Elsevier

Magnetic Resonance Imaging

Volume 19, Issue 7, September 2001, Pages 965-974
Magnetic Resonance Imaging

Magnetic resonance imaging of simple and infected hydatid cysts of the brain

https://doi.org/10.1016/S0730-725X(01)00413-1Get rights and content

Abstract

Hydatid cyst of the brain is more common in children than adults. The cyst is always solitary unless the primary site is the brain. Cerebral hydatid cyst (CHCy) is most frequently supratentorial involving the territory of the middle cerebral artery, especially the parietal lobe. This study included 16 patients who were treated for CHCy. They were 11 male patients (68.75%), and 5 female patients (31.25%), ranging in age from 6 to 40 years with an average age of 14.7 years. Most of the patients were children-12 patients (75%), between 6 to 16 years of age. All patients were from rural areas. Headache, vomiting and seizures were the predominant symptoms. Papilloedema was present in 12 patients (75%). CT and MRI were performed in all patients. The cysts were all located in the cerebral hemispheres, except one in the posterior fossa, (Rt. cerebellar hemisphere). One lobe alone was affected in 7 patients (43.8%), two lobes in 6 patients (37.5%) and 3 lobes in two patients (12.5%). Round, or oval well defined cystic lesions isointense to the CSF in T1 and T2WI, with hypointense walls in T2WI and no surrounding perifocal edema or evidence of contrast enhancement were seen in 12 patients (75%) and were classified as simple or non-complicated CHCy. Cystic lesions with surrounding, T2 hyperintense area of perifocal edema, complete and incomplete (segment) rim of contrast enhancement were seen in 4 patients (25%), and were labeled as complicated or infected cysts (cysts with superadded pyogenic infection). All patients were treated surgically, hydatid birth (delivery of unruptured cyst) was achieved in 10 patients, cyst rupture occurred in 6 patients (37.5%), with subsequent recurrence (3 patients with recurrent multiple cysts and 3 patients with recurrent solitary cysts). All the recurrent cysts were surrounded by perifocal edema and showed ring enhancement. MRI has proved to be an excellent means of studying CHCy. It will be more widely used for diagnosis and surgical planning. It provided information about the exact cyst localization, cyst contents and presence or absence of superadded cyst infection.

Introduction

Cerebral hydatid cysts are extremely rare forming only 2% of all intracranial space-occupying lesions even in countries in which the disease is endemic [1]. The cerebral hydatid cyst develops in soft tissues and grows without resistance, thus forming a single spherical vesicle which may reach a considerable size before declaring its presence clinically [2]. Cerebral hydatid cysts should be regarded as malignant because of their location and diagnosis is important [3], [4].

Several diagnostic methods have been employed, but CT provides definitive results. The exact location, size and number of hydatid cysts in the brain can be determined with CT scan [5]. MRI will come to be more widely used for diagnosis and surgical planning in cerebral hydatid disease. MRI shows details that cannot be seen on CT [6].

The CT findings of cerebral hydatid cysts have been described, but there has been little mention of the MRI findings. So, we planned for this work as an attempt to describe the MRI characteristics of simple and infected (complicated) cerebral hydatid cysts.

Section snippets

Materials and methods

This study included 16 patients who were treated for intracranial hydatid cysts in, Dr. Ali Omar Askar, Neurosurgery Center, Tripoli, Libya. They were 11 male and 5 female patients ranging in age from 6 to 40 years, with an average age of 14.7 years. All patients were evaluated with CT scan and MRI of the brain. All lesions were surgically removed. Post-operative CT scan and MRI were done at varying intervals for follow-up.

Cerebral MRI examination of all patients were performed using a 0.5-T

Clinical findings

Most of the patients were children 12 patients out of 16 (75%) between 6 and 16 years of age (Table 1). Also there was a substantial prevalence of male patients-11 cases (68.75%). Headache was the predominant symptom (Table 2), followed in order of frequency by vomiting, seizures and visual disturbances. Papilloedema was seen in 12 patients (75%), positive Babinski sign was seen in 3 patients, other neurologic findings are shown in (Table 3).

Radiologic findings

MRI is the best method for diagnosis and surgical

Discussion

Hydatid disease is endemic in sheep-raising regions of the world, notably South America, New Zealand, Australia, the Middle East and the Mediterranean area [2]. In all series including ours, most of the patients with cerebral hydatid cysts were from rural areas.

The pathogen responsible for CNS hydatid disease is Echinococcus. Two species of Echinococcus may infect the human nervous system: E. granulosus and E. multilocularis. The two cestodes differ in life cycle, morphology and epidemiology.

Conclusion

CHCy is a cystic lesion which can appear mostly in children and young adults from countries where hydatid disease is endemic. Most of the cysts are located supratentorial, particularly in the left parietal lobe. All cysts are solitary. Although CT scanning has enormously improved the diagnosis, yet MRI has come to be more widely used in diagnosis and surgical planning in cerebral hydatid disease. MRI provides additional information and details that can not be seen by CT. It provides additional

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      The disease is known for its high prevalence in Mediterranean countries. Compared to hepatic and pulmonary forms, intracranial localizations are rare and represent 0.5–3% of all hydatid diseases [1–8]. These intracranial lesions have been reported to comprise 2% of all intracranial mass lesions in affected countries [5,7,8].

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