Imaging findings in intracranial aspergillosis.
OBJECTIVE
The authors' purpose was to elucidate the various computed tomographic (CT) and magnetic resonance (MR) imaging findings in intracranial aspergillosis.


METHODS
Retrospective analysis of cranial imaging findings was performed in eight proved cases of central nervous system aspergillosis. The patients ranged in age from 17 to 75 years. Four patients were immunocompromised, and four were immunocompetent. CT was performed in all eight patients, and MR imaging in five.


RESULTS
Six patients (75%) had multiple lesions seen on the imaging studies, with a total of 27 focal brain lesions demonstrated. The lesions were most commonly seen in the cerebral hemispheres (n = 21), with lesser involvement of the basal ganglia (n = 2) and the posterior fossa (n = 4). Seven lesions were hemorrhagic on CT and/or MR images. There was a correlation between lesion size and hemorrhage, with hemorrhage more likely in larger lesions (>15 mm). At pathologic examination, foci of hemorrhage were noted within both infarcts and abscesses. Enhancement was noted in five lesions, four of which were confirmed abscesses. Contrast enhancement of the lesions was vague and week in immunocompromised patients but solid and strong in immunocompetent patients. There were 18 lesions without hemorrhage or enhancement; they were either infarcts or abscesses at pathologic examination. Some of these small nonhemorrhagic nonenhancing brain lesions in the subcortical white matter mimicked lacunar infarcts.


CONCLUSIONS
Typical imaging findings of intracranial aspergillosis include multifocal lesions involving the cerebral hemispheres, with hemorrhage in approximately 25% of lesions. Lesional contrast enhancement tends to be stronger in immunocompetent hosts.
Yamada
Kei
K
Department of Diagnostic Radiology, University of Rochester Medical Center, NY, USA.
Shrier
David A
DA
Rubio
Ana
A
Shan
Yuan
Y
Zoarski
Gregg H
GH
Yoshiura
Takashi
T
Iwanaga
Soji
S
Nishimura
Tsunehiko
T
Numaguchi
Yuji
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology; D001927:Brain Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed