Abstract Details

Title MRI and PET Imaging Discordance in Neurosarcoidosis

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 205

Objective

Background BACKGROUND: The current gold standard for imaging in neurosarcoidosis is gadolinium-enhanced MRI. FDG-PET findings have been previously reported to correlate with known MRI lesions of the neuraxis.

Design/Methods DESIGN/METHODS: Case report and literature review.

Results RESULTS: A previously healthy 43-year-old woman presented with bandlike abdominal pressure, described as "having difficulty taking deep breaths" over the course of three weeks. This pain was constant and exacerbated with deep inspiration. Review of systems revealed poor appetite due to early satiety from the abdominal pressure, a five-pound weight loss, and urinary frequency over the past few weeks. Neurologic examination was normal. Chest x-ray revealed fullness of the mediastinum, and follow-up chest CT showed superior mediastinal adenopathy. Due to concern for lymphoma, FDG-PET was performed, demonstrating increased activity correlating with the mediastinal adenopathy. Also noted was moderate activity within the T9-T12 spinal canal. Lymph node biopsy revealed non-necrotizing granulomatous inflammation consistent with sarcoidosis. Gadolinium-enhanced MRI of the spinal cord was unremarkable for abnormal signal or enhancement. CSF analysis showed lymphocytic pleocytosis with 26 nucleated cells and protein of 36, suggestive of neurosarcoidosis. She was initiated on prednisone 60 mg daily, with improvement of symptoms at 6-month follow-up. Repeat PET scan showed resolution of the signal abnormality in the thoracic cord. MRI remained normal. Repeat CSF analysis had normalized, with 1 nucleated cell and protein of 19.

Conclusions CONCLUSIONS: The preferred imaging modality for neurosarcoidosis is gadolinium-enhanced MRI. Reports of positive PET scans are reported with MRI correlates, but have not been reported without concomitant MRI findings. The FDG-PET signal without MRI correlate in this case suggests that FDG-PET may provide a more sensitive test for early detection in neurosarcoidosis.

Authors/Disclosures
Josephine F. Huang, MD PRESENTER	Dr. Huang has nothing to disclose.
Allen J. Aksamit, Jr., MD, FAAN (Mayo Clinic)	Dr. Aksamit has nothing to disclose.
Claudia Prada	No disclosure on file
Nathan P. Staff, MD, PhD, FAAN (Mayo Clinic)	Dr. Staff has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stem Cell Research & Therapy. Dr. Staff has received research support from National Institutes of Health.

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