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Neuroradiology

, Volume 58, Issue 3, pp 221–235 | Cite as

Punctate and curvilinear gadolinium enhancing lesions in the brain: a practical approach

  • Guillaume TaiebEmail author
  • Alberto Duran-Peña
  • Nicolas Menjot de Chamfleur
  • Antoine Moulignier
  • Eric Thouvenot
  • Thibaut Allou
  • Arnaud Lacour
  • Khe Hoang-Xuan
  • Jean Pelletier
  • Pierre Labauge
Continuing Education

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.

Keywords

Punctate enhancement Curvilinear enhancement Linear enhancement Blood-brain barrier CLIPPERS 

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

Notes

Acknowledgments

We want to especially thank Mr Benjamin Taieb for his help in figure design.

Compliance with ethical standards

We declare that this manuscript does not contain clinical studies. Anonymized data with a number were used to develop a practical approach.

Conflict of interest

We declare that we have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Guillaume Taieb
    • 1
    Email author
  • Alberto Duran-Peña
    • 2
  • Nicolas Menjot de Chamfleur
    • 3
  • Antoine Moulignier
    • 4
  • Eric Thouvenot
    • 5
  • Thibaut Allou
    • 1
  • Arnaud Lacour
    • 6
  • Khe Hoang-Xuan
    • 2
  • Jean Pelletier
    • 7
  • Pierre Labauge
    • 1
  1. 1.Department of Neurology, CHU MontpellierHopital Guy de ChauliacMontpellier Cedex 5France
  2. 2.Department of Neurology, MazarinGoupe Hospitalier Pitié SalpêtrièreParisFrance
  3. 3.Department of Neuroradiology, CHU MontpellierHopital Guy de ChauliacMontpellierFrance
  4. 4.Department of NeurologyFondation RothschildParisFrance
  5. 5.Department of Neurology, CHU NîmesHôpital CaremeauNîmesFrance
  6. 6.Department of NeurologyCHU De LilleLilleFrance
  7. 7.APHM, Hôpital de la Timone, Pôle de Neurosciences CliniquesService de NeurologieMarseilleFrance

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