Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
World Neurosurg. 2010 Dec;74(6):661-70. doi: 10.1016/j.wneu.2010.06.017.
To study the neuroimaging features of craniocerebral aspergillosis infection in immunocompetent patients.
The clinical and imaging data of 12 patients of aspergillus fungal infection were retrospectively reviewed. Diagnosis of fungal infection was confirmed by histopathologic examination of surgically excised specimen, stereotactic biopsy material, or endoscopic sinus biopsy. The radiologic studies were evaluated for anatomic distribution of lesions, signal intensity, contrast enhancement, presence of hemorrhage, diffusion restriction, perfusion, and spectroscopy characteristics. Medical records, biopsy reports, and autopsy findings were also reviewed.
Twelve cases of aspergillosis infections in immunocompetent patients were diagnosed at our hospital over a period of 10 years. Lesions could be classified based on imaging of lesions of sinonasal origin, intracranial mass lesion including both parenchymal or extraparenchymal meningeal based and stroke. Coexisting meningitis was also noted in one patient. Disease of sinonasal origin commonly showed invasion of the cavernous sinus and orbital apex resulting in visual symptoms and multiple cranial nerve palsies. Intracranial mass lesions without sinonasal involvement were seen in five cases that included isolated parenchymal lesion in two patients and dural-based mass lesions in three patients. Isolated intraparenchymal lesions included two cases of fungal cerebritis. Dural-based lesions were large granulomas with a significant mass effect. Infarcts were seen in three patients and angiography showed vessel narrowing or occlusion in all the three patients. CT demonstrated isodense to hyperdense attenuation of primary sinus disease with evidence of bone destruction in all the cases of sinonasal origin. Primary parenchymal lesions showed heterogenous attenuation with predominantly low-density areas. Dural-based lesions showed isodense to hyperdense attenuation. Magnetic resonance imaging revealed isointense to hypointense signal intensity on both T(1)-weighted (T1W) and T(2)-weighted (T2W) images in all lesions of sinonasal origin and isolated dural-based mass lesions. Primary parenchymal lesions showed heterogenous signal intensity pattern with predominantly hypointense signal on T1W and hyperintense signal on T2W images. Diffusion weighted imaging, magnetic resonance spectroscopy, and perfusion-weighted imaging gave valuable ancillary information in these cases.
Sinonasal disease with intracranial extension is the commonest pattern of aspergillus infection followed by intracranial mass lesions. Hyperdense sinonasal disease with bone destruction and intracranial extension on computed tomography, hypointense signal intensity of the lesions on T2W magnetic resonance images, presence of areas of restricted diffusion, decreased perfusion on perfusion-weighted imaging, and presence of hemorrhages are key to the imaging diagnosis of fungal infection.
研究免疫功能正常患者的脑颅曲霉菌病感染的神经影像学特征。
回顾性分析了 12 例曲霉菌真菌感染患者的临床和影像学资料。通过手术切除标本、立体定向活检材料或鼻内镜活检的组织病理学检查来确诊真菌感染。对病变的解剖分布、信号强度、对比增强、出血、弥散受限、灌注和波谱特征进行了影像学评估。还回顾了病历、活检报告和尸检结果。
在过去的 10 年中，我院共诊断出 12 例免疫功能正常患者的曲霉菌感染。根据病变的影像学表现，可将病变分为鼻-鼻窦来源、颅内肿块病变（包括实质或实质外脑膜病变）和中风。一名患者还同时伴有脑膜炎。鼻-鼻窦来源的疾病常侵犯海绵窦和眶尖，导致视力症状和多颅神经麻痹。无鼻-鼻窦受累的颅内肿块病变见于 5 例，其中 2 例为孤立性实质病变，3 例为硬脑膜病变。孤立性脑实质病变包括 2 例真菌性脑膜脑炎。硬脑膜病变为大的肉芽肿，有明显的肿块效应。3 例患者出现梗死，所有 3 例患者的血管造影均显示血管狭窄或闭塞。CT 显示所有鼻窦来源的原发性疾病为等密度至高密度衰减，所有病例均有骨破坏证据。原发性实质病变表现为混杂衰减，主要为低密度区。硬脑膜病变呈等密度至高密度衰减。磁共振成像（MRI）显示所有鼻-鼻窦来源的病变和孤立的硬脑膜病变在 T1 加权（T1W）和 T2 加权（T2W）图像上均为等信号强度到低信号强度。原发性实质病变的信号强度呈混杂模式，T1W 图像上以低信号强度为主，T2W 图像上以高信号强度为主。弥散加权成像、磁共振波谱和灌注加权成像为这些病例提供了有价值的辅助信息。
鼻窦疾病伴颅内延伸是曲霉菌感染最常见的模式，其次是颅内肿块病变。鼻窦疾病的高密度衰减伴骨破坏和颅内延伸，CT 上的颅内延伸，T2W MRI 上病变的低信号强度，弥散受限区域的存在，灌注加权成像上的灌注减少，以及出血是真菌感染影像学诊断的关键。
