Imaging Manifestations of Neurosarcoidosis

A practical radiology review of Imaging Manifestations of Neurosarcoidosis, focused on imaging findings, differential diagnosis, reporting points, and high-yield teaching pearls.

Core disease facts

• Systemic granulomatous disease → non-caseating granulomas
• CNS involvement in 5–25% (often presenting manifestation)
• Diagnosis often presumptive; biopsy not always feasible
• Imaging findings are protean → always in DDx with MS, TB, lymphoma

Brain parenchyma

• T2 hyperintense periventricular lesions → MS-mimic
• Enhancing mass-like lesions → can mimic tumor/lymphoma
• Often T2 dark mass lesions (helpful clue vs glioma/metastasis)
• No central necrosis usually
• Frequently coexists with leptomeningeal disease

Leptomeningeal disease (most classic)