Limits...
Magnetic resonance spectroscopy imaging characteristics of cerebral Blastomycosis.

Vachhani JA, Lee WC, Desanto JR, Tsung AJ - Surg Neurol Int (2014)

Bottom Line: There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a "trehalose" peak.There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a "trehalose" peak.This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Illinois Neurological Institute, Peoria, Illinois, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA.

ABSTRACT

Background: Blastomycosis is a dimorphic fungus that is endemic to the midwest and southwestern United States. Involvement of the central nervous system (CNS) is thought to only represent 5-10% of cases of disseminated Blastomycosis.

Case description: A 54-year-old Caucasian female presented to the Neurosurgery service with a 1-day history of progressive right sided hemiparesis. Magnetic resonance imaging (MRI) demonstrated a 2 × 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe. Single-voxel magnetic resonance spectroscopy (MRS) over the enhancing area demonstrated diminished N-acetyl aspartate (NAA) to creatine ratio (1.10), normal choline to NAA ratio (0.82), normal choline to creatine ratio (0.9), and a diminished myoinositol to creatine ratio (0.39). There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a "trehalose" peak. Due to worsening symptoms and uncertain preoperative diagnosis, the patient underwent a left fronto-parietal craniotomy for open surgical biopsy with possible resection approximately one month after presentation. Pathological analysis confirmed the diagnosis of Blastomycosis.

Conclusion: We present the second documented case of intracranial Blastomycosis with MRS imaging. There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a "trehalose" peak. This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.

No MeSH data available.


Related in: MedlinePlus

Magnetic Resonance Spectroscopy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4061578&req=5

Figure 2: Magnetic Resonance Spectroscopy

Mentions: MRI performed shortly after presentation [Figure 1] demonstrates a 2 × 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe. The lesion was hypointense on T1 sequences and had a speckled appearance upon gadolinium administration, hyperintense on T2 sequences with minimal diffusion restriction on diffusion weighted imaging (DWI). Specifically, on T2 imaging there was lack of a defined focal cavity and absence of intracavitary projections with a crenated appearance. Single and multi-voxel MRS was also performed over the area of enhancement as well as the contralateral normal brain. Single-voxel MRS over the enhancing area demonstrated diminished N-acetyl aspartate (NAA) to creatine ratio (1.10), normal choline to NAA ratio (0.82), normal choline to creatine ratio (0.9), and a diminished myoinositol to creatine ratio (0.39). There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain [Figure 2]. Repeat MRI at one month demonstrated worsening edema consistent with worsening of the pathologic process [Figure 3].


Magnetic resonance spectroscopy imaging characteristics of cerebral Blastomycosis.

Vachhani JA, Lee WC, Desanto JR, Tsung AJ - Surg Neurol Int (2014)

Magnetic Resonance Spectroscopy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061578&req=5

Figure 2: Magnetic Resonance Spectroscopy
Mentions: MRI performed shortly after presentation [Figure 1] demonstrates a 2 × 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe. The lesion was hypointense on T1 sequences and had a speckled appearance upon gadolinium administration, hyperintense on T2 sequences with minimal diffusion restriction on diffusion weighted imaging (DWI). Specifically, on T2 imaging there was lack of a defined focal cavity and absence of intracavitary projections with a crenated appearance. Single and multi-voxel MRS was also performed over the area of enhancement as well as the contralateral normal brain. Single-voxel MRS over the enhancing area demonstrated diminished N-acetyl aspartate (NAA) to creatine ratio (1.10), normal choline to NAA ratio (0.82), normal choline to creatine ratio (0.9), and a diminished myoinositol to creatine ratio (0.39). There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain [Figure 2]. Repeat MRI at one month demonstrated worsening edema consistent with worsening of the pathologic process [Figure 3].

Bottom Line: There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a "trehalose" peak.There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a "trehalose" peak.This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Illinois Neurological Institute, Peoria, Illinois, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA.

ABSTRACT

Background: Blastomycosis is a dimorphic fungus that is endemic to the midwest and southwestern United States. Involvement of the central nervous system (CNS) is thought to only represent 5-10% of cases of disseminated Blastomycosis.

Case description: A 54-year-old Caucasian female presented to the Neurosurgery service with a 1-day history of progressive right sided hemiparesis. Magnetic resonance imaging (MRI) demonstrated a 2 × 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe. Single-voxel magnetic resonance spectroscopy (MRS) over the enhancing area demonstrated diminished N-acetyl aspartate (NAA) to creatine ratio (1.10), normal choline to NAA ratio (0.82), normal choline to creatine ratio (0.9), and a diminished myoinositol to creatine ratio (0.39). There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a "trehalose" peak. Due to worsening symptoms and uncertain preoperative diagnosis, the patient underwent a left fronto-parietal craniotomy for open surgical biopsy with possible resection approximately one month after presentation. Pathological analysis confirmed the diagnosis of Blastomycosis.

Conclusion: We present the second documented case of intracranial Blastomycosis with MRS imaging. There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a "trehalose" peak. This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.

No MeSH data available.


Related in: MedlinePlus