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Imaging findings in intracranial aspergillosis
Kei Yamada1, David A Shrier, Ana Rubio
1Department of Diagnostic Radiology, University of Rochester Medical Center, NY, USA.
Insights
Computed tomographic (CT) and magnetic resonance (MR) imaging reveal multifocal brain lesions in intracranial aspergillosis. Hemorrhage is common, and contrast enhancement is stronger in immunocompetent patients.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Intracranial aspergillosis is a rare but serious fungal infection.
- Accurate diagnosis relies on characteristic imaging findings.
Purpose of the Study:
- To describe the computed tomographic (CT) and magnetic resonance (MR) imaging features of intracranial aspergillosis.
Main Methods:
- Retrospective analysis of cranial imaging in eight patients with confirmed central nervous system aspergillosis.
- Patients included both immunocompromised and immunocompetent individuals.
- CT and MR imaging findings were correlated with pathological examination.
Main Results:
- Multifocal lesions were observed in 75% of patients, predominantly in the cerebral hemispheres.
- Hemorrhage occurred in approximately 25% of lesions, correlating with larger lesion size (>15 mm).
- Contrast enhancement patterns differed between immunocompromised (vague, weak) and immunocompetent (solid, strong) patients, with enhancement seen in confirmed abscesses.
Conclusions:
- Multifocal lesions in the cerebral hemispheres with associated hemorrhage are typical imaging findings of intracranial aspergillosis.
- Contrast enhancement is a key differentiating feature, being more pronounced in immunocompetent hosts.
Rationale And Objectives:
The authors' purpose was to elucidate the various computed tomographic (CT) and magnetic resonance (MR) imaging findings in intracranial aspergillosis.
Materials And Methods:
Retrospective analysis of cranial imaging findings was performed in eight proved cases of central nervous system aspergillosis. The patients ranged in age from 17 to 75 years. Four patients were immunocompromised, and four were immunocompetent. CT was performed in all eight patients, and MR imaging in five.
Results:
Six patients (75%) had multiple lesions seen on the imaging studies, with a total of 27 focal brain lesions demonstrated. The lesions were most commonly seen in the cerebral hemispheres (n = 21), with lesser involvement of the basal ganglia (n = 2) and the posterior fossa (n = 4). Seven lesions were hemorrhagic on CT and/or MR images. There was a correlation between lesion size and hemorrhage, with hemorrhage more likely in larger lesions (>15 mm). At pathologic examination, foci of hemorrhage were noted within both infarcts and abscesses. Enhancement was noted in five lesions, four of which were confirmed abscesses. Contrast enhancement of the lesions was vague and week in immunocompromised patients but solid and strong in immunocompetent patients. There were 18 lesions without hemorrhage or enhancement; they were either infarcts or abscesses at pathologic examination. Some of these small nonhemorrhagic nonenhancing brain lesions in the subcortical white matter mimicked lacunar infarcts.
Conclusion:
Typical imaging findings of intracranial aspergillosis include multifocal lesions involving the cerebral hemispheres, with hemorrhage in approximately 25% of lesions. Lesional contrast enhancement tends to be stronger in immunocompetent hosts.