MR demonstration of spinal cord sarcoidosis

Three patients with histologically confirmed sarcoidosis with spinal cord involvement were evaluated with high-field-strength MR imaging (1.5 T) before and after administration of Gd-DTPA. In addition to intramedullary expansion, patchy, multifocal parenchymal enhancement and areas of linear peripheral enhancement were seen in all three, which have not been previously reported and are unusual for other, more common spinal cord lesions. This observation led to a correct preoperative diagnosis and a limitation of the biopsy in two of the cases. Unfortunately, this enhancement pattern is not specific for sarcoidosis, as the authors have observed similar findings in two cases of biopsy-proved inflammatory myelitis and multiple sclerosis. The peripheral enhancement is thought to be located in the leptomeninges due to leptomeningeal involvement, histologically proved in one case. This pattern of involvement, while not specific, is certainly consistent with and, in the appropriate clinical setting, highly suggestive of sarcoidosis