Imaging Features of Neurotoxoplasmosis: A Multiparametric Approach, with Emphasis on Susceptibility-weighted Imaging

Overview

Journal Eur J Radiol Open

Specialty Radiology

Date 2018 May 3

PMID 29719858

Citations 10

Authors

John C Benson

Gustavo Cervantes

Thomas R Baron

Andrew E Tyan

Siobhan Flanagan

Leandro T Lucato

Alexander M McKinney

Frederick Ott

Affiliations

Soon will be listed here.

Abstract

Background: Neurotoxoplasmosis is a common opportunistic infection in HIV/AIDS patients. Imaging identification of neurotoxoplasmosis assists in timely treatment.

Purpose: To delineate the frequency of imaging abnormalities in patients with neurotoxoplasmosis on different MR sequences with a particular focus on SWI, and NCCT.

Material And Methods: The PACS database was retroactively searched over a 5-year period for patients with neurotoxoplasmosis who underwent MRI with SWI. Included patients had imaging features of neurotoxoplasmosis based on consensus review by two neuroradiologists, a clinical diagnosis of neurotoxoplasmosis at the time of MRI, and diagnostic confirmation based on positive serum or CSF serology or histopathology; 15 patients were included. The number of abnormal foci with restricted diffusion, increased FLAIR signal, intrinsic T1 hyperintensity, abnormal enhancement (CE-T1WI), and intrinsic hyperdensity on CT were recorded.

Results: Intralesional susceptibility signal (ISS) foci on SWI were observed in 93.3% of patients with neurotoxoplasmosis (mean size 5.2 ± 3.8 mm). The average number of ISS foci was 3.9 per patient; 3/15 (20.0%) had a single ISS. Amongst other MR sequences, hyperintense FLAIR foci were the most common abnormalities observed (12.4 lesions/patient), followed by enhancing foci (8.2 lesions/patient), foci of restricted diffusion (7.1 lesions/patient), and intrinsic T1 hyperintense foci (3.4 lesions/patient). Abnormalities were least frequently observed on NCCT: abnormalities were identified in 5/15 (33.3%) patients, at a rate of 0.4 lesions/patient.

Conclusion: ISS foci are present in the vast majority of neurotoxoplasmosis patients, likely representing hemorrhage. The incidence and frequency of other abnormal foci are highest on FLAIR, and lowest on NCCT.

Citing Articles

Post-infectious central nervous system vasculitides in adults: an underdiagnosed and treatable disease : Part I. Overview.

Zedde M, Quatrale R, Andreone V, Pezzella F, Micieli G, Cortelli P Neurol Sci. 2024; 46(2):633-650.

PMID: 39663273 DOI: 10.1007/s10072-024-07935-5.

MRI differentiation of CNS fungal infections: correlating imaging features with microbiological and histopathological findings.

Khandwala K, Farooqi J, Ali R, Bakhshi S, Anwar S Neuroradiology. 2024; 67(1):25-36.

PMID: 39585369 DOI: 10.1007/s00234-024-03510-z.

Toxoplasmosis Infection in an HIV-Negative Patient Presenting with Clinical and MRI Findings Similar to those of Multiple Sclerosis.

Nurgaliyeva B, Nyssanbayeva K, Choudhary M Eur J Case Rep Intern Med. 2024; 11(11):004938.

PMID: 39525448 PMC: 11542945. DOI: 10.12890/2024_004938.

Primary central nervous system lymphoma: Imaging features and differential diagnosis.

Ribas G, De Mori L, Freddi T, Oliveira L, Souza S, Correa D Neuroradiol J. 2024; 37(6):705-722.

PMID: 38703015 PMC: 11531061. DOI: 10.1177/19714009241252625.

Tumor-like Lesions in Primary Angiitis of the Central Nervous System: The Role of Magnetic Resonance Imaging in Differential Diagnosis.

Zedde M, Napoli M, Moratti C, Pavone C, Bonacini L, Cecco G Diagnostics (Basel). 2024; 14(6).

PMID: 38535038 PMC: 10969781. DOI: 10.3390/diagnostics14060618.

References

Chaudhari A, Singh A, Jindal S, POON T . Haemorrhage in cerebral toxoplasmosis. A report on a patient with the acquired immunodeficiency syndrome. S Afr Med J. 1989; 76(6):272-4. View

Navia B, Petito C, Gold J, Cho E, Jordan B, Price R . Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: clinical and neuropathological findings in 27 patients. Ann Neurol. 1986; 19(3):224-38. DOI: 10.1002/ana.410190303. View

Ding Y, Xing Z, Liu B, Lin X, Cao D . Differentiation of primary central nervous system lymphoma from high-grade glioma and brain metastases using susceptibility-weighted imaging. Brain Behav. 2014; 4(6):841-9. PMC: 4212111. DOI: 10.1002/brb3.288. View

Rosenblum M, Levy R, Bredesen D . Neurosurgical implications of the acquired immunodeficiency syndrome (AIDS). Clin Neurosurg. 1988; 34:419-45. View

Davaro R, Thirumalai A . Life-threatening complications of HIV infection. J Intensive Care Med. 2007; 22(2):73-81. DOI: 10.1177/0885066606297964. View

Haacke E, Ye Y . The role of susceptibility weighted imaging in functional MRI. Neuroimage. 2012; 62(2):923-9. DOI: 10.1016/j.neuroimage.2012.01.020. View

Berger J . Mass lesions of the brain in AIDS: the dilemmas of distinguishing toxoplasmosis from primary CNS lymphoma. AJNR Am J Neuroradiol. 2003; 24(4):554-5. PMC: 8148702. View

Ramsey R, Gean A . Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin N Am. 1997; 7(2):171-86. View

Maeda T, Fujii T, Matsumura T, Endo T, Odawara T, Itoh D . AIDS-related cerebral toxoplasmosis with hyperintense foci on T1-weighted MR images: a case report. J Infect. 2006; 53(4):e167-70. DOI: 10.1016/j.jinf.2005.12.006. View

10.

Ciricillo S, Rosenblum M . Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients. J Neurosurg. 1990; 73(5):720-4. DOI: 10.3171/jns.1990.73.5.0720. View

11.

Buchacz K, Baker R, Palella Jr F, Chmiel J, Lichtenstein K, Novak R . AIDS-defining opportunistic illnesses in US patients, 1994-2007: a cohort study. AIDS. 2010; 24(10):1549-59. DOI: 10.1097/QAD.0b013e32833a3967. View

12.

Bhagavati S, Choi J . Frequent hemorrhagic lesions in cerebral toxoplasmosis in AIDS patients. J Neuroimaging. 2009; 19(2):169-73. DOI: 10.1111/j.1552-6569.2008.00274.x. View

13.

Haacke E, DelProposto Z, Chaturvedi S, Sehgal V, Tenzer M, Neelavalli J . Imaging cerebral amyloid angiopathy with susceptibility-weighted imaging. AJNR Am J Neuroradiol. 2007; 28(2):316-7. PMC: 7977403. View

14.

Castillo M . Brain infections in human immunodeficiency virus positive patients. Top Magn Reson Imaging. 1994; 6(1):3-10. View

15.

Haacke E, Mittal S, Wu Z, Neelavalli J, Cheng Y . Susceptibility-weighted imaging: technical aspects and clinical applications, part 1. AJNR Am J Neuroradiol. 2008; 30(1):19-30. PMC: 3805391. DOI: 10.3174/ajnr.A1400. View

16.

Antinori A . Evaluation and management of intracranial mass lesions in AIDS: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1998; 51(4):1233-4. DOI: 10.1212/wnl.51.4.1233. View

17.

Lee Y, Bruner J, Van Tassel P, Libshitz H . Primary central nervous system lymphoma: CT and pathologic correlation. AJR Am J Roentgenol. 1986; 147(4):747-52. DOI: 10.2214/ajr.147.4.747. View

18.

Revel M, Gray F, Brugieres P, Geny C, Sobel A, Gaston A . Hyperdense CT foci in treated AIDS toxoplasmosis encephalitis: MR and pathologic correlation. J Comput Assist Tomogr. 1992; 16(3):372-5. DOI: 10.1097/00004728-199205000-00007. View

19.

Trenkwalder P, Trenkwalder C, Feiden W, Vogl T, Einhaupl K, LYDTIN H . Toxoplasmosis with early intracerebral hemorrhage in a patient with the acquired immunodeficiency syndrome. Neurology. 1992; 42(2):436-8. DOI: 10.1212/wnl.42.2.436. View

20.

Haacke E, Xu Y, Cheng Y, Reichenbach J . Susceptibility weighted imaging (SWI). Magn Reson Med. 2004; 52(3):612-8. DOI: 10.1002/mrm.20198. View