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NEUROIMAGE
Year : 2020  |  Volume : 68  |  Issue : 3  |  Page : 716-717

Intraventricular Neurocysticercosis: The Role of Advanced MRI Sequences


1 Department of Neurology, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
2 Radiology Institute (InRad), School of Medicine, University of São Paulo (USP), São Paulo, Brazil

Date of Web Publication6-Jul-2020

Correspondence Address:
Dr. Bruno F Guedes
Av. Dr. Enéas de Carvalho Aguiar, 255, 5° andar, sala 5084 -Cerqueira César, 05403-900 - São Paulo -SP
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.288999

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How to cite this article:
Guedes BF, Freua F, Parmera JB, Milano BG, Comerlatti LR, Silva GD, Lucato LT. Intraventricular Neurocysticercosis: The Role of Advanced MRI Sequences. Neurol India 2020;68:716-7

How to cite this URL:
Guedes BF, Freua F, Parmera JB, Milano BG, Comerlatti LR, Silva GD, Lucato LT. Intraventricular Neurocysticercosis: The Role of Advanced MRI Sequences. Neurol India [serial online] 2020 [cited 2020 Aug 10];68:716-7. Available from: http://www.neurologyindia.com/text.asp?2020/68/3/716/288999




A 42-year-old brazilian rural worker presented to the emergency department with subacute headache, dizziness, and confusion. Clinical examination was otherwise unrevealing. Brain CT scan [Figure 1] and standard magnetic resonance sequences [Figure 2]a and [Figure 2]b (T1 and T2-weighted sequences, FLAIR, and postcontrast T1-weighted images) showed a left parietal cystic lesion, with an unclear connection to the ventricle; a cystic tumor could be a diagnostic possibility. However, the addition of advanced magnetic resonance imaging (MRI) sequences [Figure 2]c and [Figure 2]d and [Figure 3] allowed the diagnosis of intraventricular neurocysticercosis.
Figure 1: Noncontrast CT images (a-c) show some transependymal edema in the inferior horn of the left lateral ventricle (arrow in a). Superiorly a cystic lesion is seen in the left parietal region (arrow in b). Notice also some punctate residual calcifications (arrowheads in b and c)

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Figure 2: Axial FLAIR and postcontrast T1-weighted images (a and b) demonstrate that the cystic lesion seems to communicate with the ventricle, with signal similar to CSF and no enhancement. Axial DWI and ADC map (c and d) show some restricted diffusion in the cyst wall with a posterior nodular focus (arrowhead in c); notice also the presence of foci of restricted diffusion in the frontal horn of this ventricle (arrow in c)

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Figure 3: Axial and reformatted sagittal 3D-FIESTA images (a and b) demonstrate a cyst with scolex in the left frontal horn (arrow in a) and that the large cystic lesion is located inside the ventricle, associated to another scolex (arrowhead in b). A color map (c) proportional to relative cerebral blood volume (rCBV) obtained from a dynamic susceptibility contrast perfusion (T2*) study shows the lesion has no increase in rCBV. Single-voxel MR spectroscopy placed in the center of the cyst (d) demonstrates peculiar metabolites found in parasitic cysts, such as lactate, alanine and succinate

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Cysticercosis is a neglected tropical disease, affecting especially low-income populations. The thin cystic wall and signal intensity similar to the cerebrospinal fluid can lead to missed diagnoses when only T1 and T2-weighted or FLAIR imaging are employed. The addition of advanced sequences, such as 3D-FIESTA (fast imaging employing steady-state acquisition)[1],[2],[3] or diffusion-weighted imaging [4] can improve the diagnostic yield of MRI.

3D-FIESTA belongs to a class of MRI sequences known as steady-state sequences, where magnetization is kept constant throughout the acquisition. In 3D-FIESTA, balanced gradients are applied in all directions, causing flow compensation; it is also motion insensitive, T2/T1-weighted and presents high signal-to-noise ratio. All these characteristics make 3D-FIESTA ideal for studying intraventricular and cisternal lesions, due to high contrast between CSF and brain. 3D-FIESTA identifies all major features of intraventricular neurocysticercosis in many lesions that would only be partially visualized by conventional T2-weighted imaging.[1]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Govindappa SS, Narayanan JP, Krishnamoorthy VM, Shastry CH, Balasubramaniam A, Krishna SS. Improved detection of intraventricularcysticercal cysts with the use of three-dimensional constructive interference in steady state MR sequences. AJNR Am J Neuroradiol 2000;21:679-84.  Back to cited text no. 1
    
2.
Mont'Alverne Filho FEF, Machado L dos R, Lucato LT, Leite CC. The role of 3D volumetric MR sequences in diagnosing intraventricularneurocysticercosis: preliminar results. ArqNeuropsiquiatr 2011;69:74-8.  Back to cited text no. 2
    
3.
Neyaz Z, Patwari SS, Paliwal VK. Role of FIESTA and SWAN sequences in diagnosis of intraventricularneurocysticercosis. Neurol India 2012;60:646-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Santos GT, Leite CC, Machado LR, McKinney AM, Lucato LT. Reduced diffusion in neurocysticercosis: Circumstances of appearance and possible natural history implications. AJNR Am J Neuroradiol 2013;34:310-6.  Back to cited text no. 4
    


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