Authors : Loveleen Aggarwal
DOI : 10.18231/j.ijn.2019.021
Volume : 5
Issue : 3
Year : 2019
Page No : 137-144
Introduction: Solitary cysticercus granuloma (SCG) represents a degenerating single cerebral cysticercus
cyst; is a common presenting form of Neurocysticercosis (NCC) particularly in India and United States;
and may cause refractory seizures. Because of the epidemiologic importance of NCC, an optimal magnetic
resonance imaging (MRI) prognostic protocol is vital, and advanced MRI techniques have recently been
used in this context.
Objective: To study selected MRI parameters as prognostic markers in the outcome of resolution of SCG.
Materials and Methods: Patients with seizures and demonstrating intracranial SCG, diagnosed as per the
revised clinical and radiological (MRI) diagnostic criteria for SCG, over a period of one year were subjected
to non-conventional MRI evaluation including diffusion weighted imaging (DWI) with apparent diffusion
coefficient (ADC) calculation; proton magnetic resonance spectroscopy (MRS) and magnetization transfer
(MT) imaging. Six months follow up MRI scan was done. The associations of various demographic and
advanced MRI techniques in predicting the resolution of the SCG were analyzed.
Results: MRI features which favoured the trend towards resolution of the SCG lesion were supratentorial
location, lower N-Acetylaspartate/Choline (NAA/Cho) ratio and higher Choline/Creatine (Cho/Cr) as well
as NAA/Cr ratios on MRS, absence of perilesional gliosis and absence of seizure recurrence with higher
Cho/Cr and NAA/Cr ratios on MRS reaching a statistical significance.
Conclusion: MRI is the investigation of choice for determining the prognostication of SCG. Advanced
MRI techniques such as MRS and MTI are complementary to conventional MRI for this purpose. However
larger prospective studies are needed to statistically establish the above observations.
Keywords: SCG, DW imaging, MRS, MT imaging granuloma resolution