The role of 3D volumetric MR sequences in diagnosing intraventricular neurocysticercosis: preliminar results

Abstract

Objective: The purpose of this paper was to investigate the role of two three-dimensional magnetic resonance (MRI) sequences: enhanced spoiled gradient recalled echo (SPGR), and fast imaging employing steady-state acquisition (FIESTA) in the evaluation of intraventricular neurocysticercosis cysts and scolices. Method: Seven neurocysticercosis patients suspected of presenting intraventricular lesions were evaluated by magnetic resonance imaging using enhanced SPGR, and FIESTA. Results: Enhanced SPGR detected eight cystic lesions, with scolices in four. Contrast enhancement was observed in three cysts. FIESTA also detected eight cystic lesions with the presence of scolices in seven of those cystic lesions. Four patients presented parenchymal involvement, while the remaining three presented the racemose form. Conclusion: FIESTA and SPGR are sequences that can detect intraventricular cysts of neurocysticercosis, and FIESTA also is good for the detection of the scolex. Considering this information we suggest that FIESTA and SPGR should be included in the MRI protocol for the investigation of intraventricular neurocysticercosis. Key words: intraventricular neurocysticercosis, magnetic resonance imaging, FIESTA, SPGR.Papel das sequencias volumétricas 3D de RM no diagnóstico da neurocisticercose intraventricular: resultados preliminares RESUMO Objetivo: O objetivo deste trabalho foi investigar o papel de duas sequências de ressonância magnética (RM) volumétricas tridimensionais: spoiled gradient recalled echo (SPGR) pós-contraste e fast imaging employing steady-state acquisition (FIESTA) na avaliação de cistos e escólex na neurocisticercose intraventricular. Método: Sete pacientes suspeitos de neurocisticercose intraventricular foram avaliados pela ressonância magnética com SPGR pós-contraste e FIESTA. Resultados: SPGR pós-contraste evidenciou oito lesões císticas com presença de escólex em quatro. Realce foi observado em três destes cistos. FIESTA também detectou oito lesões císticas, com presença de escólex em sete destas lesões. Envolvimento do parênquima cerebral foi observado em quatro pacientes e forma racemosa em três. Conclusão: FIESTA e SPGR são sequências que permitem a detecção de cistos intraventriculares de neurocisticercose e FIESTA é uma boa sequência para a detecção de escólex. Considerando estes achados nós sugerimos que estas sequências (FIESTA e SPGR) devam ser incluídas no protocolo de RM na investigação de neurocisticercose intraventricular. Palavras-chave: neurocisticercose intraventricular, ressonância magnética, FIESTA, SPGR.

Cysticerci located in the fourth ventricle causing obstructive hydrocephalus: a radiological emergency requiring prompt diagnosis

“…The intraventricular form of NCC is the less prevalent form and occurs preferentially in the fourth ventricle, which frequently leads to acute obstructive hydrocephalus, intracranial hypertension, and consequent sudden death (2) . It is essential to include three-dimensional sequences in the MRI protocol to investigate intraventricular NCC because the cystic lesions and scolex within can be accurately detected (3) . In this dangerous form of NCC, the presumptive diagnosis should be suggested using MRI findings, and the patient should be treated promptly to avoid neurological sequelae.…”

Clinical Diagnoses of Neurocysticercosis

“…mural nodule, depicting the scolex, in the interior of some vesicular cysts (Figure 1). It is better seen on fluid attenuated inversion recovery (FLAIR) sequence [35]. As the cyst degenerates, the CT scan shows an annular or nodular enhancement surrounded by perilesional edema.…”

“…Extraparenchymal NCC is more difficult to detect by imaging because the attenuation and signal intensity of the cyst's content is similar to that of CSF, the cystic wall is usually very thin and the cysts lack frequently of a scolex and generally not enhanced after contrast administration. In these cases, new MRI techniques such as fluid attenuated inversion recovery (FLAIR) and fast imaging employing steady-state acquisition (FIESTA) sequences, that seems to permit a better diagnosis (34)(35)(36) (Figure 2) . A common neuroimaging finding is hydrocephalus related to inflammatory occlusion of Luschka and Magendie foramina and C A B D basal fibrous arachnoiditis [36].…”

Reduced Diffusion in Neurocysticercosis: Circumstances of Appearance and Possible Natural History Implications

“…[3][4][5] In this regard, advanced MR imaging techniques have been used in an attempt to increase overall accuracy. [7][8][9] DWI has been extensively used in various settings besides its primary clinical use in acute stroke. For example, DWI may be implemented in differentiating brain abscess and tumor 10,11 or in differentiating epidermoid and arachnoid cysts.…”