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Relevant imaging findings of cerebral aspergillosis on MRI: a retrospective case-based study in immunocompromised
1Diagnostic Imaging Center Dreilaendereck, Loerrach, Germany.
Abstract:
The aim of the study was to assess neuroimaging patterns of cerebral aspergillosis with magnetic resonance imaging (1.5 T). The clinical and imaging data of nine patients were reviewed. Patients were included in the study if the diagnosis of aspergillosis was confirmed by either biopsy, autopsy, aspergillus antigen determination and/or neuroradiological and clinical response to specific treatment. Four patients had single or multiple abscesses presenting as ring-enhancing lesions on T1-weighted images, hypointensity of the ring on T2-weighted MR images and low to high signal intensity on diffusion-weighted imaging. Four patients had single or multiple infarctions affecting all compartments of the brain with hyperintensities on T2-weighted images in three of four patients, irregular parenchymal contrast enhancement in all patients and hemorrhagic transformation of the infarcted parenchyma in one patient. Diffusion-weighted images were positive in all ischemic areas. One patient with paranasal sinusitis developed a mycotic aneurysm of the internal carotid artery. Cerebral aspergillosis presents three principal neuroimaging findings: areas consistent with infarction; ring lesions consistent with abscess formation following infarction; and dural or vascular infiltration originating from paranasal sinusitis or orbital infiltration. Recognition of these patterns in cerebral aspergillosis may lead to more timely and effective diagnosis and treatment.
Insights
Magnetic resonance imaging (MRI) reveals key patterns for diagnosing cerebral aspergillosis. Recognizing these neuroimaging findings aids in early detection and treatment of this fungal brain infection.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Cerebral aspergillosis is a serious fungal infection affecting the brain.
- Accurate and timely diagnosis is crucial for effective treatment and improved patient outcomes.
Purpose of the Study:
- To evaluate the neuroimaging characteristics of cerebral aspergillosis using 1.5 Tesla magnetic resonance imaging (MRI).
- To identify distinct MRI patterns associated with cerebral aspergillosis.
Main Methods:
- Retrospective review of clinical and imaging data from nine patients diagnosed with cerebral aspergillosis.
- Analysis of MRI findings including T1-weighted, T2-weighted, and diffusion-weighted imaging.
- Confirmation of diagnosis through biopsy, autopsy, antigen detection, or clinical response to treatment.
Main Results:
- Three principal neuroimaging patterns were identified: infarction, ring-enhancing lesions (abscesses), and dural/vascular infiltration.
- Abscesses appeared as ring-enhancing lesions with specific T1 and T2 signal characteristics.
- Infarction patterns showed T2 hyperintensities and contrast enhancement, with diffusion-weighted imaging positive in ischemic areas.
- One case presented with a mycotic aneurysm secondary to paranasal sinusitis.
Conclusions:
- Cerebral aspergillosis exhibits characteristic MRI patterns including infarction, abscess formation, and vascular involvement.
- Recognition of these neuroimaging findings can facilitate earlier diagnosis and prompt treatment.
- MRI is a valuable tool for assessing the extent and nature of cerebral aspergillosis.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...