Cerebral toxoplasmosis: case review and description of a new imaging sign

Masamed, Rinat; Meleis, Ahmed; Lee, E.W.; Hathout, Gasser M.

doi:10.1016/j.crad.2008.09.016

Cited by 52 publications

(48 citation statements)

References 11 publications

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“…8,9 A highly specific, but relatively insensitive finding for cerebral toxoplasmosis, seen in less than 30 % of cases, is an asymmetric target sign, exhibiting an off-centre nodular lesion along the wall of the enhancing rim. 8,10 Our patient had multiple parenchymal lesions on MRI with only moderate enhancement and surrounding edema. In patients on immunosup- pressant therapy, such as those after bone marrow transplant (BMT), cerebral toxoplasmosis may manifest differently than in patients with HIV/ AIDS.…”

Section: Discussionmentioning

confidence: 64%

“…Features suggestive of cerebral toxoplasmosis are subcortical location, multiplicity, and asymmetric target sign. 8,10 In addition to standard MR imaging, MR spectroscopy, perfusion and diffusion MRI, thallium-201 SPECT or 18F-FDG PET/CT 8,[12][13][14] can be of further aid in distinguishing cerebral toxoplasmosis from lymphoma. 8,[12][13][14] On 18F-FDG/PET CT scan, which provides remarkable accuracy for detection, treatment monitoring and follow-up of patients with systemic lymphoma as well as of patients with primary central nervous system lymphoma 15 , the standardised uptake for cerebral lesions is much higher than in toxoplasma lesions 8 .…”

Section: Discussionmentioning

confidence: 99%

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Cerebral Toxoplasmosis in a Diffuse Large B Cell Lymphoma Patient

Savšek¹,

Opaskar²

2014

Radiology and Oncology

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Disclosure: No potential conflicts of interest were disclosed.Background. Toxoplasmosis is an opportunistic protozoal infection that has, until now, probably been an underestimated cause of encephalitis in patients with hematological malignancies, independent of stem cell or bone marrow transplant. T and B cell depleting regimens are probably an important risk factor for reactivation of a latent toxoplasma infection in these patients.Case report. We describe a 62-year-old HIV-negative right-handed Caucasian female with systemic diffuse large B cell lymphoma who presented with sudden onset of high fever, headache, altered mental status, ataxia and findings of pancytopenia, a few days after receiving her final, 8 th cycle of rituximab, cyclophosphamide, vincristine, doxorubicin, prednisolone (R-CHOP) chemotherapy regimen. A progression of lymphoma to the central nervous system was suspected. MRI of the head revealed multiple on T2 and fluid attenuated inversion recovery (FLAIR) hyperintense parenchymal lesions with mild surrounding edema, located in both cerebral and cerebellar hemispheres that demonstrated moderate gadolinium enhancement. The polymerase chain reaction on cerebrospinal fluid (CSF PCR) was positive for Toxoplasma gondii. The patient was diagnosed with toxoplasmic encephalitis and successfully treated with sulfadiazine, pyrimethamine and folic acid. Due to the need for maintenance therapy with rituximab for lymphoma remission, the patient now continues with secondary prophylaxis of toxoplasmosis.Conclusions. With this case report, we wish to emphasize the need to consider cerebral toxoplasmosis in patients with hematological malignancies on immunosuppressive therapy when presenting with new neurologic deficits. In such patients, there are numerous differential diagnoses for cerebral toxoplasmosis, and the CNS lymphoma is the most difficult among all to distinguish it from. If left untreated, cerebral toxoplasmosis has a high mortality rate; therefore early recognition and treatment are of essential importance.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Cerebral Toxoplasmosis in a Diffuse Large B Cell Lymphoma Patient

Savšek¹,

Opaskar²

2014

Radiology and Oncology

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“…The "eccentric target" sign (Fig 22), if noted, is a very suggestive and typical pattern, although not very frequently seen. [38][39][40] CNS toxoplasmosis is the most common infection and the most common opportunistic space-occupying lesion in patients with HIV and/or AIDS, with lymphoma being the most important differential diagnosis. Some advanced imaging techniques may be used to differentiate toxoplasmosis from primary CNS lymphoma, such as dynamic perfusion MR, MR spectroscopy, DWI, and 18 F-FDG PET.…”

Section: Toxoplasmosismentioning

confidence: 99%

Multidisciplinary Approach to Tropical and Subtropical Infectious Diseases: Imaging with Pathologic Correlation

Hanagandi¹,

Gonçalves²,

Amaral³

et al. 2015

neurograph

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“…A more recently described sign in cerebral toxoplasmosis is the “concentric target sign” on T2W MRI, which has alternating concentric layers of T2W hypo‐ and hyperintensities, believed to be more specific for cerebral toxoplasmosis . Herein we describe the histopathological correlate of the “concentric T2 target sign” by comparing the imaging findings with large whole‐mount histopathological sections of the lesions in an autopsied case of cerebral toxoplasmosis with AIDS.…”

mentioning

confidence: 92%

Neuropathological correlate of the “concentric target sign” in MRI of HIV‐associated cerebral toxoplasmosis

Mahadevan

Ramalingaiah

Satishchandra

et al. 2013

Magnetic Resonance Imaging

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Cerebral toxoplasmosis is a frequent cause of focal brain lesions in the setting of immunodeficiency states, particularly the acquired immune deficiency syndrome (AIDS) and MR imaging is an important diagnostic modality to differentiate toxoplasmosis from tuberculoma, and primary central nervous system lymphoma with diverse therapeutic implications. Several imaging patterns have been described in cerebral toxoplasmosis. The “concentric target sign” is a recently described MRI sign on T2 weighted imaging of cerebral toxoplasmosis that has concentric alternating zones of hypo- and hyper intensities. It is believed to be more specific than the well known “eccentric target sign” in the diagnosis of cerebral toxoplasmosis and hence more useful in differentiation from other focal brain lesions in the context of AIDS. The concentric target sign, seen in deep parenchymal lesions is distinct from the surface based cortical “eccentric” target sign. The histopathological correlate of the latter has been recently described, but that of the concentric target sign is not known. In this study, we describe the neuropathological correlate of this “concentric target sign”, following post-mortem of a 40 year old man with AIDS associated cerebral toxoplasmosis. The concentric alternating zones of hypo/hyper/iso/and hyper intensities corresponded to zones of hemorrhage/fibrin rich necrosis with edema/coagulative compact necrosis/inflammation with foamy histiocytes admixed with hemorrhage forming the outer most zone respectively. The exclusive specificity of this sign in cerebral toxoplasmosis remains to be further elucidated.

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Cerebral toxoplasmosis: case review and description of a new imaging sign

Cited by 52 publications

References 11 publications

Cerebral Toxoplasmosis in a Diffuse Large B Cell Lymphoma Patient

Cerebral Toxoplasmosis in a Diffuse Large B Cell Lymphoma Patient

Multidisciplinary Approach to Tropical and Subtropical Infectious Diseases: Imaging with Pathologic Correlation

Neuropathological correlate of the “concentric target sign” in MRI of HIV‐associated cerebral toxoplasmosis

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