Analysis of the utility of diffusion-weighted MRI and apparent diffusion coefficient values in distinguishing central nervous system toxoplasmosis from lymphoma

Schroeder, Paul C.; Post, M. Judith Donovan; Oschatz, Elisabeth; Stadler, Alfred; Bruce-Gregorios, Jocelyn; Thurnher, Majda M.

doi:10.1007/s00234-006-0123-y

Cited by 90 publications

(60 citation statements)

References 12 publications

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“…These studies identified a variety of brain regions by MRI, including the frontal and parietal lobes amongst other areas of the cerebral cortex, the basal ganglia and the cerebellum (Brightbill et al, 1996;Maeda et al, 2006;Schroeder et al, 2006;Suzuki et al, 2010). In a single study focusing on psychiatric patients, 14 of whom had a diagnosis of schizophrenia, an attempt to amplify parasite DNA using nested PCR from post-mortem tissue from the orbital frontal cortex was unable to detect T. gondii DNA (Conejero-Goldberg et al, 2003).…”

Section: Localization Of T Gondii In the Cnsmentioning

confidence: 99%

Toxoplasma gondii infection and behaviour – location, location, location?

McConkey

Martin

Bristow

et al. 2013

Journal of Experimental Biology

192

156

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SummaryParasite location has been proposed as an important factor in the behavioural changes observed in rodents infected with the protozoan Toxoplasma gondii. During the chronic stages of infection, encysted parasites are found in the brain but it remains unclear whether the parasite has tropism for specific brain regions. Parasite tissue cysts are found in all brain areas with some, but not all, prior studies reporting higher numbers located in the amygdala and frontal cortex. A stochastic process of parasite location does not, however, seem to explain the distinct and often subtle changes observed in rodent behaviour. One factor that could contribute to the specific changes is increased dopamine production by T. gondii. Recently, it was found that cells encysted with parasites in the brains of experimentally infected rodents have high levels of dopamine and that the parasite encodes a tyrosine hydroxylase, the rate-limiting enzyme in the synthesis of this neurotransmitter. A mechanism is proposed that could explain the behaviour changes due to parasite regulation of dopamine. This could have important implications for T. gondii infections in humans.

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Section: Localization Of T Gondii In the Cnsmentioning

confidence: 99%

Toxoplasma gondii infection and behaviour – location, location, location?

McConkey

Martin

Bristow

et al. 2013

Journal of Experimental Biology

192

156

View full text Add to dashboard Cite

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“…44 Because CNS lymphomas are highly cellular tumors, water diffusion is often restricted, making them appear hyperintense on DWI and hypointense on ADC maps (Figs 4 and 6). 16,40,44,45 This characteristic is shared by acute ischemic stroke, the central necrosis of brain abscesses, the solid portion of high-grade gliomas, and some metastases. 45 However, PCNSL lesions often have more restricted diffusion and lower ADC values than high-grade gliomas and metastases.…”

mentioning

confidence: 99%

“…16,40,44,45 This characteristic is shared by acute ischemic stroke, the central necrosis of brain abscesses, the solid portion of high-grade gliomas, and some metastases. 45 However, PCNSL lesions often have more restricted diffusion and lower ADC values than high-grade gliomas and metastases. 40,46,47 A recent study showed that pretherapeutic ADC tumor measurements within contrast-enhancing regions were predictive of clinical outcome in patients with PCNSL.…”

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confidence: 99%

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Central Nervous System Lymphoma: Characteristic Findings on Traditional and Advanced Imaging

Haldorsen¹,

Espeland²,

Larsson³

2010

AJNR Am J Neuroradiol

390

346

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SUMMARY: CNS lymphoma consists of 2 major subtypes: secondary CNS involvement by systemic lymphoma and PCNSL. Contrast-enhanced MR imaging is the method of choice for detecting CNS lymphoma. In leptomeningeal CNS lymphoma, representing two-thirds of secondary CNS lymphomas, imaging typically shows leptomeningeal, subependymal, dural, or cranial nerve enhancement. Single or multiple periventricular and/or superficial contrast-enhancing lesions are characteristic of parenchymal CNS lymphoma, representing one-third of secondary CNS lymphomas and almost 100% of PCNSLs. New CT and MR imaging techniques and metabolic imaging have demonstrated characteristic findings in CNS lymphoma, aiding in its differentiation from other CNS lesions. Advanced imaging techniques may, in the future, substantially improve the diagnostic accuracy of imaging, ultimately facilitating a noninvasive method of diagnosis. Furthermore, these imaging techniques may play a pivotal role in planning targeted therapies, prognostication, and monitoring treatment response.ABBREVIATIONS: ADC ϭ apparent diffusion coefficient; CBV ϭ cerebral blood volume; CE ϭ contrast enhancement; Cho ϭ choline; CNS ϭ central nervous system; Cr ϭ creatine; DWI ϭ diffusion-weighted imaging; FA ϭ fractional anisotropy; FDG ϭ fluorodeoxyglucose; HAART ϭ highly active antiretroviral therapy; HIV ϭ human immunodeficiency virus; MRI ϭ MR imaging; MS ϭ multiple sclerosis; NHL ϭ non-Hodgkin lymphoma; PCNSL ϭ primary CNS lymphoma; PET ϭ positron-emission tomography; PML ϭ progressive multifocal leukoencephalopathy; rCBV ϭ relative cerebral blood volume; SPECT ϭ single-photon emission CT; SPET ϭ single photon-emission tomography; SWI ϭ susceptibility-weighted imaging L ymphoma of the CNS consists of 2 major subtypes: secondary CNS involvement by systemic lymphoma (the most common) and PCNSL, in which the lymphoma is restricted to the brain, leptomeninges, spinal cord, or eyes, without evidence of it outside the CNS at primary diagnosis.

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“…Cerebral toxoplasmosis and primary cerebral lymphoma are the common causes of ring enhancing lesions of central nervous system in patients with AIDS. However, it is often difficult to distinguish between these two conditions clinically and radiographically 5 .…”

Section: Case Reportmentioning

confidence: 99%

Multiple intracerebral lesions in a young male

2015

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Background: As the incidence of HIV infection has increased its neurological complications are being encountered in our clinical practice. Toxoplasmosis is a common cerebral opportunistic infection seen in HIV-infected patients, even though the incidence has declined with the use of antiretroviral therapy. Establishing a definitive diagnosis of cerebral toxoplasmosis is difficult in resource limited settings. Clinical case: A 20 year old gentleman was referred to our institute as a case of stroke. Magnetic resonance imaging (MRI) of his brain showed multiple ill-defined and nodular enhancing lesions in bilateral supratentorial and infratentorial neuroparenchyma. Test for HIV-1 was reactive. Toxoplasma serology revealed raised IgG antibody levels. Based on the MRI features and positive toxoplasma serology a diagnosis of cerebral toxoplasmosis was made. He was treated with trimethoprim/ sulfamethoxazole and pyrimethamine/ Sulfadoxine for 3 weeks. After 2 weeks of treatment, repeat MRI of brain was done which showed significant resolution of the lesions. Conclusion:We are presenting this case to highlight the fact that cerebral toxoplasmosis should be considered in the differential diagnosis of multiple neuroparenchymal lesions in young individuals who present with neurological deficits.

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Analysis of the utility of diffusion-weighted MRI and apparent diffusion coefficient values in distinguishing central nervous system toxoplasmosis from lymphoma

Cited by 90 publications

References 12 publications

Toxoplasma gondii infection and behaviour – location, location, location?

Toxoplasma gondii infection and behaviour – location, location, location?

Central Nervous System Lymphoma: Characteristic Findings on Traditional and Advanced Imaging

Multiple intracerebral lesions in a young male

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