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Neurology India, Vol. 58, No. 6, November-December, 2010, pp. 957-958 Letter to Editor MR spectroscopy aids diagnosis in subarachnoid space cysticercosis Uttam George, Geetika Bansal, Shubhra Rathore Department of Radiodiagnosis, Christian Medical College and Hospital, Ludhiana 141 008, Punjab, India Date of Acceptance: 06-Sep-2010 Code Number: ni10270 PMID: 21150072 Sir, A 50-year-old male, treated with a course of albendazole for neurocysticercosis (NCC) suspected on an earlier computed tomography (CT) scan, presented with simple partial seizures. Magnetic resonance imaging (MRI) brain done at this visit showed a well-defined non-enhancing cystic lesion in the left sylvian fissure. It showed no interval change in either size or character compared to the previous CT scan. Because of non-resolution of the lesion a Proton MR spectroscopy (PMRS) was done on a 1.5 T Signa Excite MR Scanner (GE Healthcare, Milwaukee, WI, USA) using a single-voxel point resolved spectroscopy sequence (PRESS) with TR 1500 ms, short TE 35 ms and long TE 144 ms. The voxel measuring 2 × 2 × 2 cm (8 ml) was placed within the confines of the lesion. Peaks at 1.33 and 1.5 ppm, both inverting on TE 144 representing lactate and alanine, respectively, were seen. Another peak was seen at 2.4 ppm attributed to succinate [Figure - 1]. These characteristic spectroscopy findings helped confirm the diagnosis of NCC and ruled out other possibilities. NCC involving the subarachnoid space lack the usual scolex and do not enhance on contrast administration. [1] Differentiation of a solitary subarachnoid cysticercal cyst from similar appearing extra-axial lesions may therefore be difficult on routine MR sequences. Differentials in our case were arachnoid and hydatid cyst. Arachnoid cysts may show lactate peak on MRS, but lack the other metabolites associated with NCC. Hydatid cysts may show peaks corresponding to lactate and succinate as well as acetate at 1.92 ppm, the latter not seen in NCC. While alanine peaks may be seen in both NCC and hydatid cyst, they are less commonly seen in the latter. [2],[3],[4] Resolution of subarachnoid cysticercosis may take longer time, as in our patient. The current consensus in the treatment recommends inclusion of corticosteroids as an adjunct to albendazole. [5] References
Copyright 2010 - Neurology India The following images related to this document are available:Photo images[ni10270f1.jpg] |
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