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Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 cases
R D Tien1, P K Chu, J R Hesselink
1Department of Radiology, UCSD Medical Center 92103.
Insights
Magnetic Resonance Imaging (MRI) is superior to Computed Tomography (CT) for diagnosing intracranial cryptococcal infections in immunocompromised patients. MRI revealed abnormalities in all patients, unlike CT scans, highlighting its diagnostic value.
Area of Science:
- Neuroimaging
- Infectious Diseases
- Immunocompromised Hosts
Background:
- Intracranial cryptococcal infection is a serious opportunistic infection, particularly in individuals with compromised immune systems.
- Accurate and timely diagnosis is crucial for effective management and improved patient outcomes.
- Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are key neuroimaging modalities used in evaluating such infections.
Purpose of the Study:
- To retrospectively compare the diagnostic utility of CT and MRI in immunocompromised patients with documented intracranial cryptococcal infection.
- To identify characteristic imaging patterns of cryptococcal infection on both CT and MRI.
- To evaluate the role of contrast enhancement in lesion detection and characterization.
Main Methods:
- Retrospective review of CT and MRI scans from 29 immunocompromised patients with confirmed intracranial cryptococcal infection.
- Analysis of CT findings, including contrast enhancement patterns.
- Detailed assessment of MRI findings, categorizing observed patterns such as cryptococcoma, dilated Virchow-Robin spaces, and nodular lesions.
Main Results:
- CT scans showed normal results in some patients, while others presented with atrophy or non-enhancing/enhancing lesions.
- All 10 patients who underwent both CT and MRI had abnormal MRI findings, whereas CT was normal in five of these.
- MRI identified four distinct patterns: parenchymal cryptococcoma, dilated Virchow-Robin spaces, miliary nodules, and mixed patterns, with postmortem correlation confirming dilated Virchow-Robin spaces filled with fungi.
Conclusions:
- MRI demonstrates superior sensitivity compared to CT in detecting intracranial abnormalities associated with cryptococcal infection in immunocompromised individuals.
- Specific MRI patterns, including dilated Virchow-Robin spaces, are characteristic findings that can aid in diagnosis.
- MRI is an invaluable tool for the comprehensive evaluation and characterization of intracranial cryptococcosis.
Abstract:
CT and MR scans of 29 immunocompromised patients (28 with AIDS or ARC, one with diabetes mellitus) who had documented intracranial cryptococcal infection were reviewed retrospectively. All patients had CT studies; 26 received iodinated contrast agent. CT findings included normal results in nine of 29, atrophy only in 13 of 29, nonenhancing lesions in three of 29, enhancing lesions in two of 20, and foci of leptomeningeal calcification in two of 29. Ten patients had both CT and MR studies, and four received gadopentetate dimeglumine. Among these 10 patients, five had normal CT studies and one showed moderate central atrophy. All 10, however, had abnormal MR findings. We observed four patterns: (1) parenchymal cryptococcoma (3/10); (2) numerous clustered tiny foci that were hyperintense on T2-weighted images and non-enhancing on postcontrast T1-weighted images, located relatively symmetrically in the basal ganglia bilaterally and in midbrain, representing dilated Virchow-Robin spaces (4/10); (3) multiple miliary enhancing parenchymal and leptomeningeal nodules (1/10); and (4) a mixed pattern, consisting of dilated Virchow-Robin spaces with mixed lesions such as cryptococcoma and miliary nodules (2/10). In the group of six patients with dilated Virchow-Robin spaces (patterns 2 and 4), two received gadopentetate dimeglumine, but the Virchow-Robin space lesions did not enhance; among the remaining four patients, two received gadopentetate dimeglumine (one with pattern 1 and one with pattern 3) and the lesions did enhance. Three patients in our study subsequently died and autopsies were performed. The postmortem results revealed dilated Virchow-Robin spaces filled with fungi in the basal ganglia, which correlated well with MR findings.(ABSTRACT TRUNCATED AT 250 WORDS)
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