Magnetic Resonance Imaging of Cerebral Aspergillosis: Imaging and Pathological Correlations.
Cerebral aspergillosis is associated with a significant morbidity and mortality rate. The imaging data present different patterns and no full consensus exists on typical imaging characteristics of the cerebral lesions. We reviewed MRI findings in 21 patients with cerebral aspergillosis and correlated them to the immune status of the patients and to neuropathological findings when tissue was available. The lesions were characterized by their number, topography, and MRI signal. Dissemination to the brain resulted from direct spread from paranasal sinuses in 8 patients, 6 of them being immunocompetent. Hematogenous dissemination was observed in 13 patients, all were immunosuppressed. In this later group we identified a total of 329 parenchymal abscesses involving the whole brain with a predilection for the corticomedullary junction. More than half the patients had a corpus callosum lesion. Hemorrhagic lesions accounted for 13% and contrast enhancement was observed in 61% of the lesions. Patients with hematogenous dissemination were younger (p = 0.003), had more intracranial lesions (p = 0.0004) and had a higher 12-week mortality rate (p = 0.046) than patients with direct spread from paranasal sinuses. Analysis of 12 aneurysms allowed us to highlight two distinct situations. In case of direct spread from the paranasal sinuses, aneurysms are saccular and located on the proximal artery portions, while the hematogenous dissemination in immunocompromised patients is more frequently associated with distal and fusiform aneurysms. MRI is the exam of choice for cerebral aspergillosis. Number and type of lesions are different according to the mode of dissemination of the infection.
Département de Neuroradiologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Guillaume
http://orcid.org/0000-0002-9421-8144
G
Marzolf
Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Marcela
M
Sabou
Service de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Béatrice
B
Lannes
Département de Neuroradiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.
François
F
Cotton
Département de Neuropathologie, Hospices Civils de Lyon, Lyon, France.
David
D
Meyronet
Département de Neuroradiologie, Hôpital de la Pitié Salpêtrière, Hôpitaux de Paris, Paris, France.
Damien
D
Galanaud
Département de Neuroradiologie, Centre Hospitalier Universitaire de Tours, Tours, France.
Jean-Philippe
JP
Cottier
Département de Neuroradiologie, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Sylvie
S
Grand
Département de Neuroradiologie, Hôpital Nord Laennec, Centre Hospitalier Universitaire de Nantes, Nantes, France.
Hubert
H
Desal
Département de Radiologie, Centre Hospitalier Universitaire de Liège, Liège, Belgium.
Julie
J
Kreutz
Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Maleka
M
Schenck
Laboratoire de Biostatistique, Faculté de Médecine de Strasbourg, Strasbourg, France.
Nicolas
N
Meyer
Service de Réanimation Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Francis
F
Schneider
Département de Neuroradiologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Jean-Louis
JL
Dietemann
Département de Neuroradiologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Meriam
M
Koob
Département d'Oncologie et d'Hématologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Raoul
R
Herbrecht
Département de Neuroradiologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Stéphane
S
Kremer
D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology*; D010256:Paranasal Sinuses / Q000382:microbiology; D011379:Prognosis; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000150:complications