MRI features of pediatric cerebral paragonimiasis in the active stage

Abstract

We retrospectively reviewed the MR images of the brains of six children (age = 5–13 years) who had cerebral paragonimiasis in the early active stage. Diagnosis was based on a positive antibody test enzyme‐linked immunosorbent assay (ELISA) for paragonimiasis in serum. The most common finding (in five patients) was irregular hemorrhage of various degrees. Moreover, in three cases some multiple irregular lesions with surrounding edema appeared to be conglomerated and aggregated. The rare appearance (in one patient) was a “tunnel sign,” which showed the migrating track of the adult worm. In one patient with abscess and minimal hemorrhage, diffusion‐weighted imaging (DWI) showed a heterogeneous high signal of lesions. Other findings included slight (one patient) or marked (one patient) irregular contrast enhancement, and large edematous areas surrounding small centers of hemorrhage (two patients). MR findings of conglomerated lesions with hemorrhage or tunnel sign may help to establish the diagnosis of active‐stage cerebral paragonimiasis. J. Magn. Reson. Imaging 2006. © 2006 Wiley‐Liss, Inc.

Angiographic findings in 2 children with cerebral paragonimiasis with hemorrhage

“…However, hemorrhage has frequently been found in association with cerebral paragonimiasis in young patients. 3,11 When children with cerebral paragonimiasis present with intracranial hemorrhage, especially with subclinical pulmonary signs, diagnosis and treatment may be delayed. 3,4 In the patient in Case 1, the intracerebral hemorrhage was also the initial finding.…”

Paragonimiasis

“…Images obtained are generally sequential "slices" through the body, similar to those produced by CT methods, and descriptions of brain lesions seen using MRI are generally similar to those based on CT images. In the earliest stages of cerebral paragonimiasis, especially in children, hemorrhage might be present, seen as high signal intensity in T1-weighted images or as high or low intensity on T2-weighted images [ 269 ]. As granulomatous lesions form, these may be seen as "soap bubbles" or a "grape cluster" of ring-like structures with surrounding edema, each ring being up to 3 cm in diameter [ 270 ].…”

“…Following eventual calcifi cation, the lesions may resemble egg shells with central content of varying intensities [ 270 , 271 ]. A lesion thought to be the migration track of a worm has been reported [ 269 ]. MRI has also been used on a number of occasions to image lesions caused by spinal paragonimiasis [ 270 , 272 ].…”

Cerebral Infarction and Cranial Venous Sinus Thrombosis Caused by Paragonimiasis

“…The paragonimus-specific ELISA has demonstrated a high sensitivity (96%) and specificity (99%) to Paragonimus westermani [3]. Multiple, round, or oval-shaped calcifications on the computerized tomography CT scans were considered a defining characteristic of paragonimiasis infection, but cranial MRI is much more valuable for diagnosis [4][5][6][7][8][9]. MR images of cerebral paragonimiasis usually show conglomerates of multiple ring-shaped shadows or enhancements of socalled "grape cluster" or "soap bubble" forms in one hemisphere [6].…”

“…Multiple, round, or oval-shaped calcifications on the computerized tomography CT scans were considered a defining characteristic of paragonimiasis infection, but cranial MRI is much more valuable for diagnosis [4][5][6][7][8][9]. MR images of cerebral paragonimiasis usually show conglomerates of multiple ring-shaped shadows or enhancements of socalled "grape cluster" or "soap bubble" forms in one hemisphere [6]. T1-weighted images of cerebral paragonimiasis nodules show a peripheral low density and central hypo-and isointensity, while T2-weighted images show widespread inflammatory changes in the surrounding tissue [4], and ringlike enhancement on the enhanced scanning [8].…”