
- Systematic evaluation of clinical and radiological data is crucial.
Conclusions:
- A systematic approach integrating clinical and radiological findings aids diagnostic work-up for miliary enhancement.
- Recognizing perivascular space involvement helps narrow differential diagnoses.
- Minimizing invasive diagnostic procedures is facilitated by improved diagnostic accuracy.
