In this educational exhibit we review different cases of cysticercosis from our diagnostic center mainly imaging findings on different modalities like radiography, ultrasound, CT and MRI.
Conventional sequences used in the diagnosis of neurocysticercosis are: T1, T2, FLAIR and post-contrast T1 and sometimes special sequences like 3D-CISS which can definitely increases diagnostic accuracy.
Neurocysticercosis is most common form of cysticercosis infection in human. As imaging findings are protean especially of MRI, the neurocysticercosis is divided into five stages: noncystic, vesicular, and colloidal vesicular, granular nodular and calcified nodular based on the stage of evolution of the larvae.6
Noncystic- It is asymptomatic with negative imaging findings.
Vesicular- Seen as fully grown cyst or a cluster of cysts of CSF density/signal intensity with thin smooth wall. 2-4 mm scolex can be seen in nearly 50% of cases as eccentric hyperdense scolex within. (cyst with dot sign). No perilesional oedema and no post contrast enhancement.
Colloidal vesicular- In this stage larva begins to degenerate, and as the scolex disintegrates, a striking perilesional inflammatory oedema response around the cyst seen. Cyst fluid becomes turbid and appears hyperattenuating to CSF. There is post-contrast enhancement. Scolex
may or may not be seen.
Granular nodular- The cyst continues to shrink in size and walls become thicker and finally transforms intoa granulomatous lesion. There is rim or nodular enhancement on post-contrast sequence. There is decreasing perilesional oedema. Other imaging findings are similar to colloidal vesicular stage
Calcified nodular- Most commonly manifests as a granulomatous lesion that has involuted and completely calcified without perifocal edema or enhancement.
Muscular cysticercosis is seen as cyst containing a scolex within the muscle. It can be associated with surrounding abscess or inflammatory edematous muscle thickening.
Disseminated cysticercosis show typical ‘rice-grain’ or cigar shaped calcification in the soft tissues on plain radiograph.