Finelli Pasquale F, Gleeson Evelyn, Ciesielski Thomas, Uphoff Dean F
Department of Neurology, Hartford Hospital, University of Connecticut School of Medicine, Hartford CT 06102, USA.
Neurologist. 2010 Nov;16(6):364-7. doi: 10.1097/NRL.0b013e3181b47001.
BACKGROUND/PURPOSE: Target lesions on diffusion-weighted imaging are uncommon and their significance not well appreciated. To assess the diagnostic value of this neuroimaging finding, a case of cerebral aspergillosis is presented and the literature reviewed.
The diffusion-weighted magnetic resonance imaging features of target lesions in a case of cerebral aspergillosis with neuropathologic correlate is presented and 8 other cases manifesting this neuroimaging finding are reviewed for etiology, patient immune status, lesion number, enhancement, and location.
The etiologies included cerebral aspergillosis, Balo concentric sclerosis, and acute necrotizing encephalopathy. The cerebral aspergillosis cases were immunocompromised with multiple lesions in 4 of 5 patients. The acute necrotizing encephalopathy and Balo concentric sclerosis patients were immunocompetent with bilateral thalamic lesions in the former and multiple random or solitary lesions in the later. Enhancement was seen in 5 patients.
Target lesions on diffusion-weighted imaging are compelling for a diagnosis of cerebral aspergillosis in immunocompromised patients and for acute necrotizing encephalopathy in immunocompetent patients when lesions are bilateral thalamic and Balo concentric sclerosis when white matter is involved.
背景/目的：扩散加权成像上的靶病变并不常见，其意义尚未得到充分认识。为评估这一神经影像学表现的诊断价值，本文报告1例脑曲霉病病例并复习相关文献。
报告1例具有神经病理学相关性的脑曲霉病靶病变的扩散加权磁共振成像特征，并复习另外8例表现出这一神经影像学表现的病例的病因、患者免疫状态、病变数量、强化情况及位置。
病因包括脑曲霉病、巴洛同心性硬化和急性坏死性脑病。脑曲霉病患者均免疫功能低下，5例中有4例有多个病变。急性坏死性脑病和巴洛同心性硬化患者免疫功能正常，前者双侧丘脑有病变，后者有多个随机或孤立病变。5例患者可见强化。
扩散加权成像上的靶病变对于免疫功能低下患者的脑曲霉病诊断、免疫功能正常患者双侧丘脑病变时的急性坏死性脑病诊断以及白质受累时的巴洛同心性硬化诊断具有重要提示意义。
