Cysticercosis CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Computerized tomography (CT) is superior to magnetic resonance imaging (MRI) for demonstrating small calcifications. However, MRI shows cysts in some locations (cerebral convexity, ventricular ependyma) better than CT, is more sensitive than CT to demonstrate surrounding edema, and may show internal changes indicating the death of cysticerci.

In recent years, the use of CT and MRI has permitted identification of neurocysticercosis cases with a benign course that would not have been detected previously.

CT findings in neurocysticercosis

• CT Can give a rough estimate about the location and number of cysts but often misses cysts in the ventricles and brain stem.
• CT is better in demonstrating calcifications than MRI.
• Calcifications Appear as hyperdense lesions without surrounding inflammation, edema nor enhancement.

Both of CT and MRI show:

1. Vesicular lesions: Well demarcated ring enhancing lesions without surrounding edema and inflammation. Scolices appear as hyperdense eccentric nodule within the cyst.
2. Colloidal and granular lesions: Ill defined lesions surrounded by brain edema and inflammation.
3. In advanced cases, images may show diffuse brain edema, encephalitis, obstruction of the ventricles and midline shift.

CT brain with and without contrast demonstrating ring enhancing lesion surrounded by brain edema

Axial CT brain without contrast - Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/4772">rID: 4772</a>	Axial CT brain with contrast - Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/4772">rID: 4772</a>

Numerous calcified lesions with surrounding edema

Axial CT brain without contrast showing calcifications - Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/7773">rID: 7773</a>

Axial, coronal and sagittal sections of CT scan showing numerous calcified lesion with no surrounding edema

Axial CT brain without contrast showing calcifications - Case courtesy of Dr Kenny Sim, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/35191">rID: 35191</a>	Coronal CT brain without contrast showing calcifications - Case courtesy of Dr Kenny Sim, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/35191">rID: 35191</a>	Sagittal CT brain without contrast showing calcifications - Case courtesy of Dr Kenny Sim, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/35191">rID: 35191</a>

Various stages of NCC .. some vesicles showing scolex and others showing calcification

Axial CT brain without contrast showing cysticerci in both hemispheres - Case courtesy of Alicia Encinas, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/35696">rID: 35696</a>

References