Cerebral Toxoplasmosis
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Findings
MR brain study reveals a fairly well defined lesion appearing isointense on T1 and heterointense on T2 and FLAIR in a parasagittal location in the right frontal lobe adjacent to the falx cerebri. The lesion measures 3x3.1x3.5 cm in CS and CC dimensions.
There is minimal surrounding edema or mass effect. On DWI, the lesion does not show significant restricted diffusion. On SWI, the lesion does not show any susceptibility artefacts. On post contrast study, the lesion shows smooth peripheral rim enhancement.
There is also thickened enhancement of the adjacent falx.
On MRSI, the lesion shows a prominent lipid-lactate peak and reduced Cho, Cr and NAA. On perfusion studies, the lesion does not show raised rCBV.
On post contrast T1WI, there is also leptomeningeal enhancement noted asymmetrically over bilateral cerebral hemispheres (left>right), including the sylvian fissures and basal cisterns.
There is minimal surrounding edema or mass effect. On DWI, the lesion does not show significant restricted diffusion. On SWI, the lesion does not show any susceptibility artefacts. On post contrast study, the lesion shows smooth peripheral rim enhancement.
There is also thickened enhancement of the adjacent falx.
On MRSI, the lesion shows a prominent lipid-lactate peak and reduced Cho, Cr and NAA. On perfusion studies, the lesion does not show raised rCBV.
On post contrast T1WI, there is also leptomeningeal enhancement noted asymmetrically over bilateral cerebral hemispheres (left>right), including the sylvian fissures and basal cisterns.
Diagnosis
MR Brain study reveals a well defined rim enhancing lesion in the right frontal lobe without surrounding oedema, diffusion restriction and MRSI, perfMR and other features as described in the text, possibly suggestive of cerebral toxoplasmosis. There is also asymmetrical generalised leptomeningeal enhancement, suggestive of meningitis.
Dr. Zohaib Hussain MD is a Consultant Radiologist from Lakhimpur with experience of 3-5 years post-graduated from Gauhati Medical College, Guwahati. Specialized in Reporting of X-RAYS , CT-SCAN , MRI , MAMMOGRAM , NUCLEAR-MEDICINE cases with expertise in Neuro-imaging , Spine-imaging , Pediatrics-imaging , Trauma , Stroke-imaging
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