Fluorodeoxyglucose positron emission tomography (FDG-PET) is useful in the diagnosis of neurosarcoidosis.

Abstract

A 45-year-old man presented with a progressive transverse spinal cord syndrome. MRI scanning revealed bitemporal and multiple spinal lesions with significant enhancement after gadolinium administration mimicking an acute disseminated encephalomyelitis. CSF analyses showed a lymphocytic pleocytosis. After treatment with high dose steroids clinical improvement was observed with a secondary decline shortly thereafter. MRI rescanning showed no remarkable alterations of the lesions. Further diagnostic work-up included a fluorodeoxyglucose positron emission tomography (FDG-PET) of the whole body to search for occult inflammation or neoplasia. The FDG-PET showed hypermetabolic foci corresponding to the lesions on MRI and additionally increased uptake in mediastinal and pulmonary hilar lymph nodes. A mediastinal lymph node was biopsied. Pathology was consistent with the diagnosis of sarcoidosis. The usual diagnostical tools to evaluate a sarcoidosis, such as serum angiotensin converting enzyme (ACE) and computed tomography of the chest were performed initially and revealed no pathological results. Therefore, in this case FDG-PET was crucial for the diagnostic work-up leading to an accessible inflammatory lesion outside the CNS for biopsy and the final diagnosis of sarcoidosis.

• Authors: Seza Bolat, Georg Berding, Reinhard Dengler, Martin Stangel, Corinna Trebst
• Journal: Journal of the neurological sciences (J Neurol Sci) Vol. 287 Issue 1-2 Pg. 257-9 (Dec 15 2009) ISSN: 1878-5883 [Electronic] Netherlands
• PMID: 19755199 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Inflammatory Agents
• Immunosuppressive Agents
• Steroids
• Fluorodeoxyglucose F18
• Azathioprine

Topics

• Anti-Inflammatory Agents (therapeutic use)
• Azathioprine (therapeutic use)
• Diagnosis, Differential
• Encephalitis (diagnostic imaging, metabolism, pathology)
• Fluorodeoxyglucose F18
• Humans
• Immunosuppressive Agents (therapeutic use)
• Lymph Nodes (diagnostic imaging, metabolism, pathology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Myelitis, Transverse (diagnostic imaging, metabolism, pathology)
• Positron-Emission Tomography (methods)
• Predictive Value of Tests
• Sarcoidosis (diagnostic imaging, metabolism, pathology)
• Sarcoidosis, Pulmonary (diagnostic imaging, metabolism, pathology)
• Spinal Cord (diagnostic imaging, metabolism, pathology)
• Steroids (therapeutic use)
• Temporal Lobe (diagnostic imaging, metabolism, pathology)
• Treatment Outcome