Cerebral Alveolar Echinococcosis Research Articles

The value of nomogram based on MRI functional imaging in differentiating cerebral alveolar echinococcosis from brain metastases

ObjectiveThis study aims to evaluate the effectiveness of a nomogram model constructed using Diffusion Kurtosis Imaging (DKI) and 3D Arterial Spin Labeling (3D-ASL) functional imaging techniques in distinguishing between cerebral alveolar echinococcosis (CAE) and brain metastases (BM).MethodsProspectively collected were 24 cases (86 lesions) of patients diagnosed with CAE and 16 cases (69 lesions) of patients diagnosed with BM at the affiliated hospital of Qinghai University from 2018 to 2023, confirmed either pathologically or through comprehensive diagnosis. Both patient groups underwent DKI and 3D-ASL scanning. DKI parameters (Kmean, Dmean, FA, ADC) and cerebral blood flow (CBF) were analyzed for the parenchymal area, edema area, and symmetrical normal brain tissue area in both groups. There were 155 lesions in total in the two groups of patients. We used SPSS to randomly select 70% as the training set (108 lesions) and the remaining 30% as the test set (47 lesions) and performed a difference analysis between the two groups. The independent factors distinguishing CAE from BM were identified using univariate and multivariate logistic regression analyses. Based on these factors, a diagnostic model was constructed and expressed as a nomogram.ResultUnivariate and multivariate logistic regression analyses identified nDmean1 and nCBF1 in the lesion parenchyma area, as well as nKmean2 and nDmean2 in the edema area, as independent factors for distinguishing CAE from BM. The model's performance, measured by the area under the ROC curve (AUC), had values of 0.942 and 0.989 for the training and test sets, respectively. Calibration curves demonstrated that the predicted probabilities were highly consistent with the actual values, and DCA confirmed the model's high clinical utility.ConclusionThe nomogram model, which incorporates DKI and 3D-ASL functional imaging, effectively distinguishes CAE from BM. It offers an intuitive, accurate, and non-invasive method for differentiation, thus providing valuable guidance for subsequent clinical decisions.

Comparison of clinicopathological features between cerebral cystic and alveolar echinococcosis: analysis of 27 cerebral echinococcosis cases in Xinjiang, China

BackgroundCerebral echinococcosis is relatively rare, and it is important to distinguish cerebral cystic echinococcosis (CCE) from cerebral alveolar echinococcosis (CAE) in terms of pathological diagnosis. We aim to describe the different clinicopathological features among patients with CCE and CAE.MethodsWe collected 27 cases of cerebral echinococcosis which were diagnosed in the Department of Pathology of the First Affiliated Hospital of Xinjiang Medical University from January 1, 2012, to June 30, 2023. We compared the patients’ clinical characteristics, MRI features, and pathologic manifestations of CCE and CAE.ResultsAmong 27 cases of cerebral echinococcosis, 23 cases were CAE and 4 cases were CCE. The clinical manifestations of both CCE and CAE patients mainly included headache (21 patients, 77.78%), limb movement disorders (6 patients, 22.22%), epileptic seizures (4 patients, 14.81%) and visual disturbances (2 patients, 7.41%). The average onset age of CAE cases was 34.96 ± 11.11 years, which was 9.00 ± 7.26 years in CCE cases. All CAE patients presented with multiple involvements in the brain and extracranial organs while all CCE patients observed a solitary lesion in the brain and 3 CCE cases had no extracranial involvement. Lesions of CCE in MRI showed a single isolated circular, which was well demarcated from the surrounding tissues and with no obvious edema around the lesions, whereas CAE lesions presented as multiple intracranial lesions, with blurred edges and edema around the lesions, and multiple small vesicles could be observed in the lesions. The edge of CAE lesions could be enhanced, while CCE lesions have no obvious enhancement. CCE foci were clear cysts with a wall of about 0.1 cm. Microscopically, the walls of the cysts were characterized by an eosinophilic keratin layer, which was flanked on one side by basophilic germinal lamina cells, which were sometimes visible as protocephalic nodes. While the CAE lesion was a nodular structure with a rough and uneven nodule surface, and the cut section was cystic and solid; microscopically, the CAE lesion had areas of coagulative necrosis, and the proto-cephalic nodes were barely visible. Inflammatory cell areas consisting of macrophages, lymphocytes, epithelioid cells, plasma cells, eosinophils, and fibroblasts can be seen around the lesion. Brain tissues in the vicinity of the inflammatory cell areas may show apoptosis, degeneration, necrosis, and cellular edema, while brain tissues a little farther away from the lesion show a normal morphology.ConclusionsWith the low incidence of brain echinococcosis, the diagnosis of echinococcosis and the differential diagnosis of CAE and CCE are challenging for pathologists. Grasping the different clinical pathology characteristics of CAE and CCE is helpful for pathologists to make accurate diagnoses.

Epidemiology and Clinical Characteristics of Cerebral Alveolar Echinococcosis in the Tibetan Region of Sichuan, China.

This study aimed to examine the epidemiology and clinical characteristics of cerebral alveolar echinococcosis in the Tibetan region of Sichuan, China. A retrospective analysis of hospitalized cases of cerebral alveolar echinococcosis from six medical units in the Garze Tibetan Autonomous Prefecture, Sichuan Province, from January 2016 to June 2021 was conducted. The study focused on the characteristics, clinical presentation, and imaging features of the disease. Of 119 cerebral alveolar echinococcosis patients, 76 were male and 43 were female. Occupationally, 62 were farmers, 46 were herdsmen, nine were monks, and two were students. The mean age was 43.9 (± 13.9) years. The primary clinical manifestations were dizziness, headaches, and epilepsy. The incidence of cerebral alveolar echinococcosis was most concentrated within 4 years after the diagnosis of hepatic alveolar echinococcosis (77/119, 64.7%). There were 86 cases (72.3%) with multiple intracranial echinococcosis lesions, with an average size of 2.0 cm × 2.5 cm. The imaging features showed that the lesion was mainly concentrated in the anterior circulation blood supply area, and the lesion had multiple aggregated small vesicular structures as its unique imaging feature. Among 98 follow-up cases, 62 could live independently (63.3%); 18 deaths were recorded (18.4%), with an approximate 5-year survival rate of 81.6%. Regular examination of patients with first diagnosis of hepatic alveolar echinococcosis without a combination of echinococcosis in other parts of the body can help monitor and prevent the occurrence of cerebral alveolar echinococcosis, improve the understanding of cerebral alveolar echinococcosis in Tibetan areas of Sichuan.

Differentiation between cerebral alveolar echinococcosis and brain metastases with radiomics combined machine learning approach

BackgroundCerebral alveolar echinococcosis (CAE) and brain metastases (BM) share similar in locations and imaging appearance. However, they require distinct treatment approaches, with CAE typically treated with chemotherapy and surgery, while BM is managed with radiotherapy and targeted therapy for the primary malignancy. Accurate diagnosis is crucial due to the divergent treatment strategies.PurposeThis study aims to evaluate the effectiveness of radiomics and machine learning techniques based on magnetic resonance imaging (MRI) to differentiate between CAE and BM.MethodsWe retrospectively analyzed MRI images of 130 patients (30 CAE and 100 BM) from Xinjiang Medical University First Affiliated Hospital and The First People's Hospital of Kashi Prefecture, between January 2014 and December 2022. The dataset was divided into training (91 cases) and testing (39 cases) sets. Three dimensional tumors were segmented by radiologists from contrast-enhanced T1WI images on open resources software 3D Slicer. Features were extracted on Pyradiomics, further feature reduction was carried out using univariate analysis, correlation analysis, and least absolute shrinkage and selection operator (LASSO). Finally, we built five machine learning models, support vector machine, logistic regression, linear discrimination analysis, k-nearest neighbors classifier, and Gaussian naïve bias and evaluated their performance via several metrics including sensitivity (recall), specificity, positive predictive value (precision), negative predictive value, accuracy and the area under the curve (AUC).ResultsThe area under curve (AUC) of support vector classifier (SVC), linear discrimination analysis (LDA), k-nearest neighbors (KNN), and gaussian naïve bias (NB) algorithms in training (testing) sets are 0.99 (0.94), 1.00 (0.87), 0.98 (0.92), 0.97 (0.97), and 0.98 (0.93), respectively. Nested cross-validation demonstrated the robustness and generalizability of the models. Additionally, the calibration plot and decision curve analysis demonstrated the practical usefulness of these models in clinical practice, with lower bias toward different subgroups during decision-making.ConclusionThe combination of radiomics and machine learning approach based on contrast enhanced T1WI images could well distinguish CAE and BM. This approach holds promise in assisting doctors with accurate diagnosis and clinical decision-making.

A rare disease: a single-center experience of cerebral alveolar echinococcosis in 12 operated patients.

In this study, we have evaluated 12 patients with cerebral alveolar echinococcosis (AE). All patients underwent surgery for cerebral AE. We aimed to demonstrate the relationship between the demographic properties of patients and surgical outcomes as well as surgical suggestions about surgical approaches. Patients were analyzed according to demographic properties, hepatic/ pulmonary AE lesion existence, symptoms, neurological and radiological examination, histopathological findings, and outcome after treatment. Preoperative diagnosis based on the history of the patient, neurological examination, serological tests, and radiology. When enhanced radiological imaging like MR-Tractography and intraoperative neuromonitoring is combined with precision surgical methods cerebral AE is treatable. Ten of twelve cerebral AE patients had favorable outcomes after surgery. AE of the brain is a rare but life-threatening parasitic disease. Wherever the primary focus is, surgery for cerebral involvement of AE is challenging but safe with appropriate surgical techniques and the help of radiological examination.

The Significance of Perfusion-Weighted Magnetic Resonance Imaging in Evaluating the Pathological Biological Activity of Cerebral Alveolar Echinococcosis.

This study aimed to evaluate the value of perfusion-weighted magnetic resonance imaging (MR-PWI) in assessing cerebral alveolar echinococcosis (CAE) biological activity. Totally, 15 cases of CAE patients who underwent surgery were enrolled. The MR-PWI perfusion parameters were measured and compared. The MR-PWI perfusion parameters cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time were different among different areas. Their values were in the descending order of lesion marginal area > contralateral normal brain area > lesion center area. However, time-to-peak value was in the ascending order of lesion marginal area < contralateral normal brain area < lesion center area. Spearman correlation analysis showed that CBF and CBV at the edge of the lesion were significantly positively correlated with microvessel density. Moreover, CBF and CBV at the edge of the lesion were also significantly positively correlated with maximum standardized uptake value. Perfusion-weighted magnetic resonance imaging can be used to dynamically reflect the neovascularization of CAE lesions and may have a good application prospect in evaluating the biological activity of CAE.

Quantitative analysis of diffusion-weighted imaging and signal-to-noise ratio on the efficacy of albendazole liposome in the treatment of cerebral alveolar echinococcosis

OBJECTIVE: To investigate the feasibility of diffusion-weighted imaging (DWI) and signal-to-noise ratio (SNR) of lesions in evaluating the efficacy of albendazole liposomes in the treatment of cerebral alveolar echinococcosis (CAE). MATERIALS AND METHODS: Sixteen patients with CAE who met the inclusion criteria from April 2017 to December 2020 were enrolled. All patients underwent routine magnetic resonance sequence examination and DWI examination. The b-value were 1000 s/mm2 and 3000 s/mm2. The apparent diffusion coefficient (ADC) value and SNR of lesions before and after treatment were compared. The data of each group were statistically analyzed by Wilcoxon signed-rank sum test. RESULTS: After 1 year of treatment with albendazole liposomes, the SNR of lesions on T2WI sequence increased. There was a significant difference between the SNR of the same lesion before and after follow-up (P &lt; 0.05). The ADC values of lesion parenchyma and edema area before and after treatment were compared. The difference between them was statistically significant in the both b values (ADC of parenchyma, P &lt; 0.05; ADC of edema area, P &lt; 0.001). Through binary linear classification, it was found that under the same b value, the effect of drugs on the edema area was more obvious than that on the parenchyma area; under different b values, the higher the b value, the higher the ability to evaluate the curative effect of drug therapy. CONCLUSION: Albendazole liposome is effective in the treatment of CAE, and long-term imaging follow-up of patients with CAE treated with albendazole liposome is necessary. When the change in conventional images is inapparent, the quantitative analysis of ADC value and SNR of lesions on T2WI can provide an objective basis for the evaluation of the curative effect of drug treatment in CAE.

Clinical Features, Radiological Characteristics, and Outcomes of Patients With Intracranial Alveolar Echinococcosis: A Case Series From Tibetan Areas of Sichuan Province, China.

Objectives: Intracranial alveolar echinococcosis (IAE), a zoonotic disease, is a critical health problem in the Tibetan region. We aimed to describe the clinical and radiological characteristics and outcomes among patients with IAE.Methods: We screened patients diagnosed with IAE between March 2015 and May 2019 at the Ganzi Tibetan Autonomous Prefecture People's Hospital. Detailed demographics, clinical characteristics, neuroimaging features, and outcomes were recorded.Results: A total of 21 patients with an average age of 44.1 ± 12.7 years were included. Thirteen (61.9%) patients were male. The most common chief neurological complaint was headache (n = 17, 81.0%), followed by dizziness, seizure, visual disturbances, hemiparesis, disturbed consciousness, and dysphasia. All the patients had coexisting liver localizations. The typical neuroimaging features of IAE on cerebral magnetic resonance imaging scans showed obvious low-signal shadow with multiple small vesicles inside the lesions on T2-weighted images and FLAIR images. The pathological HE staining demonstrates vesicular lesions with several internal sacs. For hepatic alveolar echinococcosis (AE), the hepatic portal was invaded in six (28.6%) patients, and the portal vein (n = 5, 23.8%) was the mostly commonly involved vessel. As for treatment, 11 patients (52.4%) had poor compliance with albendazole. The duration of patients taken albendazole ranged from 2 months to 3 years. Cerebral AE surgery was performed in 11 patients, five of them underwent partial resection of AE lesions, and six patients received total resection. One patient with primary IAE underwent radical surgery. Ten patients (47.6%) died during the follow-up for a mean of 21.7 ± 11.9 (3–46) months. In total, 28.9% of the patients died within 5 years, and 71.6% died within 10 years. The median interval between the date of diagnosis as AE and death was 84 (19–144) months.Conclusion: Despite substantial advances in diagnostic and therapeutic methods, the treatment of IAE remains difficult and results in unsatisfactory outcomes. The major critical issue is surgical treatment of IAE although the disease is disseminated. Besides, lifelong albendazole would be indicated, but most patients had poor medication compliance. It is important to educate patients about the necessity of medical treatment.

MR-Diffusion characteristics of cerebral alveolar echinococcosis and its role in differentiating cerebral alveolar echinococcosis from metastases

BackgroundAlmost all of the cases of cerebral alveolar echinococcos are showed T2WI hypointensity, with “coal-like” changes; as multiple and T2WI hypointensity of nodular lesions on magnetic resonance imaging (MRI). These imaging findings were also observed in other lesions like metastases. PurposeTo study the MR Diffusion-weighted imaging characteristics of cerebral alveolar echinococcosis and its role in differentiating cerebral alveolar echinococcosis from metastases. Material and methodsA total of thirty-two cerebral alveolar echinococcosis (CAE) and metastases (16 CAE and 16 metastases) were evaluated by conventional and diffusion MRI, respectively. The mean of apparent diffusion coefficient (ADC) and exponential apparent diffusion coefficient (eADC) values from the determined ROI of the solid region, the peripheral edema and control group were calculated. ResultsA total of thirty-two cerebral alveolar echinococcosis (CAE) and brain metastases (BM) (16 CAE and 16 metastases) were nodular lesions. The results showed that in solid regions, the mean ADC values of CAE (1.17 ± 0.06) were higher than BM (0.90 ± 0.07) lesions, while the mean eADC values were lower (CAE 0.31 ± 0.02, BM 0.41 ± 0.03). In the peripheral edematous region, the mean ADC values of CAE were higher than BM lesions, but there were no significant difference, whereas, the mean eADC values were opposite. ConclusionDiffusion MR is a useful tool for the assessment of cerebral alveolar echinococcosis and can help differentiate them from metastases. It also has a potential role in monitoring therapy and early detection of drug resistance.

Biological characteristics of 18F-FDG PET/CT imaging of cerebral alveolar echinococcosis.

This study aims to analyze the characteristics of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for cerebral alveolar echinococcosis (CAE).Twenty-five CAE patients underwent 18F-FDG PET/CT, and the diagnosis was confirmed by clinical and surgical pathology. The 18F-FDG PET/CT results were subject to visual and semiquantitative analysis, and the difference in 18F-FDG SUVmax for lesions among the 3 types of CAE was evaluated.In the 25 CAE patients, 62 lesions were detected by 18F-FDG PET/CT, and these lesions were classified into 3 types, according to the characteristics of the lesion's uptake of 18F-FDG on PET images: type I, 17 lesions, FDG was concentrated into a mass radioactive distribution in the CAE foci; type II, 28 lesions, FDG presented a annular concentrated radioactive distribution around the CAE foci; type III, 17 lesions, FDG in the CAE foci presented a radioactive distribution with defects and sparse areas. The difference in 18F-FDG SUVmax between type I and type II CAE was not statistically significant (P > .05), the difference in 18F-FDG SUVmax between type I and type III CAE was statistically significant (P < .001), and the difference in 18F-FDG SUVmax between type II and type III CAE was statistically significant (P < .001);The 18F-FDG PET manifestations of CAE are classified into 3 types. Both type I and type II may have invasive activity, while the lesions of type III CAE show that the focus is relatively stable or at a stationary phase. If there are no definite alveolar echinococcus focus in other sites, these patients can temporarily delay the treatment. It is recommended that the patient should undergo whole body PET/CT once a year to dynamically observe the bioactivity and size of type III CAE lesions and assess the presence of new echinococcus lesions in the rest of the body.

Preliminary study of albendazole liposome treatment of cerebral alveolar echinococcosis by 1H-MR spectroscopy

ObjectiveTo investigate the 1H-MRS characteristics of cerebral alveolar echinococcosis (CAE) treated by albendazole liposome. Materials and methodsNine patients with 20 lesions proven histologically and clinically to be CAE positive were examined via conventional MRI and 2D multivoxel spectroscopy with a 3.0 T double gradient superconductivity magnetic resonance scanner. In patients who took medication regularly for at least one year, the levels of NAA, CR, Cho, MI, Lip, Lac, and other metabolites from the same lesion parenchyma were observed and then used to calculate NAA/Cr, NAA/Cho, NAA/(Cho+Cr), and (Lip+Lac)/Cr. Statistical analysis was performed using the Wilcoxon signed-rank test. ResultsComparisons between cMRI scans taken before patients began taking medication and cMRI scans taken after patients completed one year of regular medication, the volume of legions increased slightly, and the signals of lesions increased on T2WI. The medians and interquartile ranges of NAA/Cho, NAA/CR, NAA/(Cho+Cr), and (Lip+Lac)/Cr in the same lesions in CAE patients prior to treatment via albendazole liposomes were: 2.285 (1.388–3.655), 3.620 (2.173–5.165), 0.651 (0.552–0938), and 29 (15.219–41.609), respectively. The medians and interquartile ranges of NAA/Cho, NAA/CR, NAA/(Cho+Cr), and (Lip+Lac)/Cr in the same lesions in CAE patients after treatment via albendazole liposomes were: 5.120 (1.853–12.00), 6.120 (3.690–9.733), 0.900 (0.651–1.218), and 26.427 (16.536–49.904), respectively. Proton magnetic resonance spectroscopy images of patients with CAE before and after one year of treatment via albendazole liposomes were characterized by the increase of NAA with ratios of NAA/Cho, NAA/CR, and NAA/(Cho+Cr) increasing by different degrees. Compared with the same lesion before and after treatment twice, the differences were statistically significant (P < 0.01). In regard to the change in (Lip+Lac)/Cr ratios, the differences were not statistically significant (P > 0.05). ConclusionIn patients with CAE, minimal change in CAE lesions imaged via conventional MRI, 1H-MRS was observed. Slight changes of cerebral alveolar echinococcosis lesions before and after treatment via albendazole liposome were observed, providing valuable imaging information for the treatment of CAE lesions.

Quantitative analysis of cerebral alveolar echinococcosis and brain tuberculoma by MR diffusion weighted imaging

ObjectiveTo explore the value of quantitative ADC in the identification and diagnosis of cerebral alveolar echinococcosis and tuberculoma. Materials and methodsPatients admitted to our hospital from 2010 to 2014 with diagnosis of cerebral alveolar echinococcosis and tuberculoma underwent 3.0T superconduction MRI including whole brain routine MR plain scanning, enhanced scanning and DWI examination. The b-value for the DWI gradient sensitive factor is taken as 1000 s/mm2. The apparent diffusion coefficient in the lesion solid area, the area around the edema and the brain normal solid area on the corresponding opposite location (control area) were measured respectively. The SPSS17.0 software was used for statistics, and changes in the ADC values in the both pathologic lesion solid area and the area around the edema area were analyzed. ResultsThe median and inter quartile range (IQR) of the ADC values of solid area of the cerebral alveolar echinococcosis and the brain tuberculoma lesion were: 1.08 × 10−3 mm2/s (1.03–1.13), 1.28 × 10−3 mm2/s (1.19–1.34), there was the significant difference between the average ADC values of the solid area of both diseases (t′−5.435, P < 0.0); The median and IQR of edema area of the ADC values of the cerebral alveolar echinococcosis and the brain tuberculoma lesion were: 1.08 × 10−3 mm2/s (0.99–1.19),1.39 × 10−3 mm2/s (1.23–1.49), there were the significant difference between average ADC difference around the edema area of both diseases (t′−6.191, p < 0.05); No statistical significance was shown when the ADC value of the edema area of cerebral alveolar echinococcosis was compared to the ADC value of the solid area (p > 0.05). The ADC values of solid area and the area around the edema of the brain tuberculoma were higher than that of the corresponding area of the cerebral alveolar echinococcosis. Conclusions: DWI combined with conventional MRI might be applied to provide valuable information for the diagnosis of the cerebral alveolar echinococcosis and the brain tuberculoma.

Clinical Characteristic of 12 Misdiagnosed Cases With Rare Intracranial Infection

Object: To investigate the clinical features and radiologic findings in misdiagnosed intracranial infection. Methods: A series of 12 uncommon patients with misdiagnosed intracranial infection were enrolled in the present study from January 2004 to December 2013. Results: All patients with rare intracranial infections were confirmed by histopathologic examination; the misdiagnosis rate is 100% in the present series. The initial diagnosis included metastatic tumor, glioma, meningioma, cyst disease, hematoma, and epidermoid cysts. The features of magnetic resonance imaging were isointense (5/12), hyperintense (5/12), hypointense (2/12) on T1 weight, and hypointense (4/12) and hyperintense (8/12) on T2 weight, respectively, as well as nonspecific enhanced findings in the present study. The most common etiology of misdiagnosed intracranial infections was fungal abscess and neurocysticercosis that account for 25% (3/12) of the infections. Uncommon intracranial toxoplasmosis in 1 case and 1 case of cerebral alveolar echinococcosis in 1 case were also observed, respectively (8.3%). In addition, 2 cases (16.7%) of all patients were proved to have intracranial abscess with specific pathogen: one is Staphylococcus aureus, and the other is Serratia marcescens. Two intracranial abscesses (16.7%) with nonspecific pathogen were also found in the present study. The follow-up was conducted on all patients during a period of 3 to 96 months (average, 48 mo), of which 91.7% patients had a favorable outcome (Glasgow Outcome Scale 5 and 4) and 8.3% had an unfavorable outcome (Glasgow Outcome Scale ≤3). Conclusions Primary diagnosis of rare intracranial infections should be emphasized; favorable outcome could be achieved by early microsurgical intervention and timely effective antibiotics.

Magnetic resonance spectroscopy and magnetic resonance imaging findings of the intracerebral alveolar echinococcosis.

Alveolar echinococcosis (AE) is a parasitic infestation produced by Echinococcus multilocularis. The parasite is a rare human infestation with a wide geographic distribution. It primarily affects the liver, and may spread hematogenously to produce metastatic foci in the distant organs. AE can metastise to the lungs, brain and bones. Cerebral involvement is rare but may be lethal. Cerebral AE is a rare but life-threatening parasitic disease. Here we report a 52-year-old man with cerebellar involvement of Echinococcus multilocularis.

1H MR spectroscopy characteristics of cerebral alveolar echinococcosis

Objective To investigate the characteristics of proton magnetic resonance spectroscopy (1H MRS) in patients with cerebral alveolar echinococcosis (CAE).Methods Thirteen patients with 33 lesions proven to be CAE histologically and clinically were examined by conventional MRI and 2D multivoxel spectroscopy with a 3.0 T double gradient superconductivity magnetic resonance scanner.Concentrations of the metabolites containing N-acetyl-aspartic-acid (NAA),Choline (Cho),Creatine (Cr),lipids and lactic acid (Lip + Lac),myo-Inositol (mI) were detected and the value of Cho/Cr,NAA/Cr,(Lip + Lac)/Cr,mI/Cr were calculated.The values of Cho/Cr,NAA/Cr,(Lip + Lac)/Cr,mI/Cr were compared between the lesions and the contralateral normal brain parenchyma.Statistical analysis was performed using the Wilcoxon signed-rank test.Results CAE 1H MRS in the lesions was characterized by the decrease of Cho,NAA to varying degrees,and a visible lipid with or without lactate peak.Compared with the control group,the ratio of NAA/Cr was decreased markedly,whereas Cho/Cr,mI/Cr increased mildly and (Lip + Lac)/Cr increased markedly in the lesions.The medians and interquartile ranges of Cho/Cr,NAA/Cr,(Lip + Lac)/Cr and mI/Cr in the lesions were:1.88 (1.24-2.23),1.32 (1.07-1.58),32.96 (24.59-47.30) and 0.91 (0.67-1.08),respectively.The medians and interquartile ranges of Cho/Cr,NAA/Cr,(Lip + Lac)/Cr and mI/Cr of control group were 0.84(0.704-0.98),2.00(1.80-2.18),0.90 (0.74-0.99) and 0.26 (0.18-0.31),respectively.There were statistically significant differences of the measures between the lesions and the control regions (Z =-5.932,-6.086,-6.946,-6.984,P ＜0.01).Conclusions Multi-voxel 1H MRS can reflect pathological characteristics of CAE.1 H MRS provides metabolic information for diagnosis of CAE and may be a supplement to conventional magnetic resonance examination. Key words: Echinococcosis ; Magnetic resonance spectroscopy; Brain

Primary Cerebral Alveolar Echinococcosis: Mycology to the Rescue

A case of primary cerebral alveolar echinococcosis with a favorable outcome is reported. A universal fungal PCR enabled this diagnosis, while the initial serological analysis remained noncontributive.

Inoperable Cerebral Alveolar Echinococcosis Controlled With High Dosages of Albendazole Adjusted With Monitoring of Blood Levels

Cerebral alveolar echinococcosis (AE) is a rare and difficult-to-treat zoonosis caused by Echinococcus multilocularis. A 29-year-old immigrant from Siberia with a past history of hepatic AE, presented with acute onset of grand mal seizures, weakness of the left leg, and cephalgia. Magnetic resonance imaging of the brain revealed inoperable right-sided infiltrative lesions, suggesting cerebral AE. Despite anthelmintic treatment only slow improvement occurred.

Surgical treatment options for cerebral alveolar echinococcosis: Experience in six patients

Cerebral alveolar echinococcosis (AE) is a rare but lethal parasitic disease. Its pathogenesis remains poorly understood. Currently there is no widely accepted methods for its surgical treatment. To discuss the surgical treatment options. Hospital-based observational study. Patients who had surgery for cerebral AE during 2001 and 2007 were the subjects of the study. According to the lesion location and volume, patients have been allocated to either massive resection group or radical piecemeal resection group. Postoperatively, all patients received long-term aldendazole therapy in view of the associated hepatic involvement and were follow-up in the clinic. Of the six patients with cerebral AE who were operated during the study period, four had massive resection and two had radical piece meal resection. None of the patients had postoperative neurological worsening and there was improvement in the neurological status in all the patients except for the patient with blindness. Of the 4 patients in massive resection group, two patients died during the follow-up, one because of liver failure and the other due to hydrocephalus. The remaining four patients were back to their normal activities and none had recurrence of the disease during the follow-up. Although radical massive resection is generally regarded as the surgical method treatment for cerebral AE, radical piecemeal resection can be a reasonable, effective alternative management option, especially when massive resection might result in unavoidable morbidity and mortality.

Experimental infection of larval Echinococcus multilocularis in the rodent brain as a model for cerebral alveolar echinococcosis.

Experimental infection of larval Echinococcus multilocularis in the rodent brain was attempted to establish a murine model for cerebral alveolar echinococcosis. Balb/c mice and jirds were injected intracranially with 10% of a homogenated hydatid cyst mass. Small cystic larvae were observed macroscopically in the cranial cavity 1, 2 and 5 months post-infection in both mice and jirds. Some larval cysts from both rodents contained mature or immature protoscoleces. In mice, the laminated layer was found in the lateral ventricle 2 months post-infection but without protoscoleces. At five months post-infection, larger larval cysts were found in the cranial cavity of a mouse, which also demonstrated partial palsy of the legs. A laminated layer with mature protoscoleces was observed in the third ventricle and the mouse also harboured, in the left lung, a larval cyst containing protoscoleces surrounded by lymphocytes. Jirds were also found to be infected with metacestodes in the cranial cavity, but neither unusual behaviour nor establishment of cysts inside the brain was observed in jirds during the course of infection.

Cerebral alveolar echinococcosis treated with albendazole

Cerebral alveolar echinococcosis treated with albendazole