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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Cerebral mucormycosis: neuroimaging findings and histopathological correlation
François Lersy1, Julie Royer-Leblond2, Benoit Lhermitte3
1Service d'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière 67200, Strasbourg, France.
Introduction:
Mucormycosis are infections caused by molds of the order Mucorales. These opportunistic infections are rare, difficult to diagnose, and have a poor prognosis. We aimed to describe common radiographic patterns that may help to diagnose cerebral mucormycosis and search for histopathological correlations with imaging data.
Methods:
We studied the radiological findings (CT and MRI) of 18 patients with cerebral mucormycosis and four patients' histopathological findings.
Results:
All patients were immunocompromised and/or diabetic. The type of lesions depended on the infection's dissemination pathway. Hematogenous dissemination lesions were most frequently abscesses (59 lesions), cortical, cortical-subcortical, or in the basal ganglia, with a halo aspect on DWI for lesions larger than 1.6 cm. Only seven lesions were enhanced after contrast injection, with different presentations depending on patients' immune status. Ischemia and hemorrhagic areas were also seen. Vascular lesions were represented by stenosis and thrombosis. Direct posterior extension lesions were bi-fronto basal hypodensities on CT and restricted diffusion without enhancement on MRI. A particular extension, perineural spread, was seen along the trigeminal nerve. Histopathological analysis found endovascular lesions with destruction of vessel walls by Mucorales, microbleeds around vessels, as well as acute and chronic inflammation.
Conclusions:
MRI is the critical exam for cerebral mucormycosis. Weak ring enhancement and reduced halo diffusion suggest the diagnosis of fungal infections. Involvement of the frontal lobes should raise suspicion of mucormycosis (along with aspergillosis). The perineural spread can be considered a more specific extension pathway of mucormycosis.
Insights
Cerebral mucormycosis, a rare fungal infection, presents distinct imaging patterns on MRI and CT. Radiographic findings like abscesses and perineural spread aid in diagnosing this opportunistic infection in immunocompromised patients.
Area of Science:
- Radiology
- Infectious Diseases
- Neurology
Background:
- Mucormycosis is a rare, opportunistic infection caused by Mucorales molds.
- It is challenging to diagnose and carries a poor prognosis.
- Cerebral involvement requires prompt identification and management.
Purpose of the Study:
- To describe common radiographic patterns of cerebral mucormycosis.
- To correlate imaging findings with histopathological data.
- To improve diagnostic accuracy of this severe fungal infection.
Main Methods:
- Retrospective review of CT and MRI findings in 18 patients with cerebral mucormycosis.
- Analysis of histopathological findings in four patients.
- Correlation of radiological features with disease presentation and immune status.
Main Results:
- Lesions varied based on dissemination pathway; abscesses were common (59/18 patients).
- Halo sign on DWI was noted for larger lesions (>1.6 cm).
- Weak contrast enhancement, vascular lesions (stenosis, thrombosis), and perineural spread were observed.
Conclusions:
- MRI is crucial for diagnosing cerebral mucormycosis.
- Specific imaging findings like weak ring enhancement and restricted diffusion suggest fungal infection.
- Frontal lobe involvement and perineural spread are key indicators.
