24 Stjepanovi IM, et al. Neurosarcoidosis Clinical Center of Serbia, - PDF document

24 Stjepanović IM, et al. Neurosarcoidosis Clinical Center of Serbia, Belgrade, Serbia Review article Department of Pulmonology 1 Pregledni članak University of Belgrade, Faculty of Medicine, Belgrade, Serbia 2 UDK 616.831-002.7-073 Clinical Center of Serbia, Belgrade, Serbia, Department of Neurology 3 DOI: 10.2298/MPNS1402024S RADIOLOGICAL PRESENTATION OF NEUROSARCOIDOSIS RADIOLOŠKA PREZENTACIJA NEUROSARKOIDOZE Mihailo I. STJEPANOVIĆ 1 , Violeta MIHAILOVIĆ VUČINIĆ 1,2 , Dragana JOVANOVIĆ 1,2 , Milija MIJAJLOVIĆ 3 , Vesna ŠKODRIĆ TRIFUNOVIĆ 1,2 and Jelica VIDENOVIĆ IVANOV 1,2 Summary Sažetak Introduction . In diagnostics of neurosarcoidosis, radiological Uvod . U dijagnostici neurosarkoidoze radiološke dijagnostičke diagnostic procedures are available, non-invasive and they con- procedure su dospupne, neinazivne i značajno doprinose dija- tribute significantly to the diagnosis of this disease. The aim of gnostici ove bolesti. Cilj ovog rada je da prikaže kratak osvrt na this paper is to present a brief overview of the radiological diag- radiološke dijagnostičke metode i njihovu primenu, tj. značaj u nostic methods, their application, and their importance in daily svakodnevnom kliničkom radu sa ovim bolesnicima. Radiološ- clinical work with these patients. Radiological Presentation of ka prezentacija neurosarkoidoze . U dijagnostici ove bolesti Neurosarcoidosis . Magnetic resonance is the method of choice magnetna rezonancija je metoda izbora. Skener takođe može in diagnostics of this disease. Computed tomography can also biti koristan za bolesnike sa kontraindikacijama za magnetnu be helpful in patients with contraindications for magnetic reso- rezonanciju, mada se sa manjom preciznošću mogu utvrditi za- nance, although it is less precise in assessing the involvement of hvaćenost periventrikularne bele mase, hipotalamusa i krani- the periventricular white matter, hypothalamus, and cranial jalnih nerava. Broj lezija i stepen zahvaćenosti parenhima i lep- nerves. The number of lesions and the degree of involvement of tomeninga takođe su bolje vidljivi magnetnom rezonancijom, the parenchyma and leptomeninges are better seen by magnetic nego skenerom. Važno je napomenuti da snimak magnetnom resonance than by computed tomography scan. It is important to rezonancijom može biti normalan kod bolesnika sa neurosarko- note that the magnetic resonance imaging may be normal in pa- idozom, naročito kod bolesnika sa kranijalnom neuropatijom ili tients with neurosarcoidosis, especially in patients with cranial kod bolesnika na terapiji kortikosteroidima. Postoje brojne va- neuropathy, or in patients treated with corticosteroids. There is a rijabilnosti u pojavljivanju neurosarkoidoze na radiološkim number of variability in the occurrence of neurosarcoidosis on snimcima. Zaključak . Radiološke procedure, zbog svoje do- radiological images. Conclusion . Radiological procedures are stupnoisti, neivazivnosti i preciznosti, veoma su važne i stavlja- on the very top of diagnostic pyramid of this disease due to their ju se na sam vrh dijagnostičke piramide za ovo oboljenje. availability, non-invasiveness, and precision. Ključne reči : Magnetna rezonanca; Sarkoidoza; Oboljenja Key words: Magnetic Resonance Imaging; Sarcoidosis; Cen- centralnog nervnog sistema; Kompjuterska tomografija; Dija- tral Nervous System Diseases; Tomography, X-Ray Comput- noza ed; Diagnosis Introduction all available diagnostic methods are very important in diagnostics of this disease. Radiological diagnos- Sarcoidosis is a systemic granulomatous disease tic procedures are available to us, they are noninva- most frequently affecting lungs and hilar lymph sive and they contribute significantly to diagnostics nodes. Nowadays, it is known that sarcoidosis may of this disease. The aim of this paper is to present a affect any organ in the human body, as well as the brief review of radiological diagnostic methods, central nervous system (CNS) [1]. The golden their application, and their importance in everyday standard in diagnostics of neurosarcoidosis is clinical work with these patients. pathohistological verification of non-caseating granuloma in CNS. However, this procedure is Radiological presentation of neurosarcoidosis rarely applied in practice because of invasiveness and serious complications [2]. Due to these reasons Magnetic resonance imaging (MRI) is the meth- od of choice in diagnostics of this disease. Comput- Acknowledgement ed tomography (CT) scan may also be helpful in The present work was supported by the Ministry of Education patients with contraindications for MRI, although and Science the Republic of Serbia, Projects No. 175064 and the involvement of periventricular white matter, 175081, 2011-2014. Corresponding Author: Dr Mihailo Stjepanović, Klinički centar Srbije, Klinika za pulmologiju, 11000 Beograd, Koste Todorovića 26, E-mail: mihailo.stjepanovic@kcs.ac.rs