Solitary cerebral parenchymal cysticercosis: a prospective comparative study with computed tomography and magnetic...

To present a prospective series of 86 patients with solitary cerebral cysticerci who underwent both contrast computed tomography (CT) and contrast magnetic resonance imaging (MRI), and to correlate and compare the imaging findings using these two modalities.

Lesion characteristics, staging of the cyst and perilesional hypodensity on CT and hyperintensity on MRI were analyzed, and the lesion was described with regard to the appearance of the scolex, cyst fluid, cyst wall and the perilesional area.

Patients were largely children and adolescents (mean age 17.4 years, range 6-52) with 52.3% males. MRI was performed, on average, 10.7 days after CT. MRI was more sensitive than plain CT scan in detecting cysticercal lesions (P = 0.003), but there was no statistically significant difference between contrast CT and MRI. None of the patients were detected with an alternative disease on serial MRI. No cyst showed significant mass effect. Non-contrast CT was less sensitive than either contrast CT or MRI in detecting the scolex (P = 0.011), but no difference was seen between the latter two modalities. Qualitative imaging characteristics of the cysticercus on MRI and CT scan are described. All cysts were round in shape, with an average diameter of <10 mm, and maximum diameter of 19 mm.

In the present prospective series, contrast CT was nearly as sensitive as MRI in detecting solitary cerebral cysticerci. Thus, in highly resource-limited settings contrast CT may be sufficient for the diagnosis and management of neurocysticercosis.