ObjectiveTo assess the magnetic resonance imaging (MRI) patterns associated with
central nervous system infection with Cryptococcus sp. in
relation to patient immune status.Materials and MethodsThis was a retrospective study of MRI data for 19 patients with
neurocryptococcosis who underwent the examination between January 2000 and
March 2014. The MRI characteristics examined included lesion topography,
aspects of diffusion, T1-weighted images, T2-weighted images, and contrast
enhancement patterns.ResultsIn all cases, cryptococcal infection was confirmed by cerebrospinal fluid
analysis. Of the 19 patients, 10 were immunocompromised and 9 were
immunocompetent. Abnormal imaging patterns occurred alone or in conjunction
with other manifestations. The imaging patterns found in immunocompromised
patients included the following: leptomeningeal enhancement, in 6;
pachymeningeal enhancement, in 3 (due to intracranial hypotension in 2);
perivascular space involvement, in 4; granulomas, in 2; hydrocephalus, in 2;
miliary nodules, in 1; and plexitis, in 1. In immunocompetent patients, the
following imaging patterns were observed: leptomeningeal enhancement, in 5;
perivascular space involvement, in 3; granulomas, in 3; cryptococcoma, in 1;
ventriculitis, in 1; and hydrocephalus, in 1. In 2 immunocompetent patients,
diffusion-weighted imaging showed diffusion restriction in cerebral
cryptococcal granuloma.ConclusionIn both groups, the most common imaging finding was leptomeningeal
enhancement, followed by dilatation of perivascular spaces with the presence
of mucoid material. Rare presentations, such as miliary nodules, plexitis,
ventriculitis, and pachymeningeal enhancement, were also observed. None of
the imaging patterns common to immunocompetent and immunocompromised
patients differed significantly in frequency between them.
