HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Patsalides, A. D. Articles by Wilson, W. H. Search for Related Content PubMed PubMed Citation Articles by Patsalides, A. D. Articles by Wilson, W. H.

Lymphomatoid Granulomatosis: Abnormalities of the Brain at MR Imaging¹

¹ From the Department of Diagnostic Radiology, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg 10, Room 1C660, 9000 Rockville Pike, Bethesda, MD 20892-1182 (A.D.P., G.A., A.D., N.J.P.); Georgetown University Hospital, Washington, DC (A.D.P.); and Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (U.H., J.J., N.G., E.S.J., W.H.W.). From the 2001 RSNA Annual Meeting. Received June 21, 2004; revision requested August 27; revision received November 21; accepted December 30. Address correspondence to A.D.P. (e-mail: apatsalides{at}cc.nih.gov).

View larger version (146K): [in a new window]   Figure 1a. Patient 6. Typical pattern of angiocentric involvement with lymphomatoid granulomatosis in 53-year-old man. (a) Sagittal and (b) transverse postcontrast T1-weighted MR images (400/9) of the brainstem and (c) transverse postcontrast T1-weighted images (400/9) of the cerebral hemispheres show multiple punctate enhancing foci (arrows) in the corpus callosum, midbrain, pons, medulla, and proximal cervical cord. Edema also was present around these lesions; some are noted with arrows in (d) transverse T2-weighted MR image (2500/100). (e, f) Transverse postcontrast T1-weighted MR images (400/9) obtained after treatment show complete resolution of the enhancing lesions in the (e) brainstem and the (f) cerebral hemispheres.

View larger version (93K): [in a new window]   Figure 1b. Patient 6. Typical pattern of angiocentric involvement with lymphomatoid granulomatosis in 53-year-old man. (a) Sagittal and (b) transverse postcontrast T1-weighted MR images (400/9) of the brainstem and (c) transverse postcontrast T1-weighted images (400/9) of the cerebral hemispheres show multiple punctate enhancing foci (arrows) in the corpus callosum, midbrain, pons, medulla, and proximal cervical cord. Edema also was present around these lesions; some are noted with arrows in (d) transverse T2-weighted MR image (2500/100). (e, f) Transverse postcontrast T1-weighted MR images (400/9) obtained after treatment show complete resolution of the enhancing lesions in the (e) brainstem and the (f) cerebral hemispheres.

View larger version (125K): [in a new window]   Figure 1c. Patient 6. Typical pattern of angiocentric involvement with lymphomatoid granulomatosis in 53-year-old man. (a) Sagittal and (b) transverse postcontrast T1-weighted MR images (400/9) of the brainstem and (c) transverse postcontrast T1-weighted images (400/9) of the cerebral hemispheres show multiple punctate enhancing foci (arrows) in the corpus callosum, midbrain, pons, medulla, and proximal cervical cord. Edema also was present around these lesions; some are noted with arrows in (d) transverse T2-weighted MR image (2500/100). (e, f) Transverse postcontrast T1-weighted MR images (400/9) obtained after treatment show complete resolution of the enhancing lesions in the (e) brainstem and the (f) cerebral hemispheres.

View larger version (146K): [in a new window]   Figure 1d. Patient 6. Typical pattern of angiocentric involvement with lymphomatoid granulomatosis in 53-year-old man. (a) Sagittal and (b) transverse postcontrast T1-weighted MR images (400/9) of the brainstem and (c) transverse postcontrast T1-weighted images (400/9) of the cerebral hemispheres show multiple punctate enhancing foci (arrows) in the corpus callosum, midbrain, pons, medulla, and proximal cervical cord. Edema also was present around these lesions; some are noted with arrows in (d) transverse T2-weighted MR image (2500/100). (e, f) Transverse postcontrast T1-weighted MR images (400/9) obtained after treatment show complete resolution of the enhancing lesions in the (e) brainstem and the (f) cerebral hemispheres.

View larger version (124K): [in a new window]   Figure 1e. Patient 6. Typical pattern of angiocentric involvement with lymphomatoid granulomatosis in 53-year-old man. (a) Sagittal and (b) transverse postcontrast T1-weighted MR images (400/9) of the brainstem and (c) transverse postcontrast T1-weighted images (400/9) of the cerebral hemispheres show multiple punctate enhancing foci (arrows) in the corpus callosum, midbrain, pons, medulla, and proximal cervical cord. Edema also was present around these lesions; some are noted with arrows in (d) transverse T2-weighted MR image (2500/100). (e, f) Transverse postcontrast T1-weighted MR images (400/9) obtained after treatment show complete resolution of the enhancing lesions in the (e) brainstem and the (f) cerebral hemispheres.

View larger version (128K): [in a new window]   Figure 1f. Patient 6. Typical pattern of angiocentric involvement with lymphomatoid granulomatosis in 53-year-old man. (a) Sagittal and (b) transverse postcontrast T1-weighted MR images (400/9) of the brainstem and (c) transverse postcontrast T1-weighted images (400/9) of the cerebral hemispheres show multiple punctate enhancing foci (arrows) in the corpus callosum, midbrain, pons, medulla, and proximal cervical cord. Edema also was present around these lesions; some are noted with arrows in (d) transverse T2-weighted MR image (2500/100). (e, f) Transverse postcontrast T1-weighted MR images (400/9) obtained after treatment show complete resolution of the enhancing lesions in the (e) brainstem and the (f) cerebral hemispheres.

View larger version (100K): [in a new window]   Figure 2a. Patient 5. Leptomeningeal involvement with lymphomatoid granulomatosis in 37-year-old man. Transverse (a, b) precontrast and (c, d) postcontrast T1-weighted MR images (400/9) show abnormal enhancement in the leptomeninges (arrows) of the suprasellar region. Slight dilatation of the temporal horns is also present. (e) Transverse postcontrast T1-weighted MR image (400/9) of the posterior fossa shows enhancement and increased thickness of the leptomeninges in the cerebellomedullary cisterns bilaterally and choroid plexus involvement in the foramen of Luschka (arrows) on the left. (f) Transverse fluid-attenuated inversion-recovery MR image (10 000/137) of the posterior fossa after intravenous contrast material administration demonstrates abnormally increased signal intensity in the left internal auditory canal (short arrow), which is indicative of leptomeningeal inflammation, and also involves the seventh and eighth cranial nerves. There is edema (long arrow) in the left cerebellar peduncle and adjacent pons.

View larger version (101K): [in a new window]   Figure 2b. Patient 5. Leptomeningeal involvement with lymphomatoid granulomatosis in 37-year-old man. Transverse (a, b) precontrast and (c, d) postcontrast T1-weighted MR images (400/9) show abnormal enhancement in the leptomeninges (arrows) of the suprasellar region. Slight dilatation of the temporal horns is also present. (e) Transverse postcontrast T1-weighted MR image (400/9) of the posterior fossa shows enhancement and increased thickness of the leptomeninges in the cerebellomedullary cisterns bilaterally and choroid plexus involvement in the foramen of Luschka (arrows) on the left. (f) Transverse fluid-attenuated inversion-recovery MR image (10 000/137) of the posterior fossa after intravenous contrast material administration demonstrates abnormally increased signal intensity in the left internal auditory canal (short arrow), which is indicative of leptomeningeal inflammation, and also involves the seventh and eighth cranial nerves. There is edema (long arrow) in the left cerebellar peduncle and adjacent pons.

View larger version (102K): [in a new window]   Figure 2c. Patient 5. Leptomeningeal involvement with lymphomatoid granulomatosis in 37-year-old man. Transverse (a, b) precontrast and (c, d) postcontrast T1-weighted MR images (400/9) show abnormal enhancement in the leptomeninges (arrows) of the suprasellar region. Slight dilatation of the temporal horns is also present. (e) Transverse postcontrast T1-weighted MR image (400/9) of the posterior fossa shows enhancement and increased thickness of the leptomeninges in the cerebellomedullary cisterns bilaterally and choroid plexus involvement in the foramen of Luschka (arrows) on the left. (f) Transverse fluid-attenuated inversion-recovery MR image (10 000/137) of the posterior fossa after intravenous contrast material administration demonstrates abnormally increased signal intensity in the left internal auditory canal (short arrow), which is indicative of leptomeningeal inflammation, and also involves the seventh and eighth cranial nerves. There is edema (long arrow) in the left cerebellar peduncle and adjacent pons.

View larger version (100K): [in a new window]   Figure 2d. Patient 5. Leptomeningeal involvement with lymphomatoid granulomatosis in 37-year-old man. Transverse (a, b) precontrast and (c, d) postcontrast T1-weighted MR images (400/9) show abnormal enhancement in the leptomeninges (arrows) of the suprasellar region. Slight dilatation of the temporal horns is also present. (e) Transverse postcontrast T1-weighted MR image (400/9) of the posterior fossa shows enhancement and increased thickness of the leptomeninges in the cerebellomedullary cisterns bilaterally and choroid plexus involvement in the foramen of Luschka (arrows) on the left. (f) Transverse fluid-attenuated inversion-recovery MR image (10 000/137) of the posterior fossa after intravenous contrast material administration demonstrates abnormally increased signal intensity in the left internal auditory canal (short arrow), which is indicative of leptomeningeal inflammation, and also involves the seventh and eighth cranial nerves. There is edema (long arrow) in the left cerebellar peduncle and adjacent pons.

View larger version (103K): [in a new window]   Figure 2e. Patient 5. Leptomeningeal involvement with lymphomatoid granulomatosis in 37-year-old man. Transverse (a, b) precontrast and (c, d) postcontrast T1-weighted MR images (400/9) show abnormal enhancement in the leptomeninges (arrows) of the suprasellar region. Slight dilatation of the temporal horns is also present. (e) Transverse postcontrast T1-weighted MR image (400/9) of the posterior fossa shows enhancement and increased thickness of the leptomeninges in the cerebellomedullary cisterns bilaterally and choroid plexus involvement in the foramen of Luschka (arrows) on the left. (f) Transverse fluid-attenuated inversion-recovery MR image (10 000/137) of the posterior fossa after intravenous contrast material administration demonstrates abnormally increased signal intensity in the left internal auditory canal (short arrow), which is indicative of leptomeningeal inflammation, and also involves the seventh and eighth cranial nerves. There is edema (long arrow) in the left cerebellar peduncle and adjacent pons.

View larger version (144K): [in a new window]   Figure 2f. Patient 5. Leptomeningeal involvement with lymphomatoid granulomatosis in 37-year-old man. Transverse (a, b) precontrast and (c, d) postcontrast T1-weighted MR images (400/9) show abnormal enhancement in the leptomeninges (arrows) of the suprasellar region. Slight dilatation of the temporal horns is also present. (e) Transverse postcontrast T1-weighted MR image (400/9) of the posterior fossa shows enhancement and increased thickness of the leptomeninges in the cerebellomedullary cisterns bilaterally and choroid plexus involvement in the foramen of Luschka (arrows) on the left. (f) Transverse fluid-attenuated inversion-recovery MR image (10 000/137) of the posterior fossa after intravenous contrast material administration demonstrates abnormally increased signal intensity in the left internal auditory canal (short arrow), which is indicative of leptomeningeal inflammation, and also involves the seventh and eighth cranial nerves. There is edema (long arrow) in the left cerebellar peduncle and adjacent pons.

View larger version (130K): [in a new window]   Figure 3a. Patient 3. Cranial nerve involvement in 24-year-old man. (a) Transverse postcontrast T1-weighted MR image (400/9) of the internal auditory canals (composite image from two consecutive transverse images) before treatment shows abnormal enhancing seventh and eighth cranial nerves bilaterally (arrows). (b) Transverse postcontrast T1-weighted MR image (400/9) of the internal auditory canals after treatment shows resolution of the abnormal enhancement of the seventh and eighth cranial nerves (arrows).

View larger version (137K): [in a new window]   Figure 3b. Patient 3. Cranial nerve involvement in 24-year-old man. (a) Transverse postcontrast T1-weighted MR image (400/9) of the internal auditory canals (composite image from two consecutive transverse images) before treatment shows abnormal enhancing seventh and eighth cranial nerves bilaterally (arrows). (b) Transverse postcontrast T1-weighted MR image (400/9) of the internal auditory canals after treatment shows resolution of the abnormal enhancement of the seventh and eighth cranial nerves (arrows).

View larger version (104K): [in a new window]   Figure 4a. Patient 11. Intraparenchymal mass in lymphomatoid granulomatosis in 17-year-old female patient. Transverse (a) postcontrast T1-weighted (400/9) and (b) fluid-attenuated inversion-recovery (10 000/137) MR images of the brain before treatment show a large heterogeneously enhancing mass in the right basal ganglia (arrow in a), surrounded by a relatively small zone of edema (arrow in b). Transverse (c) postcontrast T1-weighted (400/9) and (d) fluid-attenuated inversion-recovery (10 000/137) MR images after treatment show resolution of the granulomatous mass (arrow in c). An area of gliosis, possibly with a cavitation, is noted at the site of the mass (arrow in d).

View larger version (135K): [in a new window]   Figure 4b. Patient 11. Intraparenchymal mass in lymphomatoid granulomatosis in 17-year-old female patient. Transverse (a) postcontrast T1-weighted (400/9) and (b) fluid-attenuated inversion-recovery (10 000/137) MR images of the brain before treatment show a large heterogeneously enhancing mass in the right basal ganglia (arrow in a), surrounded by a relatively small zone of edema (arrow in b). Transverse (c) postcontrast T1-weighted (400/9) and (d) fluid-attenuated inversion-recovery (10 000/137) MR images after treatment show resolution of the granulomatous mass (arrow in c). An area of gliosis, possibly with a cavitation, is noted at the site of the mass (arrow in d).

View larger version (115K): [in a new window]   Figure 4c. Patient 11. Intraparenchymal mass in lymphomatoid granulomatosis in 17-year-old female patient. Transverse (a) postcontrast T1-weighted (400/9) and (b) fluid-attenuated inversion-recovery (10 000/137) MR images of the brain before treatment show a large heterogeneously enhancing mass in the right basal ganglia (arrow in a), surrounded by a relatively small zone of edema (arrow in b). Transverse (c) postcontrast T1-weighted (400/9) and (d) fluid-attenuated inversion-recovery (10 000/137) MR images after treatment show resolution of the granulomatous mass (arrow in c). An area of gliosis, possibly with a cavitation, is noted at the site of the mass (arrow in d).

View larger version (139K): [in a new window]   Figure 4d. Patient 11. Intraparenchymal mass in lymphomatoid granulomatosis in 17-year-old female patient. Transverse (a) postcontrast T1-weighted (400/9) and (b) fluid-attenuated inversion-recovery (10 000/137) MR images of the brain before treatment show a large heterogeneously enhancing mass in the right basal ganglia (arrow in a), surrounded by a relatively small zone of edema (arrow in b). Transverse (c) postcontrast T1-weighted (400/9) and (d) fluid-attenuated inversion-recovery (10 000/137) MR images after treatment show resolution of the granulomatous mass (arrow in c). An area of gliosis, possibly with a cavitation, is noted at the site of the mass (arrow in d).

View larger version (128K): [in a new window]   Figure 5a. Patient 5. Choroid plexus involvement with lymphomatoid granulomatosis in 37-year-old man. (a) Transverse postcontrast T1-weighted (400/9) MR image of the brain before treatment shows abnormally increased volume of the right choroid plexus in the body of the lateral ventricle, associated with intense and homogeneous enhancement (arrow). (b) Transverse postcontrast T1-weighted (400/9) MR image of the brain after treatment shows near complete resolution of the abnormality in the right choroid plexus.

View larger version (138K): [in a new window]   Figure 5b. Patient 5. Choroid plexus involvement with lymphomatoid granulomatosis in 37-year-old man. (a) Transverse postcontrast T1-weighted (400/9) MR image of the brain before treatment shows abnormally increased volume of the right choroid plexus in the body of the lateral ventricle, associated with intense and homogeneous enhancement (arrow). (b) Transverse postcontrast T1-weighted (400/9) MR image of the brain after treatment shows near complete resolution of the abnormality in the right choroid plexus.