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Diffusion-Weighted MRI of Cerebral Toxoplasma Abscess

Crispina H. Chong-Han1, Selina C. Cortez2 and Glenn A. Tung1

1 Department of Diagnostic Imaging, Brown University School of Medicine, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.
2 Department of Pathology, Our Lady of Fatima Hospital, 200 High Service Ave., North Providence, RI 02904.



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  		Fig. 1A. —54-year-old man with cerebral toxoplasmosis that responded to treatment with sulfamethoxazole and trimethoprim. Axial enhanced T1-weighted image (TR/TE, 690/17) shows rim-enhancing mass in left inferior parietal lobe with eccentric central contrast enhancement.

 


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  		Fig. 1B. —54-year-old man with cerebral toxoplasmosis that responded to treatment with sulfamethoxazole and trimethoprim. Axial diffusion-weighted image shows that center of abscess is isointense (asterisk) and surrounding edema (arrow) is hyperintense.

 


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  		Fig. 1C. —54-year-old man with cerebral toxoplasmosis that responded to treatment with sulfamethoxazole and trimethoprim. Quantitative analysis of apparent diffusion coefficient (ADC) map image shows center of abscess (asterisk) has slightly greater ADC value (mean, 1.10 x 10–3 mm2/sec) than does contralateral white matter (mean, 0.85 x 10–3 mm2/sec). Mean ADC value of surrounding edema (arrow) is 1.64 x 10–3 mm2/sec, nearly twice that of normal white matter.

 


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  		Fig. 2A. —34-year-old woman with biopsy-proven Toxoplasma abscess. Axial contrast-enhanced T1-weighted image (TR/TE, 650/17) shows right frontal rim-enhancing mass (arrow) and smaller enhancing lesion in parietal lobe.

 


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  		Fig. 2B. —34-year-old woman with biopsy-proven Toxoplasma abscess. Apparent diffusion coefficient (ADC) map image shows diffusion in abscess core (asterisk) is increased (mean ADC, 2.13 x 10–3 mm2/sec) relative to unaffected white matter, whereas diffusion in abscess wall (straight arrow) is relatively decreased (mean ADC, 0.82 x 10–3 mm2/sec). Diffusion in edema (curved arrow) surrounding abscess is greater than that of unaffected white matter but lower than that of abscess core (mean ADC, 1.74 x 10–3 mm2/sec).

 


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  		Fig. 3A. —61-year-old man with biopsy-proven Toxoplasma abscess. Axial contrast-enhanced T1-weighted image (TR/TE, 700/17) shows peripherally enhancing mass (arrow) in left basal ganglia.

 


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  		Fig. 3B. —61-year-old man with biopsy-proven Toxoplasma abscess. Apparent diffusion coefficient (ADC) map image shows that signal intensity in abscess core tissue (asterisk; mean ADC, 1.15 x 10–3 mm2/sec) is qualitatively similar to that of right basal ganglia. ADC ratio was 1:4.

 


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  		Fig. 4A. —50-year-old man with biopsy-proven Toxoplasma abscess. Axial contrast-enhanced T1-weighted image (TR/TE, 650/17) shows 1.7-cm rim-enhancing lesion in left frontal lobe.

 


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  		Fig. 4B. —50-year-old man with biopsy-proven Toxoplasma abscess. On diffusion-weighted image, center of abscess (asterisk) is slightly hyperintense relative to unaffected white matter.

 


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  		Fig. 4C. —50-year-old man with biopsy-proven Toxoplasma abscess. Apparent diffusion coefficient (ADC) map image shows signal intensity of core of Toxoplasma abscess (asterisk; mean ADC, 0.69 x 10–3 mm2/sec) is equal to that of uninvolved white matter. ADC ratio was 1.1.

 


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  		Fig. 5A. —Photomicrographs of histopathologic specimens of cerebral Toxoplasma abscess in 50-year-old man. (H and E, magnification unknown) Center of abscess consists of necrotic tissue and inflammatory cells with karyorrhexis (curved arrow) and nuclear debris (straight arrow). Neither pus nor viable organisms are present.

 


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  		Fig. 5B. —Photomicrographs of histopathologic specimens of cerebral Toxoplasma abscess in 50-year-old man. (H and E, magnification unknown) Wall of abscess consists of viable acute inflammatory cells including macrophages and Toxoplasma tachyzoites (short arrow) and encysted bradyzoites (long arrow).

 

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