Relevant imaging findings of cerebral aspergillosis on MRI: a retrospective case‐based study in immunocompromised patients

Abstract

The aim of the study was to assess neuroimaging patterns of cerebral aspergillosis with magnetic resonance imaging (1.5 T). The clinical and imaging data of nine patients were reviewed. Patients were included in the study if the diagnosis of aspergillosis was confirmed by either biopsy, autopsy, aspergillus antigen determination and/or neuroradiological and clinical response to specific treatment. Four patients had single or multiple abscesses presenting as ring-enhancing lesions on T1-weighted images, hypointensity of the ring on T2-weighted MR images and low to high signal intensity on diffusion-weighted imaging. Four patients had single or multiple infarctions affecting all compartments of the brain with hyperintensities on T2-weighted images in three of four patients, irregular parenchymal contrast enhancement in all patients and hemorrhagic transformation of the infarcted parenchyma in one patient. Diffusion-weighted images were positive in all ischemic areas. One patient with paranasal sinusitis developed a mycotic aneurysm of the internal carotid artery. Cerebral aspergillosis presents three principal neuroimaging findings: areas consistent with infarction; ring lesions consistent with abscess formation following infarction; and dural or vascular infiltration originating from paranasal sinusitis or orbital infiltration. Recognition of these patterns in cerebral aspergillosis may lead to more timely and effective diagnosis and treatment.

Frontal intra-axial mass lesion in an adult

“…1,2 Consequently, early and accurate diagnosis of this infection, with initiation of antifungal agents prior to surgery, has become essential for the management of affected patients. Although evidence of co-existing extracranial infection may facilitate the diagnosis in many patients, 3 its presence is not the rule. The most common neuroimaging pattern in patients with cerebral aspergillosis includes ring enhancement on MRI, central hyperintensity with reduced apparent diffusion coefficient values consistent with restricted diffusion as described recently, and enhancing soft-tissue abnormalities of the adjacent paranasal sinuses or orbit.…”

“…The most common neuroimaging pattern in patients with cerebral aspergillosis includes ring enhancement on MRI, central hyperintensity with reduced apparent diffusion coefficient values consistent with restricted diffusion as described recently, and enhancing soft-tissue abnormalities of the adjacent paranasal sinuses or orbit. [3][4][5] However, the enhancement pattern may vary markedly depending on the immune status of the host and stage of the disease. 3 Apart from markedly restricted diffusion, the other characteristic imaging findings of invasive cerebral aspergillosis were absent in our patient.…”

“…[3][4][5] However, the enhancement pattern may vary markedly depending on the immune status of the host and stage of the disease. 3 Apart from markedly restricted diffusion, the other characteristic imaging findings of invasive cerebral aspergillosis were absent in our patient. Also, the involvement of the corpus callosum and fulminant intracranial mass effect, akin to that seen in a cerebral neoplasm, often including glioblastoma multiforme and lymphoma, discouraged us from considering the diagnosis of aspergillosis.…”

Granulomatous infectious disease in an immunosuppressed patient: A case report with radiological and pathological correlation

“…Intracranial infection can affect the brain parenchyma and/or meninges and such cerebral extension has a poor prognosis, with mortality rates of 85 to 100% [7]. The newer aggressive antifungal therapies are promising if treatment is initiated early.…”

Common Who, Which, Why, How, What and When Questions of Invasive Fungal Infections

“…Magnetic resonance imaging (MRI) has no additional benefit compared to CT scanning for early diagnosis of invasive pulmonary Aspergillosis, but is the preferred imaging modality to ascertain and illustrate osseous, paranasal sinus lesions, or central nervous system disease [6][7][8].…”