Magnetic resonance imaging of eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis following eating freshwater snails.

BACKGROUND: Angiostrongyliasis cantonensis is a worldwide-existing parasitic disease. However, the relevant reports on its radiological appearances are limited. In this study, we investigated magnetic resonance imaging (MRI) features of eosinophilic meningoencephalitis in a group of consecutive patients caused by human infection with Angiostrongylus cantonensis after eating freshwater snails.
METHODS: We performed brain MR imaging on 74 patients with angiostrongyliasis cantonensis. The scanner was a 0.5T unit. For each patient MR pulse sequences of SE T1-weighted image (T1WI) and FSE T2-weighted image (T2WI) were used. After intravenous administration of gadolinium chelate (Gd-DTPA) repeated T1-weighted images were obtained. MRI features of the lesions in the brain and meninges were analyzed and recorded after observing initial and follow-up MR images. The classification of the types of angiostrongyliasis cantonensis infection was done on the basis of locations of the disorders.
RESULTS: Forty-one (55%) normal and 33 (45%) abnormal MRI appearances in the brain were found. According to locations of the disorders, the types of angiostrongyliasis cantonensis infection were determined as follows: seventeen cases of type meningitis, three of type myeloencephalitis, one of type neuritis and twelve of mixed type (eight of type ventriculitis and five of type pneumonitis were among them). In type meningitis, abnormal leptomeningeal enhancement was visualized. In type myeloencephalitis, lesions in the brain parenchyma may have iso- or slightly low signal intensity on T1WI and high signal intensity on T2WI. Enhanced nodules in various shapes were shown on gadolinium-enhanced T1WI, a few lesions appeared as crescent enhancements and some lesions did not reveal abnormal enhancement. Other than brain lesions, an enhanced nodule was seen in the cervical spinal cord in one patient. In type ventriculitis, brain ventricular enlargement was demonstrated. In type neuritis, a nodule and abnormal enhancement in the right optic nerve was revealed. In type pneumonitis, patchy ground-glass opacity and consolidative lesions at the periphery of the lungs were seen. Follow-up results indicated that most lesions in the brain could resolve in 2 to 8 weeks.
CONCLUSIONS: Angiostrongyliasis cantonensis presented as both single type and mixed type. Nodular enhancing lesions in the brain and/or linear enhancement in the leptomeninges were the main findings, while crescent enhancement would be the characteristic sign of the disease on gadolinium-enhanced T1WI. Focal edematous changes without contrast enhancement in the brain could be seen on MRI in some cases.