Abstract
Introduction
Cerebral punctate and curvilinear gadolinium enhancements (PCGE) correspond to opacification of small vessel lumen or its perivascular areas in case of blood-brain barrier (BBB) disruption. We will discuss the possible causes of intra-parenchymal central nervous system PCGE.
Methods
Our review is based on French database including patients presenting with central nervous system PCGE and literature search using PubMed database with the following keywords: punctate enhancement, linear enhancement, and curvilinear enhancement. Disorders which displayed linear leptomeningeal or periventricular enhancements without intra-parenchymal PCGE are excluded of this review.
Results
Among our 39 patients with PCGE, 16 different diagnoses were established. After combining our PCGE causes with those described in the literature, we propose a practical approach. Besides physiologic post-contrast enhancement of small vessels, three pathologic conditions may exhibit PCGE: (1) small collateral artery network seen in Moyamoya syndrome, (2) small veins congestions related to developmental or acquired venous outflow disturbance, and (3) disorders causing small vessels BBB disruption indicated by T2 and FLAIR hyperintensities in the corresponding areas of PCGE. Disruption of the BBB could be caused by a direct injury of the endothelial cell, as in posterior reversible encephalopathy syndrome, Susac syndrome, and radiochemotherapy-induced injuries, or by an angiocentric cellular infiltrate, as in inflammatory disorders, demyelinating diseases, host immune responses fighting against infections, prelymphoma states, lymphoma, and in CLIPPERS.
Conclusion
PCGE may conceal several causes, including physiological and pathological conditions. Nevertheless, a practical approach could improve its management and limit the indications of brain biopsy to very specific situations.
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Abbreviations
- DWI:
-
Diffusion-weighted images with increased
- ADC:
-
Apparent diffusion coefficient
- BBB:
-
Blood-brain barrier
- MRI:
-
Magnetic resonance imaging
- PCGE:
-
Punctate and curvilinear gadolinium enhancements
- SWI:
-
Susceptibility-weighted imaging
- T1WI:
-
T1-weighted images
- T2WI:
-
T2-weighted images
- PRES:
-
Posterior reversible encephalopathy syndrome
- SLE:
-
Systemic lupus erythematosus
- LCH:
-
Langerhans cell histiocytosis
- NLCH:
-
Non-Langerhans cell histiocytosis
- PCACNS:
-
Primary arteritis of the CNS
- ADEM:
-
Acute demyelinating encephalomyelitis\
- MS:
-
Multiple sclerosis
- NMOSD:
-
Neuromyelitis optica spectrum disorders
- IRIS:
-
Immune reconstitution inflammatory syndrome
- PML:
-
Progressive multifocal leukoencephalopathy
- PCNSL:
-
Primary CNS lymphoma
- LYG:
-
Lymphomatoid granulomatosis
- IVL:
-
Intravascular lymphoma
- CLIPPERS:
-
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids
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Acknowledgments
We want to especially thank Mr Benjamin Taieb for his help in figure design.
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We declare that this manuscript does not contain clinical studies. Anonymized data with a number were used to develop a practical approach.
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We declare that we have no conflict of interest.
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Taieb, G., Duran-Peña, A., de Chamfleur, N.M. et al. Punctate and curvilinear gadolinium enhancing lesions in the brain: a practical approach. Neuroradiology 58, 221–235 (2016). https://doi.org/10.1007/s00234-015-1629-y
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DOI: https://doi.org/10.1007/s00234-015-1629-y