Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients

Duarte, Stenio Bruno Leal; Oshima, Mariana Mari; Mesquita, João Vitor do Amaral; Nascimento, Felipe Barjud Pereira do; Azevedo, Paula Christina de; Reis, Fabiano

doi:10.1590/0100-3984.2016.0017

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Radiol Bras 50 (6) • Nov-Dec 2017 • https://doi.org/10.1590/0100-3984.2016.0017 copy

Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients

Achados de ressonância magnética em criptococose do sistema nervoso central: comparação entre pacientes imunocompetentes e imunossuprimidos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To assess the magnetic resonance imaging (MRI) patterns associated with central nervous system infection with Cryptococcus sp. in relation to patient immune status.

Materials and Methods:

This was a retrospective study of MRI data for 19 patients with neurocryptococcosis who underwent the examination between January 2000 and March 2014. The MRI characteristics examined included lesion topography, aspects of diffusion, T1-weighted images, T2-weighted images, and contrast enhancement patterns.

Results:

In all cases, cryptococcal infection was confirmed by cerebrospinal fluid analysis. Of the 19 patients, 10 were immunocompromised and 9 were immunocompetent. Abnormal imaging patterns occurred alone or in conjunction with other manifestations. The imaging patterns found in immunocompromised patients included the following: leptomeningeal enhancement, in 6; pachymeningeal enhancement, in 3 (due to intracranial hypotension in 2); perivascular space involvement, in 4; granulomas, in 2; hydrocephalus, in 2; miliary nodules, in 1; and plexitis, in 1. In immunocompetent patients, the following imaging patterns were observed: leptomeningeal enhancement, in 5; perivascular space involvement, in 3; granulomas, in 3; cryptococcoma, in 1; ventriculitis, in 1; and hydrocephalus, in 1. In 2 immunocompetent patients, diffusion-weighted imaging showed diffusion restriction in cerebral cryptococcal granuloma.

Conclusion:

In both groups, the most common imaging finding was leptomeningeal enhancement, followed by dilatation of perivascular spaces with the presence of mucoid material. Rare presentations, such as miliary nodules, plexitis, ventriculitis, and pachymeningeal enhancement, were also observed. None of the imaging patterns common to immunocompetent and immunocompromised patients differed significantly in frequency between them.

Keywords:
Cryptococcosis/diagnostic imaging; Central nervous system infections/diagnostic imaging; Brain injuries/pathology; Magnetic resonance imaging; Diagnostic imaging; Meninges/pathology

Case	Age (years)	Gender	HIV status	Findings	Imaging pattern
1	55	Male	Negative/organ transplantation	Multiple	Granuloma/leptomeningeal/perivascular space
2	40	Female	Positive	Multiple	Pachymeningeal^* * Intracranial hypotension. /leptomeningeal/granuloma
3	33	Female	Positive	Single	Leptomeningeal
4	37	Female	Positive	Multiple	Leptomeningeal/pachymeningeal^* * Intracranial hypotension. /perivascular space/plexitis
5	43	Male	Positive	Single	Miliary
6	41	Male	Positive	Multiple	Leptomeningeal/hydrocephalus
7	35	Male	Negative	Single	Perivascular space
8	48	Male	Negative	Multiple	Leptomeningeal/hydrocephalus
9	44	Male	Positive	Multiple	Hydrocephalus/pachymeningeal
10	50	Male	Negative	Multiple	Perivascular space/leptomeningeal/ventriculitis
11	32	Male	Negative	Single	Granuloma
12	20	Male	Negative	Multiple	Leptomeningeal/granuloma
13	30	Male	Negative	Multiple	Perivascular space/leptomeningeal
14	58	Male	Negative	Single	Leptomeningeal
15	55	Male	Positive	Single	Perivascular space
16	29	Male	Positive	Single	Perivascular space
17	41	Male	Positive	Single	Leptomeningeal
18	26	Female	Negative	Single	Cryptococcoma
19	39	Female	Negative	Single	Granuloma

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Mailing address: Dr. Fabiano Reis. Departamento de Radiologia - FCM-Unicamp. Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz. Campinas, SP, Brazil, 13083-887. E-mail: fabianoreis2@gmail.com.