{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:54:15Z","timestamp":1780469655456,"version":"3.54.1"},"reference-count":8,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2019,9,21]],"date-time":"2019-09-21T00:00:00Z","timestamp":1569024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Neurosarcoidosis is a highly variable condition with many clinical and radiological manifestations, that can lead to difficult identification of isolated central nervous system (CNS) forms, because it could mimic inflammatory, infective or neoplastic disorders. Conventional magnetic resonance imaging (MRI) is gold standard to evaluate CNS involvement in neurosarcoidosis, despite the reported high sensitivity but low specificity in the diagnosis. Case presentation: Here, we describe a 52-year-old man that presented to our hospital with a 10-year history of focal seizures, progressive cognitive decline and motor impairment. Neurological examination revealed ataxic gait, bilateral telekinetic and postural tremor, brisk reflexes, left extensor plantar response and hypoesthesia to the right side of body. Brain 3T-magnetic resonance imaging (MRI) showed a leukoencephalopathy with multifocal nodular lesions hyperintense on T2\/ fluid attenuated inversion recovery (FLAIR) weighted images involving basal ganglia, periventricular and deep white matter. The interpretation of this pattern on conventional MRI was unclear, opening a challenge on the differential diagnosis between inflammatory, infective or neoplastic disorders. Thus, to better understand the nature of these nodules, single-voxel 1H-magnetic resonance spectroscopy (1H-MRS), contrast enhanced computed tomography (CT) scan and fluorine-18-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET)\/3T-MRI were performed. The parenchymal multifocal lesions exhibited slight N-acetyl-aspartate\/creatine reduction without abnormal peaks on 1H-MRS, enhancement after the administration of contrast agent on CT and hypermetabolism on 18F-FDG-PET\/3T-MRI. All these findings excluded primary neoplasms, metastasis, neurotuberculosis, neurocysticercosis and brain abscess, strongly suggesting a diagnosis of neurosarcoidosis. Therefore, a whole-body 18F-FDG-PET\/CT was performed in order to identify subclinical extraneural sarcoidosis localizations, and a hypermetabolic nodule of the left lung upper lobe was found. Subsequently, a biopsy documented the presence of systemic sarcoidosis, supporting a diagnosis of probable neurosarcoidosis. Conclusions: This case demonstrated that a multimodal neuroimaging approach can provide different but complementary evidences to suspect sarcoidosis, especially in apparently CNS isolated forms.<\/jats:p>","DOI":"10.3390\/brainsci9100243","type":"journal-article","created":{"date-parts":[[2019,9,23]],"date-time":"2019-09-23T03:26:32Z","timestamp":1569209192000},"page":"243","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Value of Multimodal Imaging Approach to Diagnosis of Neurosarcoidosis"],"prefix":"10.3390","volume":"9","author":[{"given":"Ilaria","family":"Sammarra","sequence":"first","affiliation":[{"name":"Institute of Neurology, Magna Gr\u00e6cia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2237-3006","authenticated-orcid":false,"given":"Gaetano","family":"Barbagallo","sequence":"additional","affiliation":[{"name":"Institute of Neurology, Magna Gr\u00e6cia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8827-7324","authenticated-orcid":false,"given":"Angelo","family":"Labate","sequence":"additional","affiliation":[{"name":"Institute of Neurology, Magna Gr\u00e6cia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baldassare","family":"Mondello","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Grande Ospedale Metropolitano di Reggio Calabria, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Albonico","sequence":"additional","affiliation":[{"name":"Unit of Anatomical Pathology, Grande Ospedale Metropolitano di Reggio Calabria, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Maisano","sequence":"additional","affiliation":[{"name":"Unit of Anatomical Pathology, Grande Ospedale Metropolitano di Reggio Calabria, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe Lucio","family":"Cascini","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Nuclear Medicine Unit, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo","family":"Quattrone","sequence":"additional","affiliation":[{"name":"Neuroimaging Research Unit, IBFM, National Research Council, 88100 Catanzaro, Italy"},{"name":"Neuroscience Research Centre, Magna Gr\u00e6cia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Gambardella","sequence":"additional","affiliation":[{"name":"Institute of Neurology, Magna Gr\u00e6cia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1001\/jamaneurol.2018.2295","article-title":"Definition and Consensus Diagnostic Criteria for Neurosarcoidosis: From the Neurosarcoidosis Consortium Consensus Group","volume":"75","author":"Stern","year":"2018","journal-title":"JAMA Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"98","DOI":"10.4103\/2278-330X.110509","article-title":"A systematic approach to diagnosis of cystic brain lesions","volume":"2","author":"Sharma","year":"2013","journal-title":"South Asian J. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.clineuro.2012.03.042","article-title":"FDG PET findings leading to diagnosis of neurosarcoidosis","volume":"115","author":"Bartels","year":"2013","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1212\/WNL.0b013e3182684672","article-title":"MRI and PET imaging discordance in neurosarcoidosis","volume":"79","author":"Huang","year":"2012","journal-title":"Neurology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e506","DOI":"10.1212\/NXI.0000000000000506","article-title":"FDG-PET abnormalities leading to the diagnosis of an unusual case of probable neurosarcoidosis","volume":"5","author":"Wang","year":"2018","journal-title":"Neurol. Neuroimmunol. Neuroinflamm."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e110","DOI":"10.1097\/RLU.0b013e3182817ad8","article-title":"Neurocysticercosis on 18F-FDG PET\/MRI: co-registered Images","volume":"39","author":"Jolepalem","year":"2014","journal-title":"Clin. Nucl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/(SICI)1099-1492(199905)12:3<139::AID-NBM550>3.0.CO;2-H","article-title":"Inflammatory granulomas: evaluation with proton MRS","volume":"12","author":"Jayasundar","year":"1999","journal-title":"NMR Biomed."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1097\/RLU.0000000000001797","article-title":"Ictal 18F-FDG PET\/MRI in a Patient with Cortical Heterotopia and Focal Epilepsy","volume":"42","author":"Calabria","year":"2017","journal-title":"Clin Nucl Med."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/9\/10\/243\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:22:38Z","timestamp":1760188958000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/9\/10\/243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,21]]},"references-count":8,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,10]]}},"alternative-id":["brainsci9100243"],"URL":"https:\/\/doi.org\/10.3390\/brainsci9100243","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,21]]}}}