PMC4899563_01
32-year-old male with intramedullary spinal neurosarcoidosis. Postcontrast T1-weighted images revealed a 1cm enhancing lesion (arrow) at C5-C6 with associated cord edema and expansion.
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T1-weighted scan, with associated cord edema and cord expansion (Fig. 1).
32-year-old male with intramedullary spinal neurosarcoidosis. The lesion (arrow) had low signal intensity centrally with peripheral hyperintensity on T2-weighted images (A). A hyperintense syrinx, extending 1.8cm, lies proximal to the lesion (arrow) (B).
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T2-weighted images, the lesion had central low-signal intensity with peripheral hyperintensity (Fig. 2A). The T2 scans further revealed a proximal hyperintense syrinx, likely postobstructive, extending 1.8cm from C4-C5 (Fig. 2B). The presence of the syrinx increased concern for a space-occupying lesion such as an ependymoma or astrocytoma.
32-year-old male with intramedullary spinal neurosarcoidosis. T2-weighted images demonstrated increasing cord expansion and edema (A). Imaging six weeks later demonstrated markedly increased cord edema and cord expansion extending from C2 to T2 and associated with a syrinx in the upper thoracic spinal cord (B).
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A repeated cervical MRI revealed enlargement of the enhancing mass at the C5-C6 level (Fig. 3A). Repeated imaging revealed further enlargement of the mass and increased cord edema (Fig. 3B).
32-year-old male with intramedullary spinal neurosarcoidosis. Postoperative MRI scans with laminectomies from C4-C7. The postcontrast T1-weighted image showed decreased enhancement of the lesion (arrow) at C5-C6 compared to pre-operative scans (A). The T2-weighted image showed marked decrease in hyperintensity (arrow) compared to pre-operative scans. There was only mild cord enlargement at the level of the lesion, and the edema extended only from C4-C7, compared to C2-T2 before surgery (B).
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Cervical MRI scans continue to demonstrate some signal abnormality; however, the intensity of the enhancement is markedly decreased, as are the caliber of the cord and surrounding edema (Fig. 4A and 4B).