TY - JOUR
T1 - Brain miliary enhancement
AU - Bot, Joseph C J
AU - Mazzai, Linda
AU - Hagenbeek, Rogier E
AU - Ingala, Silvia
AU - van Oosten, Bob
AU - Sanchez-Aliaga, Esther
AU - Barkhof, Frederik
PY - 2020/3
Y1 - 2020/3
N2 - Purpose: Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted post-contrast 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 T1-weighted 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.
AB - Purpose: Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted post-contrast 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 T1-weighted 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.
KW - Biopsy
KW - Brain Diseases/diagnostic imaging
KW - Contrast Media
KW - Diagnosis, Differential
KW - Humans
KW - Magnetic Resonance Imaging/methods
UR - http://www.scopus.com/inward/record.url?scp=85077721910&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00234-019-02335-5
DO - https://doi.org/10.1007/s00234-019-02335-5
M3 - Review article
C2 - 31925469
SN - 0028-3940
VL - 62
SP - 283
EP - 300
JO - Neuroradiology
JF - Neuroradiology
IS - 3
ER -