Nodular sarcoidosis of the liver and spleen: Appearance on MR images

Abstract

Small nodular lesions in the liver and spleen have been reported as an infrequent manifestation of sarcoidosis. Five patients with this appearance on either dynamic contrast material-enhanced computed tomographic (CT) or ultrasound scans underwent magnetic resonance (MR) imaging with and without dynamic gadolinium enhancement. The lesions were relatively uniform in size, ranging from 0.5 to 1.5 cm. On CT scans, they were hypoattenuating relative to surrounding parenchyma. On MR images, the lesions were hypointense relative to background parenchyma with all sequences. No substantial enhancement was observed in the lesions, although lesion conspicuity decreased over time on serial postcontrast images. Lesion conspicuity was greatest on either T2-weighted fat-suppressed (T2FS) images or early-phase dynamic contrast-enhanced images. Abdominal adenopathy was seen in three of the five patients and was hyperintense relative to liver on T2FS images in two and intermediate in intensity in one patient.

Abdominal sarcoidosis: cross-sectional imaging findings

“…They enhance less than the background liver on gadolinium-enhanced T1-weighted images ( Fig. 5b) (22). Contour irregularity of the liver and high periportal signal intensity are the other reported MRI findings of hepatic sarcoidosis (19).…”

“…5a) (22). This finding helps excluding metastases and inflammatory diseases which are usually hyperintense on T2-weighted fat-saturated images.…”

“…6, 7a). They tend to be discrete, but may coalesce as they increase in size (22). Contour irregularity is another abnormal finding of splenic sarcoidosis (Fig.…”

Sarcoidosis in the aged: review and management

“…Liver biopsy revealed sarcoid granulomas [28]. Five sarcoidosis patients, 29-64 years in age, showed hypoattenuating small nodular hepatic and splenic lesions on abdominal CT and multiple small focal hypointense lesions on T1 and T2 weighted and gadolinium-enhanced images on magnetic reasonance [29]. Seventeen of 32 sarcoidosis patients, with intrathoracic lesions in 75%, ranged 25-68 years old, presented multiple low-attenuation discrete liver nodules.…”

Hepatosplenic Sarcoidosis: Contrast-Enhanced Ultrasound Findings and Implications for Clinical Practice

“…MRI can also serve as an adjunctive diagnostic tool to confirm the presence of both hepatic and splenic nodules that appear hypointense, relative to the adjacent parenchyma on all sequences, without substantial contrast enhancement after gadolinium administration, and appear less evident on delayed imaging, suggesting equilibration. The nodules are best visualized on T2-weighted fat-suppressed and early-phase dynamic contrast-enhanced images [42]. Furthermore, MRI can be useful to reveal nonspecific hepatic findings such as periportal hyperintensity on T2-weighted images; some authors have suggested that this sign could be associated with a greater tendency of granulomas to localize within periportal spaces [17, 22].…”