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Research ArticleBRAIN

Diffusion-Weighted Imaging of Fungal Cerebral Infection

Paola Gaviani, Richard B. Schwartz, E. Tessa Hedley-Whyte, Keith L. Ligon, Ari Robicsek, Pamela Schaefer and John W. Henson
American Journal of Neuroradiology May 2005, 26 (5) 1115-1121;
Paola Gaviani
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Richard B. Schwartz
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E. Tessa Hedley-Whyte
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Keith L. Ligon
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Ari Robicsek
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Pamela Schaefer
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John W. Henson
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  • Fig 1.
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    Fig 1.

    Patient 1. Fungal cerebritis due to Rhizopus infection of the left basal ganglia and corona radiata.

    A, On Gd-enhanced T1-weighted imaging, the lesion is hypointense with minimal peripheral enhancement.

    B, On FLAIR imaging, the lesion has heterogeneous signal intensity with moderate surrounding edema.

    C and D, DWI (C) and ADC (D) images show predominantly decreased diffusion (short arrow in D) with a smaller region of elevated diffusion (long arrow in D).

    E, Hematoxylin-eosin stain (40×) shows perivascular ring hemorrhages and necrosis. Moderate amount of acute and chronic inflammation was also found (data not shown).

    F, Methenamine silver stain (450×) shows fungal organisms predominantly in the lumen of blood vessels (arrows).

  • Fig 2.
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    Fig 2.

    Patient 7. Fungal abscess due to Scedosporium infection.

    A, On Gd-enhanced T1-weighted imaging, the lesion is ring enhancing.

    B, On FLAIR imaging, the lesion is isointense to brain parenchyma, with moderate surrounding edema.

    C and D, DWI (C) and ADC (D) images show homogeneously decreased diffusion in the center of the lesion, similar to that seen with pyogenic abscess.

    E and F, Hematoxylin-eosin (E) (450×) and methenamine silver stain (F) (250×) stains show fungal organisms (arrow) in necrotic tissue and chronic inflammation.

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    Fig 3.

    Patient 6. Fungal abscess due to Aspergillus infection.

    A, On Gd-enhanced T1-weighted imaging, the lesion is ring enhancing.

    B, On FLAIR imaging, the lesion is hyperintense to brain parenchyma, without surrounding edema.

    C and D, DWI (C) and ADC (D) images show homogeneously decreased diffusion in the center of the lesion.

    E, Hematoxylin-eosin stain (100×) shows a lesion discrete from brain with a well-defined capsule (arrows). Lesions were composed of granulomatous chronic inflammation with numerous histiocytes and giant cells engulfing fungal organisms (asterisk).

    F, Methenamine silver stain (250×) shows fungal organisms (arrow) with 45° angle branching, consistent with Aspergillus infection.

  • Fig 4.
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    Fig 4.

    Patient 3. Early fungal abscess due to Aspergillus infection.

    A, On Gd-enhanced T1-weighted imaging, the lesion has a thin rim of peripheral enhancement.

    B, On FLAIR imaging, the lesion has heterogeneous signal intensity with minimal surrounding edema.

    C and D, DWI (C) and ADC (D) maps show peripherally decreased diffusion, with elevated diffusion in the center of the lesion.

    E, Hematoxylin-eosin stain (100×) shows acute and chronic inflammation in the brain parenchyma, without a well-defined capsule.

    F, Methenamine silver stain (250×) shows septate and 45°-branching hyphae in necrotic parenchyma.

Tables

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  • Clinical presentation and pathologic and DWI findings in patients with fungal cerebral infection or pyogenic bacterial abscess

    PatientClinical PresentationLesion AspirationOrganismMR Imaging FindingADC (×10−3 mm2/s)ADC Ratio
    LesionWM
    1AcuteNot done, autopsyRhizopusMinimal enhancement, DWI heterogeneously hyperintense0.20 ± 0.050.86 ± 0.060.23
    2AcuteNot done, autopsyAspergillusNo enhancement, DWI heterogeneously hyperintense0.23 ± 0.040.85 ± 0.050.27
    3SubacuteNot done, autopsyAspergillusRing-enhancement, DWI peripherally hyperintense0.13 ± 0.070.69 ± 0.050.19
    4SubacuteMucoid fluidAspergillusRing-enhancement, DWI centrally hyperintense0.59 ± 0.050.80 ± 0.060.74
    5SubacuteNot done, autopsyAspergillusRing-enhancement, DWI centrally hyperintense0.71 ± 0.030.87 ± 0.040.81
    6SubacuteMucoid fluidAspergillusRing-enhancement, DWI centrally hyperintense0.39 ± 0.080.74 ± 0.050.53
    7SubacuteMucoid fluidScedosporiumRing-enhancement, DWI centrally hyperintense0.22 ± 0.050.58 ± 0.060.39
    8SubacuteMucoid fluidAspergillusRing-enhancement, DWI hyperintense0.21 ± 0.080.66 ± 0.060.31
    • Note.—Mean lesion and white matter ADC and ADC ratio were, respectively, 0.33 ± 0.06 × 10−3 mm2/s, 0.76 ± 0.05 × 10−3 mm2/s, and 0.43 in the fungal group and 0.46 ± 0.06 × 10−3 mm2/s (difference not significant), 0.76 ± 0.05 × 10−3 mm2/s, and 0.61 (difference not significant) in the bacterial group.

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American Journal of Neuroradiology: 26 (5)
American Journal of Neuroradiology
Vol. 26, Issue 5
1 May 2005
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Cite this article
Paola Gaviani, Richard B. Schwartz, E. Tessa Hedley-Whyte, Keith L. Ligon, Ari Robicsek, Pamela Schaefer, John W. Henson
Diffusion-Weighted Imaging of Fungal Cerebral Infection
American Journal of Neuroradiology May 2005, 26 (5) 1115-1121;

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Diffusion-Weighted Imaging of Fungal Cerebral Infection
Paola Gaviani, Richard B. Schwartz, E. Tessa Hedley-Whyte, Keith L. Ligon, Ari Robicsek, Pamela Schaefer, John W. Henson
American Journal of Neuroradiology May 2005, 26 (5) 1115-1121;
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