MRI in Cerebral Schistosomiasis: Characteristic Nodular Enhancement in 33 Patients

Abstract

Cerebral infection with S. japonicum can cause a characteristic MRI pattern of a large mass comprising multiple intensely enhancing nodules, sometimes with areas of linear enhancement. The typical appearance may be useful for diagnosis in endemic regions and may potentially be useful in cases imported into countries in which the disease is not endemic.

Cerebral neuroschistosomiasis: a rare clinical presentation and review of the literature

“…The typical image findings of neuroschistosomiasis are one or several grouped hyperintense lesions with punctuate or nodular enhancement (arborised pattern) and a heterogeneous internal structure surrounded by oedema with marked mass effect 12 , 13. In a recent review of 33 patients with cerebral schistosomiasis,14 MRI scans showed a characteristic pattern of a single or multiple lesions compromising multiple intensely enhancing nodules, sometimes with areas of linear enhancement. This characteristic pattern of clustered nodular enhancement may be useful for non-invasive diagnosis and to avoid unnecessary surgery 14.…”

Neuroschistosomiasis mansoni

“…MR of the spinal cord can show enlargement of the middle and lower thoracic spinal cord in the acute phase on T1-weighted images, hyperintense areas on the T2-weighted sequence, heterogeneous areas of intramedullary contrast enhancement following intravenous gadolinium injection on T1-weighted sequence, and swelling of the conus medullaris with irregular enhancement. 66,75,76 Previous reports have described a similar variable enhancement pattern, using such terms as diffuse, spotty, or nodular. 77,78 In 1998, Bennett and Provenzale 78 described a nodular, peripheral spinal enhancement without a linear central enhancement.…”

Neuroschistosomiasis

“…MRI can show inflammatory granulomas in the cerebral cortex with heterogeneous enhancement of gadolinium contrast, and are surrounded by variable degrees of edema ( Figure 1) [25,26]. Brain MRI findings are unspecific, so a wide list of conditions should be considered in the differential diagnosis of neuroschistosomiasis (Box 1).…”