Use of Susceptibility-Weighted MRI for detecting calcified Neurocysticercosis

Figure 1: SUSCEPTIBILITY-WEIGHT IMAGING (SWI) MRI demonstrating left frontal calcified cysticercus granuloma
Figure 2: FLAIR MRI imaging sequences demonstrating perilesional gliosis in left frontal cysticercus granuloma

Neurocysticercosis (NCC) is the the commonest cause of symptomatic epilepsy in India and many other countries. NCC infection is caused by Taenia solium (tapeworm). Active NCC infection is suggested by presence of scolex, contrast-enhancement, perilesional edema and cystic appearance on brain scan (CT or MRI, however, MRI is preferred). Active infection increases the risk of seizure recurrence and this point is well known.

There are two other lesser known facts of NCC infection, which could indicate a higher risk of seizure recurrence. These include: 1. Calcification of the lesion. Calcification can be well appreciated on a CT scan. However, it may get missed on routine MRI. SWI sequences are the best to demonstrate calcification on MRI (as shown in figure 1 above). 2. Perilesional gliosis: Tapeworm infection may heal over time (either spontaneously or with albendazole, however, in some cases gliosis (scar) can be seen around the lesion. This perilesional gliosis, if present, indicates a higher risk of seizure recurrence. Perilesional gliosis can be seen on good quality FLAIR images (Figure 2 above)

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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