Role of fluorodeoxyglucose positron emission tomography in the diagnosis of neurosarcoidosis

Dubey, Neeraj; Miletich, Robert S; Wasay, Mohammad; Mechtler, Laszlo L; Bakshi, Rohit

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Volume 205, Issue 1 , Pages 77-81, 15 December 2002

Role of fluorodeoxyglucose positron emission tomography in the diagnosis of neurosarcoidosis

Neeraj Dubey
- Dent Neurologic Institute, Buffalo, NY, USA
- Imaging Services, Kaleida Health-Millard Fillmore Hospital, Buffalo, NY, USA
Robert S Miletich
- Dent Neurologic Institute, Buffalo, NY, USA
- Imaging Services, Kaleida Health-Millard Fillmore Hospital, Buffalo, NY, USA
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
Mohammad Wasay
- Department of Neurology, The Aga Khan University, Karachi, Pakistan
Laszlo L Mechtler
- Dent Neurologic Institute, Buffalo, NY, USA
- Imaging Services, Kaleida Health-Millard Fillmore Hospital, Buffalo, NY, USA
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
Rohit Bakshi
- Corresponding author. Buffalo Neuroimaging Analysis Center, The Jacobs Neurological Institute, 100 High St. Buffalo, NY 14203, USA. Tel.: +1-716-859-7592; fax: +1-716-859-7573.
- Dent Neurologic Institute, Buffalo, NY, USA
- Imaging Services, Kaleida Health-Millard Fillmore Hospital, Buffalo, NY, USA
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- Buffalo Neuroimaging Analysis Center, The Jacobs Neurological Institute, Buffalo, NY, USA

Received 22 October 1999; received in revised form 28 June 2002; accepted 3 July 2002.

Abstract

A 45-year-old man developed seizures and myelopathy. MRI showed bitemporal and cervical spinal cord hyperintense lesions on T2-weighted and FLAIR images that contrast-enhanced. Initial evaluation for sarcoidosis was negative, including serum angiotensin converting enzyme (ACE) and chest X-ray. Whole body fluorodeoxyglucose positron emission tomography (FDG-PET) revealed multiple hypermetabolic hilar and mediastinal foci and spinal cord hypermetabolism at the site of MRI abnormality. Temporal lobe MRI lesions were hypometabolic. Mediastinal lymph node biopsy was consistent with sarcoidosis. The brain, spinal cord, and chest metabolic abnormalities together with the clinical presentation were interpreted as being most consistent with sarcoidosis. FDG-PET helped target the site of biopsy that subsequently confirmed the diagnosis histologically. In patients with perplexing neurologic presentations, whole body FDG-PET can help secure a timely and minimally invasive diagnosis of neurosarcoidosis.

Keywords: Sarcoidosis, Neurosarcoidosis, Brain, Inflammation, Positron emission tomography, Magnetic resonance imaging