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Fig. 14 | Insights into Imaging

Fig. 14

From: Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions

Fig. 14

Neurosarcoidosis. Known case of systemic sarcoidosis. Conventional MRI Findings: a, b Axial and coronal T2W, (c) axial FLAIR and (d) post-contrast T1W sequences, showing a diffuse infiltrative lesion with enhancing foci in the right cerebellar peduncle extending to the brainstem, mimicking tumour. Multiparametric MRI: e DWI shows focal areas of low ADC. f PWI shows low perfusion in comparison to the contralateral side. g MRS with a short TE (30 ms) shows moderately high Cho/Cr ratio (< 2), near normal NAA/Cr and mI/Cr, presence of glutamate and glutamine at 2.4–2.6 ppm and large lipid peaks at 0.9 and 1.3 ppm suggesting necrosis. h MRS with a TE 135 ms shows slightly low NAA/creatine ratio and absence of lactate. In this case, the findings of low perfusion (< 2), absence of a lactate peak and presence of glutamine and glutamate favour an inflammatory aetiology such as neurosarcoidosis rather than a high-grade glioma. A tapering dose of oral prednisolone was commenced, during which neurological symptoms improved. Three-month follow-up MRI; (i) axial T2W, (j) post-contrast T1W, (k) FLAIR and (l) ADC sequences show near complete resolution of the lesion after treatment with steroids

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