MR of Toxoplasma encephalitis: Signal characteristics on T2-weighted images and pathologic correlation

T. C. Brightbill, M. Judith Post, George T. Hensley, Armando Ruiz

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Purpose: Our goal was to determine if there are any T2-weighted MR signal characteristics of Toxoplasma encephalitis that might be useful in diagnosis and/or in gauging the effectiveness of medical therapy. Method: We retrospectively analyzed the MR, CT, thallium-201 SPECT brain scans, and medical records of 27 patients with medically proven (26) and biopsy proven (1) Toxoplasma encephalitis, supplemented by autopsy findings in 4 additional patients, 2 of whom had postmortem MR correlation. The neuropathologic literature was also reviewed. Results: Among the 27 patients, we discovered three distinct imaging patterns. Ten (37%) patients had predominantly T2- weighted hyperintense lesions and had been on medical therapy an average of 3 days (excluding one outlier). Ten (37%) patients had T2-weighted isointense lesions and had received medical therapy an average of 61 days. Seven (26%) patients had lesions with mixed signal on T2-weighted images and had been on treatment an average of 6 days. Analysis of autopsy material from the four additional patients revealed the presence of organizing abscesses in three and necrotizing encephalitis in one, while the patient who had a brain biopsy demonstrated both types of pathologic lesions. In both cases having postmortem MRI, organizing abscesses appeared isointense to hypointense on T2-weighted images. Conclusion: There is a definite variation in the appearance of lesions of Toxoplasma encephalitis on T2-weighted images that precludes a definitive diagnosis based on signal characteristics alone. Pathologically, our data suggest that T2-weighted hyperintensity correlates with necrotizing encephalitis and T2-weighted isointensity with organizing abscesses. Furthermore, in patients on medical therapy the T2-weighted MR appearance may be a transition from hyperintensity to isointensity as a function of a positive response to antibiotic treatment, indicating that the signal change might be used to gauge the effectiveness of medical therapy.

Original languageEnglish
Pages (from-to)417-422
Number of pages6
JournalJournal of Computer Assisted Tomography
Volume20
Issue number3
DOIs
StatePublished - May 22 1996

Fingerprint

Toxoplasma
Encephalitis
Abscess
Therapeutics
Autopsy
Biopsy
Thallium
Brain
Single-Photon Emission-Computed Tomography
Medical Records
Anti-Bacterial Agents

Keywords

  • Magnetic resonance
  • Necrosis
  • Pathology
  • T2-weighted images
  • Toxoplasma encephalitis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

MR of Toxoplasma encephalitis : Signal characteristics on T2-weighted images and pathologic correlation. / Brightbill, T. C.; Judith Post, M.; Hensley, George T.; Ruiz, Armando.

In: Journal of Computer Assisted Tomography, Vol. 20, No. 3, 22.05.1996, p. 417-422.

Research output: Contribution to journalArticle

Brightbill, T. C. ; Judith Post, M. ; Hensley, George T. ; Ruiz, Armando. / MR of Toxoplasma encephalitis : Signal characteristics on T2-weighted images and pathologic correlation. In: Journal of Computer Assisted Tomography. 1996 ; Vol. 20, No. 3. pp. 417-422.
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AB - Purpose: Our goal was to determine if there are any T2-weighted MR signal characteristics of Toxoplasma encephalitis that might be useful in diagnosis and/or in gauging the effectiveness of medical therapy. Method: We retrospectively analyzed the MR, CT, thallium-201 SPECT brain scans, and medical records of 27 patients with medically proven (26) and biopsy proven (1) Toxoplasma encephalitis, supplemented by autopsy findings in 4 additional patients, 2 of whom had postmortem MR correlation. The neuropathologic literature was also reviewed. Results: Among the 27 patients, we discovered three distinct imaging patterns. Ten (37%) patients had predominantly T2- weighted hyperintense lesions and had been on medical therapy an average of 3 days (excluding one outlier). Ten (37%) patients had T2-weighted isointense lesions and had received medical therapy an average of 61 days. Seven (26%) patients had lesions with mixed signal on T2-weighted images and had been on treatment an average of 6 days. Analysis of autopsy material from the four additional patients revealed the presence of organizing abscesses in three and necrotizing encephalitis in one, while the patient who had a brain biopsy demonstrated both types of pathologic lesions. In both cases having postmortem MRI, organizing abscesses appeared isointense to hypointense on T2-weighted images. Conclusion: There is a definite variation in the appearance of lesions of Toxoplasma encephalitis on T2-weighted images that precludes a definitive diagnosis based on signal characteristics alone. Pathologically, our data suggest that T2-weighted hyperintensity correlates with necrotizing encephalitis and T2-weighted isointensity with organizing abscesses. Furthermore, in patients on medical therapy the T2-weighted MR appearance may be a transition from hyperintensity to isointensity as a function of a positive response to antibiotic treatment, indicating that the signal change might be used to gauge the effectiveness of medical therapy.

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