Type:
Educational Exhibit
Keywords:
Neuroradiology brain, Soft tissues / Skin, Other, CT, MR, Treatment effects, Infection
Authors:
M.-T. Ciubuc-Batcu
DOI:
10.26044/ranzcr2023/C-169
Imaging findings OR Procedure details
Imaging of pulmonary cryptococcal disease predominantly shows nodules that may occasionally be cavitating, with surrounding ground-glass opacity [15,16]. There may also be mediastinal lymphadenopathy and pleural effusions. FDG uptake is variable but FDG-avid nodules may mimic malignancy.
Radiographic presentation of intracranial disease is variable, depending on the form of infection. CT findings may be non-specific and up to 40% of scans are reported as normal; MRI is the modality of choice. Meningeal disease typically shows leptomeningeal and pachymeningeal enhancement on T1 C+, and a high T2 signal in the subarachnoid space on FLAIR C+ [17]. Cryptococcomas (fig 9-13) show low signal on T1 and high signal on T2 and FLAIR. On T1 C+, they may show no enhancement or peripheral nodular enhancement [18,19]. Cryptococcomas have variable diffusion on DWI and ADC [17,20]. Immunocompromised patients generally show dilated perivascular spaces that coalesce into gelatinous pseudocyts, with enhancement in different MRI sequences the same as for cryptococcomas [17,19,20].
Re-imaging is recommended if a relapse is suspected, not to guide duration of therapy; subsequent imaging may show new lesions, enlargement of lesions and/or increased perilesional oedema. These findings may indicate either failure of therapy or mycologic cure with IRIS-like reaction, and culture is recommended to distinguish the two. Of note, intra-cerebral cryptococcomas may persist for up to 2 years despite appropriate and sufficient therapy [4].