Al wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
Metropolitan Hospital Center, New York Medical College, NY, USA.
J Neuroradiol. 2018 May;45(3):169-176. doi: 10.1016/j.neurad.2017.11.001. Epub 2017 Dec 19.
CNS Aspergillosis is very rare and difficult to diagnose clinically and on imaging. Our objective was to elucidate distinct neuroimaging pattern of CNS aspergillosis in the immunocompetent population that helps to differentiate from other differential diagnosis.
Retrospective analysis of brain imaging findings was performed in eight proven cases of central nervous system aspergillosis in immunocompetent patients. Immunocompetent status was screened with clinical and radiological information. Cases were evaluated for anatomical distribution, T1 and T2 signal pattern in MRI and attenuation characteristics in CT scan, post-contrast enhancement pattern, internal inhomogeneity, vascular involvement, calvarial involvement and concomitant paranasal, cavernous sinus or orbital extension. All patients were operated and diagnosis was confirmed on histopathology.
The age range was 19-50 years with mean age of 33.7 years. Concomitant sinonasal disease was seen in six patients (75%). Three patients had orbital extensions. Most of the lesions (n=7) were profoundly hypointense in T2-weighted imaging. The most common enhancement pattern was bright, solid and homogenous enhancement (n=7). Cavernous extension with ICA encasement was always associated with paranasal sinus disease. Six patients showed demineralization or complete resorption of involved bone. All of the fungal masses appear hyperdense on available CT scan images.
CNS aspergillus infection in immunocompetent patients has distinct imaging features as compared to CNS aspergillosis in immunocompromised patients. A high index of suspicion in proper clinical settings, even with immunocompetent status and typical imaging features allow us to diagnose CNS aspergillosis in such patients.
中枢神经系统曲霉病非常罕见，临床上和影像学诊断都很困难。我们的目的是阐明免疫功能正常人群中中枢神经系统曲霉病的独特神经影像学模式，以帮助与其他鉴别诊断区分开来。
对 8 例免疫功能正常的中枢神经系统曲霉病患者的脑部影像学表现进行回顾性分析。通过临床和影像学信息筛选免疫功能正常状态。评估病例的解剖分布、MRI 上的 T1 和 T2 信号模式以及 CT 扫描中的衰减特征、对比后增强模式、内部不均匀性、血管受累、颅骨受累以及同时存在的鼻旁、海绵窦或眼眶延伸。所有患者均接受手术治疗，并通过组织病理学证实诊断。
年龄范围为 19-50 岁，平均年龄为 33.7 岁。6 例患者（75%）同时存在鼻旁疾病。3 例患者有眼眶延伸。大多数病变（n=7）在 T2 加权成像中呈明显低信号。最常见的增强模式为明亮、坚实和均匀的增强（n=7）。海绵窦延伸伴颈内动脉包绕总是与鼻旁窦疾病相关。6 例患者显示受累骨的脱矿化或完全吸收。所有真菌肿块在现有 CT 扫描图像上均呈高密度。
与免疫功能低下患者的中枢神经系统曲霉病相比，免疫功能正常患者的中枢神经系统曲霉感染具有独特的影像学特征。在适当的临床环境中，即使存在免疫功能正常状态和典型的影像学特征，也应高度怀疑，从而在这些患者中诊断中枢神经系统曲霉病。
