Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0659
CT and MR Characteristics of Cerebral Sparganosis
T. Songa,
W.-S. Wangd,
B.-R. Zhoub,
W.-W. Maia,
Z.-Z. Lia,
H.-C. Guoc and
F. Zhouc
a Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical College, Guangdong, China
b Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical College, Guangdong, China
c Department of Pathology, The Third Affiliated Hospital of Guangzhou Medical College, Guangdong, China
d Imaging Center, Guangdong 999 Brain Hospital, Guangdong, China
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Fig 1. Case 1. Images of the brain of an 80-year-old man with a history of headache, seizure, and left hemiparesis for 2 years. A, Precontrast CT scan shows patchy area of hypoattenuation in the white matter of the right parietal lobe with a punctate calcification located centrally. B, Axial T2-weighted MR image of the same day shows hyperintense area and cortical atrophy in the right parietal lobe. However, calcification seen on CT image cannot be found on MR images. C–D, Sagittal and coronal postcontrast images show tunnel-shaped enhancement representing inflammatory granuloma. No ipsilateral ventricular dilation is seen. E, Postoperative gross photograph of resected specimen shows a degenerated worm of Spirometra mansoni surrounded by inflammatory granulomatous tissues. F, Photomicrograph of histologic specimen shows a removed degenerated worm (W) surrounded by collagen capsule (C) and peripheral inflammatory cells and gliosis (G) (H&E stain x 40). G–H, Sagittal and coronal postcontrast images 1 year after a craniotomy in the same patient show lesions excised, with edematous area in the right parietal lobe.
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Fig 2. Case 2. Images of the brain of a 45-year-old woman with a 6-year history of severe headache, intermittent seizures, and right hemiparesis. A, Precontrast CT scan reveals unilateral extensive area of low attenuation in the white matter of the left parietal lobe, with ipsilateral ventricular dilation. Small, punctate calcifications are seen in the left parietal lobe. B–D, Axial T1-weighted (A), T2-weighted (B), and FLAIR images (C) of the same section show a wide area of hypointensity on T1-weighted image (B), heterogeneous hyperintensity on T2-weighted (C) and FLAIR images (D), with a small central area of isointensity and slight hyperintensity on T2-weighted image (C), corresponding to isointensity or hypointensity on FLAIR image (D), representing encephalomalacia. E–G, Postcontrast axial (E), coronal (F), and sagittal (G) T1-weighted images show a tunnel about 5 cm in length and 1.5 cm in width, appearing as a hollow tube located in the left temporal and parietal lobe. H, Intraoperative photograph shows a whitish, wrinkled, threadlike live worm approximately 6 cm in length with slow peristalsis.
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Fig 3. Case 6. Images of the brain of a 14-year-old boy with a 4-year history of seizures and left hemiparesis. A, Precontrast CT scan shows an extensive area of low attenuation in the right basal ganglia with a punctate calcification centrally. B, Axial T2-weighted image of the same section as the CT image in (A) shows hyperintense area in the right basal ganglia. However, calcification seen on CT image cannot be shown clearly on MR image. C–D, Postcontrast axial (C) and coronal (D) T1-weighted images show bead-shaped enhancement in the right basal ganglia. E–F, After 4 months, postcontrast axial (E) and coronal (F) T1-weighted images of the same patient show the tunnel-shaped enhancement in the right parietal lobe with small amounts of residual bead-shaped enhancement in the right basal ganglia, representing the migration of the worm and lesions shifting from the right basal ganglia to the right parietal lobe. Preoperative ELISA on serum and on CSF revealed strongly positive against Spirometra mansoni. A live worm was found at craniotomy.
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