Table 1 Diagnostic results of three patients
From: Reevaluating the relevance of 18F-FDG PET findings for diagnosis of neurosarcoidosis: a case series
Characteristics | Patient 1 | Patient 2 | Patient 3 |
|---|---|---|---|
Sex | Female | Female | Male |
Concomitant diseases | Hypothyreosis, hypertension | Depression | Known systemic sarcoidosis |
Neurological symptoms | Visual impairment, headache | Sensory spinal cord syndrom | Spastic atactic gait disorder Bladder dysfunction |
Magnetic resonance imaging (MRI) | Unsuspicious, no enhancement | Unsuspicious, no enhancement | Unsuspicious, no enhancement |
Positron emission tomography (18F-FDG PET) | Spinal cord hypermetabolism (cervical/thoracical) bihilar lymphadenopathy | Spinal cord hypermetabolism (cercival) | Cerebral hypermetabolism (precuneus) |
Histopathology | LN epitheloid granuloma | LN epitheloid granuloma | LN epitheloid granuloma (diagnosed before) |
Extraneuronal manifestations | Bihilar lymphadenopathy | Bihilar lymphadenopathy | Pulmonary, renal and osseus |
Electrophysiology (electromyography/-neurography, evoked potentials) | Visual evoked potential: prolonged latency | Not obtained | Somatosensory evoked potential: prolonged latency |
Blood | sIL2R normal autoimmune and infectious test parameters negative | sIL2R elevation, autoimmune and infectious test parameters negative | sIL2R elevation autoimmune and infectious test parameters negative |
Cerebral spinal fluid | Pleocytosis, protein elevation, NFL elevation sIL2R normal, no Ig sysnthesis, CD4/CD8 elevated | Pleocytosis, protein elevation, sIL2R elevation, CD4/CD8 normal, no IG synthesis | Pleocytosis, protein elevation, sIL2R elevation, NFL elevation, no Ig synthesis, CD4/CD8 normal |
Benefits from 18F-FDG PET | Identification of biopsy target leading to diagnosis Initiation of immunodsuppressive treatment targeting at neurosarcoidosis | Initiation of immunosuppressive treatment targeting at neurosarcoidosis | Escalation of immunosuppressive treatment regime targeting at neurosarcoidosis |
Treatment; follow up duration | Steroid pulse, methotrexate and prednisolone; 2,5 years | Steroid pulse, methotrexate and prednisolone; 2 years | Steroid pulse, mycophenolate-mofetil and prednisolone; 2 years |