MRI findings and differential diagnosis in children with cerebral paragonimiasis

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• 作者：Zhen Zeng ; Gao-feng Zhang ; Chong Tian ; Chun-yan Ran ; Wen-fu Li ; Ya-nan Wang ; Ti-jiang Zhang ; ^{tijzhang@163.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Parasitic infection ; Cerebral paragonimiasis ; Magnetic resonance imaging ; Pediatric
• 刊名：Radiology of Infectious Diseases
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：3
• 期：2
• 页码：54-59
• 全文大小：1238 K

文摘

To analyze the clinical characteristics and MRI features of cerebral paragonimiasis in children.

Methods

Twenty-four patients (17 males and 7 females, ages: 5–14 years; mean age: 9.67 years) with cerebral paragonimiasis were recruited from June 2012 to December 2015. The diagnosis was confirmed by IgG enzyme-linked immunosorbent assays or pathologic examination. The clinical and MRI findings of all patients were analyzed retrospectively. Pre- and post-contrast MR imaging of the brain were performed using a GE Signa HDxt 3.0T scanner in all patients, and diffusion and susceptibility weighted imaging were obtained in 3 patients.

Results

Consumption of raw or undercooked fresh water crabs or crayfish within one year prior to the presentation was confirmed in 18 cases. The most common presenting symptom was headache, followed by vomiting, seizures, hemiparesis, hypesthesia and blurred vision. Twenty-two cases had high eosinophil counts (≥0.5 × 10⁹/L), and the paragonimus serum antibody were positive in 23 cases. The lesions were surgically removed in 2 cases and the diagnoses were confirmed by pathologic examination. Of 24 cases, 17 cases manifested with cerebral hemorrhage, showing short T1 and long T2 signal intensities, most of which were located in cerebral cortex and subcortical areas. Of 17 cases with cerebral hemorrhage, 2 cases showed nodular and ring-like enhancement, while the other 15 patients revealed no enhancement. Seven cases of encephalitis type showed multiple conglomerate, and ring-like enhancements. The “tunnel” sign was found in 3 cases. Most patients showed small lesions surrounded by extensive vasogenic edema that was isointense on diffusion weighted imaging.

Conclusions

The clinical manifestations of cerebral paragonimiasis are nonspecific in children while the MRI findings of cerebral paragonimiasis are characteristic, including irregular hemorrhage, ring-like enhancement and disproportionately large areas of surrounding edema. Brain MRI plays an important role in the diagnosis of cerebral paragonimiasis in children.