Magnetic resonance imaging-derived relative cerebral blood volume characteristics in a case of pathologically confirmed neurocysticercosis: illustrative case. J Neurosurg Case Lessons 2023 Dec 18;6(25)
Date
12/18/2023Pubmed ID
38109728Pubmed Central ID
PMC10732321DOI
10.3171/CASE23446Scopus ID
2-s2.0-85185333375 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Neurocysticercosis (NCC) is a parasitic infection of the brain caused by ingesting water or food contaminated with tapeworm eggs. When it presents as a solitary mass, differentiation from a primary brain tumor on imaging can be difficult. Magnetic resonance imaging (MRI)-derived relative cerebral blood volume (rCBV) is a newer imaging technique used to identify areas of neovascularization in tumors, which may advance the differential diagnosis.
OBSERVATIONS: A 25-year-old male presented after a seizure. Computed tomography (CT) and MRI demonstrated a partially enhancing lesion with microcalcifications and vasogenic edema. Follow-up rCBV assessment demonstrated mild hyperperfusion and/or small vessels at the lesional margins consistent with either an intermediate grade glioma or infection. Given the radiological equipoise, surgical accessibility, and differential diagnosis including primary neoplasm, metastatic disease, NCC, and abscess, resection was pursued. The calcified mass was excised en bloc and was confirmed as larval-stage NCC.
LESSONS: CT or MRI may not always provide sufficient information to distinguish NCC from brain tumors. Although reports have suggested that rCBV may aid in identifying NCC, here the authors describe a case of pathologically confirmed NCC in which preoperative, qualitative, standardized rCBV findings raised concern for a primary neoplasm. This case documents the first standardized rCBV values reported in a pathologically confirmed case of NCC in the United States.
Author List
Botros NE, Polinger-Hyman D, Beck RT, Kleefisch C, Mrachek EKS, Connelly J, Schmainda KM, Krucoff MOAuthors
Ryan T. Beck MD Assistant Professor in the Radiology department at Medical College of WisconsinJennifer M. Connelly MD Professor in the Neurology department at Medical College of Wisconsin
Max O. Krucoff MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin
Edward Kelly S. Mrachek MD Assistant Professor in the Pathology department at Medical College of Wisconsin
David Polinger-Hyman MD Assistant Professor in the Radiology department at Medical College of Wisconsin
Kathleen M. Schmainda PhD Professor in the Biophysics department at Medical College of Wisconsin
