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MR of cerebral aspergillosis in patients who have had bone marrow transplantation
Y Miaux1, P Ribaud, M Williams
1Department of Radiology, Höpital Saint-Louis, Paris, France.
Purpose:
To assess the CT and MR appearance of cerebral aspergillosis in patients who have undergone bone marrow transplantation.
Methods:
The imaging and clinical data of five patients with cerebral aspergillosis were reviewed retrospectively and compared with autopsy findings.
Results:
Lesions are often located in the basal ganglia and demonstrate an intermediate signal intensity within surrounding high-signal areas on long-repetition-time MR scans. The lesions were multiple in four of the five patients and more numerous on MR images than on CT scans. The lesions (which demonstrate no parenchymal enhancement) are consistent with acute infarcts as confirmed at autopsy. In the large lesions, there is early intravascular and meningeal enhancement, as expected in acute infarcts involving an appreciable portion of the territory of a cerebral artery.
Conclusion:
The diagnosis of early cerebral infarction in a patient considered at risk for invasive aspergillosis, even without overt pulmonary disease, is an indication to institute aggressive antifungal therapy.
Insights
Cerebral aspergillosis in bone marrow transplant patients can mimic stroke on CT and MR imaging. Early diagnosis of cerebral infarction is crucial for initiating antifungal therapy.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Bone marrow transplantation (BMT) recipients are immunocompromised, increasing susceptibility to opportunistic infections.
- Cerebral aspergillosis is a rare but serious complication in BMT patients, often presenting with non-specific neurological symptoms.
Purpose of the Study:
- To evaluate the characteristic findings of cerebral aspergillosis on computed tomography (CT) and magnetic resonance (MR) imaging.
- To correlate imaging findings with autopsy results in a cohort of BMT patients.
Main Methods:
- Retrospective review of imaging (CT and MR) and clinical data from five BMT patients diagnosed with cerebral aspergillosis.
- Comparison of imaging findings with histopathological autopsy results.
Main Results:
- Lesions typically occurred in the basal ganglia, showing intermediate signal intensity on T2-weighted MR images.
- Multiple lesions were common (4/5 patients), and MR identified more lesions than CT.
- Imaging findings were consistent with acute infarcts, with no parenchymal enhancement in smaller lesions.
- Larger lesions showed early intravascular and meningeal enhancement, typical of cerebral artery territory infarcts.
Conclusions:
- Cerebral aspergillosis can present as infarct-like lesions on neuroimaging.
- Suspected early cerebral infarction in at-risk BMT patients warrants prompt antifungal treatment, even without pulmonary symptoms.