Authors: Loveleen Aggarwal
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
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