Wegener granulomatosis: MR imaging findings in brain and meninges

PURPOSE: To determine the spectrum of intracranial magnetic resonance (MR) imaging appearances of Wegener granulomatosis. MATERIALS AND METHODS: MR imaging studies in 19 patients with Wegener granu lomatosis and possible central nervous system involvement were reviewed by two neuroradiologists. Intermediate-weighted and T2-weighted fast spin-echo MR images of the brain had been acquired in all patients, and spin-echo T1 -weighted nonenhanced and gadolinium-enhanced images had been acquired in 1 8 patients. RESULTS: MR imaging findings included diffuse linear dural thickening and e nhancement (n = 6); focal dural thickening and enhancement contiguous with orbital, nasal, or paranasal disease (n = 5); infarcts (n = 4); nonspecific white matter areas of high signal intensity on intermediate-weighted and T 2-weighted images (n = 10); enlarged pituitary gland with infundibular thic kening and enhancement (n = 2); a discrete cerebellar lesion that was proba bly granulomatous in origin (n = 1); and cerebral (n = 8) and cerebellar at rophy (n = 2). CONCLUSION: MR imaging demonstrated the wide spectrum of findings of centra l nervous system involvement in patients with Wegener granulomatosis, and w as particularly useful for the evaluation of direct intracranial spread fro m orbital, nasal, or paranasal disease.