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CT and MRI Findings in Cerebral Aspergilloma
Friederike Gärtner1, Julia Forstenpointner2, Birgit Ertl-Wagner3
1Department of Radiology and Neuroradiology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany.
Purpose:
Invasive aspergillosis usually affects immunocompromised patients. It carries a high risk of morbidity and mortality and usually has a nonspecific clinical presentation. Early diagnosis is essential in order to start effective treatment and improve clinical outcome.
Materials And Methods:
In a retrospective search of the PACS databases from two medical centers, we identified 9 patients with histologically proven cerebral aspergilloma. We systematically analyzed CT and MRI imaging findings to identify typical imaging appearances of cerebral aspergilloma.
Results:
CT did not show a typical appearance of the aspergillomas. In 100 % (9/9) there was a rim-attenuated diffusion restriction on MRI imaging. Multiple hypointense layers in the aspergillus wall, especially on the internal side, were detected in 100 % on T2-weighted imaging (9/9). Aspergillomas were T1-hypointense in 66 % of cases (6/9) and partly T1-hyperintense in 33 % (3/9). In 78 % (7/9) of cases, a rim-attenuated diffusion restriction was detected after contrast agent application.
Conclusion:
Nine cases were identified. Whereas CT features were less typical, we observed the following imaging features on MRI: A strong, rim-attenuated diffusion restriction (9/9); onion layer-like hypointense zones, in particular in the innermost part of the abscess wall on T2-weighted images (9/9). Enhancement of the lesion border was present in the majority of the cases (7/9).
Key Points:
· There are typical MRI imaging features of aspergillomas.. · However, these findings could be affected by the immune status of the patient.. · Swift identification of aspergilloma imaging patterns is essential to allow for adequate therapeutic decision making..
Citation Format:
· Gärtner F, Forstenpointner J, Ertl-Wagner B et al. CT and MRI Findings in Cerebral Aspergilloma. Fortschr Röntgenstr 2018; 190: 967 - 970.
Insights
Typical MRI findings can aid in diagnosing cerebral aspergilloma, a serious fungal infection. Early identification of these imaging patterns is crucial for timely treatment and improved patient outcomes.
Area of Science:
- Radiology
- Infectious Diseases
- Neuroimaging
Background:
- Invasive aspergillosis is a severe infection primarily affecting immunocompromised individuals.
- It presents with nonspecific clinical signs, making early diagnosis challenging.
- Prompt treatment is vital for improving outcomes in patients with aspergillosis.
Purpose of the Study:
- To identify characteristic imaging features of cerebral aspergilloma using CT and MRI.
- To evaluate the diagnostic utility of different imaging modalities for cerebral aspergilloma.
Main Methods:
- A retrospective analysis of CT and MRI scans from nine patients with confirmed cerebral aspergilloma.
- Systematic evaluation of imaging findings to determine typical appearances.
Main Results:
- CT scans lacked specific features for aspergilloma diagnosis.
- MRI revealed consistent findings: rim-attenuated diffusion restriction (100%), onion-layer-like hypointense zones on T2-weighted images (100%), and lesion border enhancement (78%).
- T1-weighted images showed variable signal intensity.
Conclusions:
- MRI demonstrates distinct imaging patterns suggestive of cerebral aspergilloma.
- These MRI findings are essential for guiding therapeutic decisions.
- Awareness of these patterns can improve the early diagnosis of cerebral aspergilloma.
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