MR and CT evaluation of intracranial sarcoidosis

Fourteen patients with CNS manifestations of neurosarcoidosis were evaluated by MR imaging and CT. Evaluations were done on a 0.5-T superconductive magnet with T1- and T2-weighted sequences. CT with contrast was obtained in all patients. The granulomatous lesions were classified by location into basilar, convexity, intrahemispheric, and periventricular white-matter involvement. Hydrocephalus with or without an associated lesion was also noted. MR determined the presence of disease in all patients (100%), but was less accurate than CT in depicting disease in two patients (14%). CT determined the presence of disease in 12 patients (85%) and was less accurate than MR in delineating hypothalamic involvement in two patients and periventricular white-matter disease in three patients. There was great variability in the appearance of intracranial sarcoidosis on MR. Three patients had lesions that were isointense or hypointense (relative to cerebral cortex) on both T1- and T2-weighted images while nine patients had lesions that were hyperintense on T2-weighted images. Convexity involvement and hydrocephalus were well documented by both CT and MR. These results indicate that both MR and CT are helpful in fully evaluating a patient with suspected intracranial sarcoidosis.