Conglomerate ring-enhancing lesions are common in solitary neurocysticercosis and do not always suggest neurotuberculosis

Abstract

Background and Purpose:Differentiating between neurocysticercosis (NCC) and neurotuberculosis has serious therapeutic implications and this distinction relies heavily on neuroimaging. Few case reports discuss the conglomeration of ring-enhancing lesions (RELs) in patients with solitary NCC. The aim of our study is to describe the imaging findings of conglomerate RELs in a cohort of patients with solitary NCC, emphasizing the frequency of conglomeration.Materials and Methods:This retrospective study included 100 patients with solitary NCC. Two neuroradiologists analyzed contrast-enhanced computed tomography (CT) images regarding morphology, enhancement pattern, location, number of lesions, and degree of perilesional edema. The solitary lesions were classified as solitary discrete RELs (SD-RELs) when a well-defined lesion was seen and solitary conglomerate RELs (SC-RELs) when two or more ring lesions or ring/rings plus disc lesions were present contiguously. Follow-up CT scans were evaluated for the resolution of lesions and surrounding edema.Results:Out of 100 patients, 42 were SD-RELs and 58 were SC-RELs. No statistically significant difference was found between both groups in terms of age of presentation, clinical presentation, lesion size and location, and degree of perilesional edema. Larger lesions (>10 mm) were more likely to show scolex and were associated with greater degree of edema in both subgroups. During follow-up, 13 patients had new lesions (SD-RELs-5, SC-RELs-8). In SD-RELs, follow-up lesions were in the same location in four patients and new location in one; and in SC-RELs, lesions were in the same location in seven and in new location in one case.Conclusion:Conglomeration of RELs is a common finding in patients with solitary NCC.

Utility of Clinical and Radiological Markers in Diagnosing Cerebral Tuberculoma and Neurocysticercosis

“…21 Garg et al, in a similar study of NCC cases, reported 96% of the lesion distribution to be supratentorial, 3% to be brainstem, and 1% to be cerebellar. 24 Observations from these studies including ours show that tuberculomas tend to have a higher prevalence of infratentorial distribution than NCCs.…”

Complex neurocysticercosis lesions on imaging: Explained through correlative histomorphology

“…Previously considered unusual, Garg et al recently highlighted such phenotype in more than half of their cases on CT scans. [10][11][12]15 Epidemiologically, tuberculosis is also prevalent in NCC endemic populations. Tuberculomas also present similarly on imaging with only a minority of cases having other supporting features outside CNS.…”

“…We frequently encounter such atypical phenotype in solitary NCC and other centers have similar experience. [10][11][12] Apart from tuberculosis, such morphology also needs exclusion of other possibilities like non-tubercular infections, demyelination and more importantly tumors. [10][11][12][13][14][15] This may cause delay in starting or disruption of ongoing cysticidal treatment, initiation of anti-tubercular treatment (ATT) or even lead to brain biopsy to rule out a neoplasm.…”

“…[10][11][12] Apart from tuberculosis, such morphology also needs exclusion of other possibilities like non-tubercular infections, demyelination and more importantly tumors. [10][11][12][13][14][15] This may cause delay in starting or disruption of ongoing cysticidal treatment, initiation of anti-tubercular treatment (ATT) or even lead to brain biopsy to rule out a neoplasm. 12 There is scanty literature on early degenerative changes in the parasite, specifically in description of radiohistopathological equivalents, as lesion resection is seldom performed.…”

A Neurocysticercosis Infestation Masquerading as Malignant Brain Tumour

“…which unusual in NCC. [ 4 ] Conglomerate NCC are common presentation of single NCC lesion[ 5 ] and these may become more than 2.5 cm in size, mimicking giant NCC lesions, which is a rare form of NCC. [ 6 ] Most giant NCC lesions are cysts located in cisterns and may be associated with perilesional edema in adjacent brain parenchyma.…”