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Published on: October 20, 2017
MRI of intraventricular cysticercosis: surgical implications
C S Zee1, H D Segall, S Destian
1LAC/USC Imaging Science Center 90033.
Objective:
Our goal was to evaluate the role of Gd-enhanced MR in the diagnosis and surgical planning of intraventricular cysticercosis cysts.
Materials And Methods:
Thirty-three patients with intraventricular cysticercosis were evaluated with Gd-enhanced MRI including follow-up studies ranging over time periods from 6 months to 8 years. The patient age ranged from 17 to 65 years. All had lived in Mexico or Central America.
Results:
Twenty patients had surgical removal of the cysts. The majority of patients (18 of 20) who had surgical removal of the cyst showed improvement with resolution of hydrocephalus. Two of 20 patients required additional shunting to alleviate hydrocephalus. In these two patients, Gd-enhanced MR showed cyst wall enhancement. Ependymitis with adhesion was found at surgery in these two patients. Nine patients had shunt placement; one of nine patients showed cyst enlargement 2.5 years later that required surgical removal. Of the remaining eight patients, four showed irregular, thick, ring-like enhancement mimicking a neoplasm on follow-up imaging studies. Four patients with cysts in the lateral ventricle did not require treatment. Two of the four patients showed irregular, thick, ring-like enhancement on follow-up imaging studies.
Conclusion:
Gadolinium-enhanced MR is more sensitive than contrast-enhanced CT for detecting ependymitis, which is essential in deciding whether surgical removal of the cyst or shunt placement is indicated. A degenerating intraventricular cysticercosis cyst may present as an irregular, thick, ring-like enhancing lesion or a nodular enhancing lesion with varying degrees of surrounding edema, mimicking a neoplasm.
Insights
Gadolinium-enhanced MRI aids in diagnosing and planning surgery for intraventricular cysticercosis. It is more sensitive than CT for detecting ependymitis, guiding treatment decisions for these brain cysts.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Intraventricular cysticercosis is a parasitic infection affecting the brain's ventricles.
- Accurate diagnosis and surgical planning are crucial for managing hydrocephalus and other complications.
Purpose of the Study:
- To evaluate the role of Gadolinium-enhanced Magnetic Resonance (Gd-enhanced MR) in diagnosing and planning surgical interventions for intraventricular cysticercosis.
Main Methods:
- A study involving 33 patients diagnosed with intraventricular cysticercosis.
- Gd-enhanced MR imaging was utilized, with follow-up studies conducted over 6 months to 8 years.
- Patient demographics and geographical origins (Mexico, Central America) were noted.
Main Results:
- Surgical removal of cysts led to improvement in hydrocephalus for most patients (18/20).
- Gd-enhanced MR identified ependymitis in two patients requiring additional shunting, correlating with surgical findings.
- Follow-up imaging revealed ring-like enhancement in some degenerating cysts, mimicking neoplasms.
Conclusions:
- Gd-enhanced MR surpasses contrast-enhanced CT in detecting ependymitis, crucial for surgical vs. shunt decisions.
- Degenerating intraventricular cysticercosis can present with complex imaging features, including ring-like enhancement, potentially mimicking tumors.
