Spectrum of Imaging Findings in Oriental Cerebral Schistosomiasis and Their Categorization by MRI

Guangyao Wu,Prasanna Ghimire

doi:10.3126/njr.v10i1.33169

Abstract

Introduction: To describe the spectrum of imaging findings in oriental cerebral schistosomiasis and characterizing different stages by MRI.Methods: A retrospective review of the clinical and MRI images of twenty nine pathologically proven cases of neuroschistomiasis was performed. Patients with either absence of complete MR examination, previously treated patients were excluded from the study. MRI images were analyzed and lesions were evaluated for the following parameters - distribution, size, clusterity, perilesional edema, mass effect, intralesional hemorrhage, necrosis, cystic degeneration, any abnormal enhancements, any atypical features as abscess,vasculitis, infarctions, or focal atrophy and encephalomalacia.Results: Lesions were only supratentorial in 25 cases, only infratentorial in 3 cases while were both supratentorial and infratentorial in 1 case. Lesions were unilateral in 26 cases. Significant mass effect was noted in 8 cases. All nodular and mass lesions were hyperintense or isointense in T1WI while all but two lesions were hyperintense in T2WI. Lesions were predominantly as clustered nodules (12 cases). All nodules enhanced homogeneously except three that demonstrated ring like enhancement. Masses were demonstrated either homogeneous (2 cases) or heterogeneous in enhancement (2 cases). Central linear enhancement was noted in 12 cases, leptomeningeal enhancement in 10 cases while gyral enhancement was noted in 1 case.Conclusions: Radiological presentation of neuroschistosomiasis varies at different stages of infection as well as among the asymptomatic groups. Recognition of spectrum of presentation has an implied role in the overall management and outcome in cases

Highlights

IntroductionGhimire P et al Oriental Cerebral Schistosomiasis estimated, more than 200 million people in the tropical and sub-tropical countries are infected with 120 million being symptomatic and 20 million having severe clinical disease.[1,2] Of the three major schistosome species infecting humans, Asian or Oriental schistosomiasis, caused by S.japonicum is the most pathogenetic as well as more difficult to control because of its zoonotic nature
To describe the spectrum of imaging findings in oriental cerebral schistosomiasis and characterizing different stages by Magnetic resonance imaging (MRI)
Among the threemajor Schistosomal species, S.japonicum preferentially causes cerebral disease while S.mansoni and S.hematobium causes spinal myeloradiculopathy.[5]. This difference has been attributed to various pathogenetic pathways including the assumption of smaller size of the ova of S. japonicum that can travel without impedance to the leptomeningeal veins.[3,4]

Summary

Introduction

Ghimire P et al Oriental Cerebral Schistosomiasis estimated, more than 200 million people in the tropical and sub-tropical countries are infected with 120 million being symptomatic and 20 million having severe clinical disease.[1,2] Of the three major schistosome species infecting humans, Asian or Oriental schistosomiasis, caused by S.japonicum is the most pathogenetic as well as more difficult to control because of its zoonotic nature. It has been seen that the treatment modalities differ in the varying stages of infection and a radiological recognition is all but pivotal.[10] It is necessary to be aware of these radiological findings which affects the overall management when an individual hailing from or having history of travel to an endemic region presents with equivocal clinical and radiologic presentations. We attempt to classify the MR imaging features at different stages of cerebral schistosomiasis and discuss the magnetic resonance spectroscopy findings in a series of patients

Methods

Results

Conclusion