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MRI in Cerebral Schistosomiasis: Characteristic Nodular Enhancement in 33 Patients

¹ Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd., Shanghai, P.R. China, 200040.
² Department of Neuroradiology, National Neuroscience Institute, Singapore.
³ Department of Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴ Department of MRI, Yijishan Hospital, Wannan Medical College, Wuhu, P.R. China.

View larger version (182K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —47-year-old woman with cerebral schistosomiasis and 2-week history of headache and seizures. Sagittal T2-weighted (A) and axial T1-weighted (B) MR images show prominent vasogenic edema in frontal and parietal lobes, with well-defined deep surface and fingerlike projections (arrow, A) into subcortical white matter.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —47-year-old woman with cerebral schistosomiasis and 2-week history of headache and seizures. Sagittal T2-weighted (A) and axial T1-weighted (B) MR images show prominent vasogenic edema in frontal and parietal lobes, with well-defined deep surface and fingerlike projections (arrow, A) into subcortical white matter.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —47-year-old woman with cerebral schistosomiasis and 2-week history of headache and seizures. Axial (C) and coronal (D) T1-weighted images after IV administration of contrast material show multiple intensely enhancing small nodules, 1–3 mm in diameter (arrows), clustered closely together. Second cluster in right frontal lobe superiorly is poorly seen because of partial volume effects.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —47-year-old woman with cerebral schistosomiasis and 2-week history of headache and seizures. Axial (C) and coronal (D) T1-weighted images after IV administration of contrast material show multiple intensely enhancing small nodules, 1–3 mm in diameter (arrows), clustered closely together. Second cluster in right frontal lobe superiorly is poorly seen because of partial volume effects.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —67-year-old woman with headache and seizures for 1 week. Axial contrast-enhanced MR images show large confluent enhancing mass (arrows) in left frontal lobe and multiple small nodules in periphery (arrowheads).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —67-year-old woman with headache and seizures for 1 week. Axial contrast-enhanced MR images show large confluent enhancing mass (arrows) in left frontal lobe and multiple small nodules in periphery (arrowheads).

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —13-year-old boy with headache and seizures for 1 week. Axial (A) and sagittal (B) contrast-enhanced MR images show multiple discrete enhancing nodules (arrows) clustered around area of central linear enhancement (arrowheads).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —13-year-old boy with headache and seizures for 1 week. Axial (A) and sagittal (B) contrast-enhanced MR images show multiple discrete enhancing nodules (arrows) clustered around area of central linear enhancement (arrowheads).

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —51-year-old man with cerebral schistosomiasis and 4-week history of right hand jerking. Photomicrograph of histologic section shows granuloma formation around characteristic Schistosoma japonicum ova (arrows). Note absence of protruding spines, unlike other schistosomal species. (H and E, x200)

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —52-year-old man with 8-week history of headache and right hemianopia. FLAIR (A) and coronal contrast-enhanced (B) MR images show enhancing nodules (arrow, B) surrounded by vasogenic edema in left occipital, parietal, and bilateral frontal lobes.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —52-year-old man with 8-week history of headache and right hemianopia. FLAIR (A) and coronal contrast-enhanced (B) MR images show enhancing nodules (arrow, B) surrounded by vasogenic edema in left occipital, parietal, and bilateral frontal lobes.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —52-year-old man with 8-week history of headache and right hemianopia. Two months after treatment, images corresponding to A and B show near-complete resolution of abnormal FLAIR signal and enhancement.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —52-year-old man with 8-week history of headache and right hemianopia. Two months after treatment, images corresponding to A and B show near-complete resolution of abnormal FLAIR signal and enhancement.

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