Neuroimaging of Cryptococcal Meningitis in Patients without Human Immunodeficiency Virus: Data from a Multi-Center Cohort Study

Abstract

Background: A clearer understanding is needed about the use of brain MRI in non-HIV patients with cryptococcal meningitis. Methods: Cerebral CT and MRI were studied in 62 patients in a multicenter study of cryptococcal meningitis in non-HIV patients. CT was performed in 51 and MRI in 44. MRI results are reported for the images read at NIH for 29 of the 44 patients. CT reports obtained from the original REDCap database were added to calculate the incidence of normal findings. Results: CTs were read as normal in 24 of 51 (47%), MRIs were normal in 10% (three of 29). The most characteristic lesions of cryptococcal meningitis on MRI were small basal ganglia lesions representing dilated perivascular spaces in 24% and basal ganglia lesions with restricted diffusion (infarcts) in 38%. In the 18 patients who received contrast, contrast-enhancing lesions, likely representing masses of cryptococci and inflammatory cells, were found in the basal ganglia in 22% and elsewhere in the brain in 22%. Meningeal enhancement was seen in 56%, ependymal enhancement in 24%, and choroid plexus enhancement in 11%. Hydrocephalus was found in five (18%), though increased intacranial pressure was not detected. Suboptimal imaging (n = 6), lack of contrast administration (n = 11) and lack of follow-up, however, markedly limited the accurate assessment of abnormalities in multiple cases. Conclusion: MRI characteristics of non-HIV cryptococcal meningitis include hydrocephalus, meningeal and ependymal enhancement and basal ganglia lesions. Optimal imaging is, however, necessary to maximize the diagnostic and prognostic usefulness of MRI.

A Retrospective Analysis of Central and Peripheral Metabolic Characteristics in Patients with Cryptococcal Meningitis

“…Based on the imaging of the brain, we found that patients with CM with structural damage of the brain accounted for 60%, while patients with CM with non-structural damage of the brain accounted for 40%. This result is fairly different from the studies of Zhong et al [ 11 ] and Anjum et al [ 12 ], possibly due to regional and population differences. The levels of CSF-protein are considered an indicator of the severity of inflammation in the brain [ 49 ].…”

“…Previous studies have identified two stages of pathogenic microorganism-induced CNS damage, where the first stage involves metabolic disorders [ 7 – 9 ], while the second involves structural lesions [ 10 ]. As per the results of previous experiments, structural damage of the brain was observed in 86.84–90.00% of patients with CM, while no structural damage of the brain was observed in the remaining patients [ 11 , 12 ]. Zhong et al demonstrated that the brain structure of patients with CM was normal in the early stage, manifesting only a few symptoms of nerve damage, followed by gradually appearing imaging changes, namely, structural damage [ 11 ].…”

Intracranial granulomatous inflammation caused by cryptococcal infection: a case study and literature analysis

“…When patients present with symptoms similar to those of cryptococcal intracranial infections, radiologic imaging should be performed to examine the intracranial situation, with MRI being more valuable than CT in this regard ( 11 ). The imaging manifestations of intracranial cryptococcal infection are diverse, including dilated Virchow-Robin (V-R) spaces and pseudocysts, cryptococcal granulomas (cryptococcomas), cornified nodules or patchy signals, meningitis with edema, and meningeal enhancement ( 12 , 13 ).…”

Preclinical Models for Cryptococcosis of the CNS and Their Characterization Using In Vivo Imaging Techniques

“…The most commonly used imaging techniques in the central nervous system include computed tomography (CT), magnetic resonance imaging (MRI), and methods using radioactive tracers like positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Existing clinical imaging modalities provide rapid and reliable assessment of brain disorders; however, they are often not specific to infections of the CNS [217,218]. As animal models are a valuable tool to understand the underlying mechanisms of CNS infections, non-invasive imaging of animal models has evolved into an important research tool in the biomedical sciences.…”