Table 1.
Review of comparable studies.
Table 2.
Characteristics of 21 patients with cerebral aspergillosis.
Fig 1.
Multiplanar reconstruction of a frontal cerebral abscess with a frontal sinus starting point (patient #5) explored with gadolinium-enhanced T1W (A, B and C) and T2W (D).
These sequences show a large frontal edema and a polylobulated abscess with a necrotic center and a peripheral annular enhancement.
Table 3.
Numbers and type of lesions on initial MRI for the eight patients with direct spread of infection.
Fig 2.
Left thalamic abscess with target-like characteristics (patient #10).
The DWI sequence (A) and the ADC cartography (B) show a central hypointense area on DWI (high ADC value), a hyperintense circular area on DWI (low ADC) and a peripheral milder hyperintensity (upper ADC value rim). (C) Annular peripheral enhancement after gadolinium injection on T1W images. (D) Mild hypointense rim on T2*W images.
Fig 3.
Aspergillosis abscess in the right thalamolenticular area due to hematogenous dissemination (patient #13).
(A) On gross examination, the lesion is non-hemorrhagic with central necrosis (arrow). (B) On T2*, the abscess is surrounded by a mild hypointense ring (arrow). (C) Gadolinium-enhanced T1W imaging shows mild annular enhancement. (D) ADC cartography shows a target-like lesion with a central high ADC value, a circular area with a low ADC value and a peripheral upper ADC value rim.
Table 4.
Numbers and type of lesions on initial MRI for the 13 patients with hematogenous dissemination.
Fig 4.
Macroscopic and imaging characteristics of vascular complications (patient #13).
Gross examination (A) and cerebral angiogram (B) show aneurysmal lesions on superior cerebellar artery, posterior cerebral artery (arrows) and a ruptured aneurysm of the distal part of the basilar artery (arrowhead). The 3D angiography (C) shows an additional distal fusiform aneurysm on the middle cerebral artery (arrowhead). Massive cerebral hemorrhage into the basal cisterns (interpedoncular and pontine cisterns) visualized on gross examination (D) and non-enhanced CT scan (E and F).
Table 5.
Characteristics of vascular complications.
Fig 5.
Histological findings (patients #9, #12, #13).
(A) Hematoxylin-eosin stain (HE) (×20), destruction of a vessel with fibrinoid necrosis (arrows). (B) Grocott methenamine silver stain (GMS) (×40), vascular wall invaded by branching septate hyphae. (C) GMS (×4), intracerebral fungal aneurysm (dotted ellipse) with the interruption of the internal elastic lamina (arrows). (D) HE (×20), aneurysm wall containing hyphae, polynuclear cells (arrows) and giant cells (arrowheads).
Fig 6.
Periodic acid-Schiff stain (×20) shows distinct areas with (1) central necrosis, (2a) an intermediate dense hyphal rim, (2b) an external layer of granulation tissue and (3) edematous brain tissue. On MRI, annular enhancement after gadolinium and mild hypointense signal on T2*-weighted images correspond to layer 2a and 2b (see Fig 2C and 2D).
Fig 7.
Evolution of a left thalamic abscess (patient #10) from day 1 to month 30.
T1 after gadolinium injection, T2*, FLAIR and Diffusion-weighted images show annular peripheral enhancement with central necrosis and a progressive decrease in size starting at month 3.
Fig 8.
Comparison between a hemorrhagic lesion (marked central and peripheral hypointensity areas) (arrow) and a non-hemorrhagic abscess (mild annular hypointensity) (arrowhead) (patient #11).