Cerebral mucormycosis: neuroimaging findings and histopathological correlation.
J Neurol. 2021-07-08; 269(3): 1386-1395
DOI: 10.1007/s00415-021-10701-8
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Lersy F(#)(1), Royer-Leblond J(#)(2), Lhermitte B(3), Chammas A(1), Schneider
F(4), Hansmann Y(5), Lefebvre N(5), Denis J(6), Sabou M(6)(7), Lafitte F(8),
Cotton F(9)(10), Boncoeur-Martel MP(11)(12)(13)(14), Tourdias T(15)(16), Pruvo
JP(17)(18), Cottier JP(19), Herbrecht R(20), Kremer S(21)(22).
Author information:
(1)Service d’imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de
Strasbourg, 1 avenue Molière 67200, Strasbourg, France.
(2)Service de Radiologie, Centre Hospitalier de Haguenau, Haguenau, France.
(3)Department of Pathology, Hautepierre University Hospital, 1 avenue Molière,
67200, Strasbourg, France.
(4)Service de Médecine-Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux
Universitaires de Strasbourg, Strasbourg, France.
(5)Service de Maladies Infectieuses, NHC, CHU de Strasbourg, Strasbourg, France.
(6)CHU de Strasbourg, Laboratoire de Parasitologie Et de Mycologie Médicale,
Plateau Technique de Microbiologie, 1 rue Koeberlé, 67000, Strasbourg, France.
(7)Université de Strasbourg, Institut de Parasitologie Et de Pathologie
Tropicale, DIHP-UR 7292, Fédération de Médecine Translationnelle, 3 rue
Koeberlé, 67000, Strasbourg, France.
(8)Radiology Department, Rothschild Foundation in Paris, Paris, France.
(9)Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon,
Pierre-Bénite, Lyon, France.
(10)Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne,
CNRS, Inserm, CREATIS UMR 5220, U1206, Pierre-Bénite, F-69495, Lyon, France.
(11)INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France.
(12)Univ. Limoges, U1094, Neuroépidémiologie Tropicale, Institut D’Epidémiologie
Et de Neurologie Tropicale, GEIST, Limoges, France.
(13)IRD, Unité Associée, Neuroépidémiologie Tropicale, Limoges, France.
(14)Service de Neuroradiologie, CHU Limoges, Limoges, France.
(15)CHU de Bordeaux, Neuro imagerie diagnostique et thérapeutique, 33000,
Bordeaux, France.
(16)Univ. Bordeaux, INSERM U1215, Neurocentre Magendie, 33000, Bordeaux, France.
(17)Inserm U 1172, CHU de Lille, University of Lille, Lille, France.
(18)Department of Neuroradiology, CHU de Lille, University of Lille, Lille,
France.
(19)Service de Radiologie, CHU Tours, Tours, France.
(20)Department of Hematology, Institut de Cancérologie Strasbourg.Europe (ICANS)
and Université de Strasbourg, Inserm UMR-S1113/IRFAC, Strasbourg, France.
(21)Service d’imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de
Strasbourg, 1 avenue Molière 67200, Strasbourg, France.
.
(22)Engineering Science, Computer Science and Imaging Laboratory (ICube),
Integrative Multimodal Imaging in Healthcare, UMR 7357, University of
Strasbourg-CNRS, Strasbourg, France. .
(#)Contributed equally
INTRODUCTION: Mucormycosis are infections caused by molds of the order
Mucorales. These opportunistic infections are rare, difficult to diagnose, and
have a poor prognosis. We aimed to describe common radiographic patterns that
may help to diagnose cerebral mucormycosis and search for histopathological
correlations with imaging data.
METHODS: We studied the radiological findings (CT and MRI) of 18 patients with
cerebral mucormycosis and four patients’ histopathological findings.
RESULTS: All patients were immunocompromised and/or diabetic. The type of
lesions depended on the infection’s dissemination pathway. Hematogenous
dissemination lesions were most frequently abscesses (59 lesions), cortical,
cortical-subcortical, or in the basal ganglia, with a halo aspect on DWI for
lesions larger than 1.6 cm. Only seven lesions were enhanced after contrast
injection, with different presentations depending on patients’ immune status.
Ischemia and hemorrhagic areas were also seen. Vascular lesions were represented
by stenosis and thrombosis. Direct posterior extension lesions were bi-fronto
basal hypodensities on CT and restricted diffusion without enhancement on MRI. A
particular extension, perineural spread, was seen along the trigeminal nerve.
Histopathological analysis found endovascular lesions with destruction of vessel
walls by Mucorales, microbleeds around vessels, as well as acute and chronic
inflammation.
CONCLUSIONS: MRI is the critical exam for cerebral mucormycosis. Weak ring
enhancement and reduced halo diffusion suggest the diagnosis of fungal
infections. Involvement of the frontal lobes should raise suspicion of
mucormycosis (along with aspergillosis). The perineural spread can be considered
a more specific extension pathway of mucormycosis.
© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
DOI: 10.1007/s00415-021-10701-8
PMID: 34240320 [Indexed for MEDLINE]