Devendra Kumar MBBS, MD, Presenter: Nothing to Disclose

Rakesh K Sheoran DMRD, MD, Abstract Co-Author: Nothing to Disclose

Santosh D Patil MD, Abstract Co-Author: Nothing to Disclose

Sk Bansal MChir, Abstract Co-Author: Nothing to Disclose

CNS aspergillosis is rare infection and has been reported in immunocompromised patients with either concomitant sinonasal/orbital or hematogenous spread.Increasing incidence of CNS aspergillosis has been seen in immunocompetent patient without any risk factor which make the probable diagnosis very difficult on imaging.The purpose of our study is to demonstrate the tumor like solid aspergillosis at typical and atypical locations with emphasis on changing neuroimaging pattern of CNS aspergillosis in immunocompetent population .

Total eight patients of surgically proven CNS aspergillosis were evaluated (19-50 years of age, 2 female and 6 male) over a period of 2 years. All cases were evaluated for anatomical distribution, T1 and T2 signal pattern, enhancement pattern, internal inhomogeniety, vascular involvement and concomitant paranasal or orbital extension. All patients were operated and diagnosis was confirmed with histopathology. Only one patient was diabetic, otherwise no risk factor was indentified in the rest of patients (No immunocompromised).

Neoplastic lesions were suspected in seven patients due to solid enhancing lesions in anterior and middle cranial fossa regions. Seven patients had concomitant sinonasal involvement. One young patient had solitary large occipital granuloma with spectroscopic findings suggestive of high grade glioma. Orbital extension was noted in three patients. Callosal lesion was noted in one patient. ICA infiltration with large MCA infarct was identified in two patients. Pituitary gland and infundibulum involvement was reported first time with sinonasal aspergillosis mimicking olfactory groove meningioma.   Only one patient succumbed to death due to malignant MCA infarct (angioaggressive aspergillosis).  

Careful evaluation of signal intensities, anatomical locations, enhancement pattern, concomitant sinonasal and orbital extension, and angioaggressive nature of lesion with high index of suspicious are essential to call CNS aspergillosis as prompt surgical and antifungal treatment is required for its dismal prognosis even in immunocompetent population. Profound T2 hypointensity and intense solid enhancement are primary imaging findings in our series.

Profound T2 hypointensity and intense solid enhancement are primary imaging findings in our series. Spectroscopy cannot be relied upon due to undetermined results.  

Kumar, D, Sheoran, R, Patil, S, Bansal, S, CNS Aspergillosis Mimicking the Tumors: Review the Increasing Atypical Imaging Characteristics of CNS Aspergillosis in Immunocompetent Population.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004352.html