Brain miliary enhancement

Abstract

Purpose Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted postcontrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes. Methods An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement. Results Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses. Conclusion A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.

Magnetic resonance imaging in the diagnosis of non-tumorous multifocal brain lesions mimicking multiple sclerosis

“…Хронические очаги, в свою очередь, могут иметь пониженный МР-сигнал в режиме Т1-ВИ и пониженный с ободком повышенного в режиме Т2-FLAIR, что отражает их кистозную перестройку. При синдроме Сусака в литературе описаны случаи феномена лептоменингеального контрастирования, наличие которого также обсуждается при прогрессирующих формах РС [23][24][25].…”

White Matter Lesions in Adults – a Differential Diagnostic Approach

“…Vascular-associated diseases as well as inflammatory and neoplastic processes may exhibit an angiocentric lesion pattern on T2 WI due to the anatomically predetermined propagation along the PVS, which is illustrated by taking into account the T1 WI after contrast application (pc T1 WI) [39,[66][67][68][69]. In addition to sarcoidosis (see ▶ Fig.…”

Miliary breast cancer brain metastasis: a rare and aggressive form of central nervous system metastasis

“…4 Even when miliary brain lesions are detected by MRI, the appropriate treatment can be delayed, as miliary brain lesions represent a broad differential diagnosis, including infectious, inflammatory and nutritional aetiologies. 13 Much of the current understanding of MiM is based on postmortem pathological examination. Ogawa et al 3 found that MiM is localised within the perivascular (Virchow-Robin) space with extension into the subpial space without invasion of the brain parenchyma, consistent with prior reports.…”

“… 4 Even when miliary brain lesions are detected by MRI, the appropriate treatment can be delayed, as miliary brain lesions represent a broad differential diagnosis, including infectious, inflammatory and nutritional aetiologies. 13 …”