Imaging features of neurotoxoplasmosis: A multiparametric approach, with emphasis on susceptibility-weighted imaging John C. Benson, Gustavo Cervantes,

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Imaging features of neurotoxoplasmosis: A multiparametric approach, with emphasis on susceptibility-weighted imaging John C. Benson, Gustavo Cervantes, Thomas R. Baron, Andrew E. Tyan, Siobhan Flanagan, Leandro T. Lucato, Alexander M. McKinney, Frederick Ott European Journal of Radiology Open Volume 5, Pages 45-51 (January 2018) DOI: 10.1016/j.ejro.2018.03.004 Copyright © 2018 Terms and Conditions

Fig. 1 Noncontrast T1WI (A), FLAIR (B), T2WI (C), CE-T1WI axial (D) and coronal (E), and axial SWI (F) images in a 37 yearold patient with toxoplasmosis. A rim-enhancing lesion was noted in the right cerebellar hemisphere, with moderate associated surrounding edema noted on T2WI (B) and FLAIR (C). Several ISS were identified with the center of the lesion (white arrow on F). Other, less conspicuous SWI foci were also noted along the lesion’s periphery (not shown). European Journal of Radiology Open 2018 5, 45-51DOI: (10.1016/j.ejro.2018.03.004) Copyright © 2018 Terms and Conditions

Fig. 2 Baseline noncontrast T1WI (A), CE-T1WI (B), mIP SWI (C), and 2-week followup noncontrast T1WI images (D) of a patient treated with anti-toxoplasma medication. Two weeks later, the lesion in the left temporal lobe and a lesion in the left cerebellum (not shown) developed speckled intrinsic hyperintense foci on noncontrast T1WI (white arrowheads on A and D), a consequence that occurs in response to protein hydration layers that fill up the cytoplasm of reactive astrocytes. Two susceptibility signal foci (black arrowheads on D) are shown in the left temporal lobe lesion. While the SWI signal abnormalities remained stable on followup, the unusual T1-hyperintense signal changes was a transitory condition detected after empiric anti-toxoplasma therapy on most patients with toxoplasmosis. European Journal of Radiology Open 2018 5, 45-51DOI: (10.1016/j.ejro.2018.03.004) Copyright © 2018 Terms and Conditions

Fig. 3 Patient who presented with alterered mental status and a recent syncopal event. NCCT (A) demonstrated an ill-defined low-density lesion in the left cerebellar hemisphere (curved arrow on A, B, and C), as well as other lesions within the left basal ganglia (not shown). MR demonstrated hyperintense signal within this region on T2WI (B). On coronal contrast-enhanced T1WI (C), a ring-enhancement was noted within this region; a single intralesional susceptibility signal focus was identified (D). European Journal of Radiology Open 2018 5, 45-51DOI: (10.1016/j.ejro.2018.03.004) Copyright © 2018 Terms and Conditions

Fig. 4 A patient with known toxoplamosis and poor adherence to medication presented with new neurologic symptoms. Contrast enhanced T1WI (A) showed a ring-enhancing lesion in the right frontal lobe. Mixed intensity within this region was noted on corresponding FLAIR (B) images, as well as other scattered white matter disease. The lesion demonstrated mild restricted diffusion (C) as well as intralesional susceptibility signal foci (D). European Journal of Radiology Open 2018 5, 45-51DOI: (10.1016/j.ejro.2018.03.004) Copyright © 2018 Terms and Conditions

Fig. 5 Multiple ring-enhancing lesions in a patient with toxoplasmosis are noted (A and C). Intralesional susceptibility signal foci are identified within each lesion: including the medial right thalamus (straight arrow, B) and the gray-white junction of the cerebral cortex (curved arrow, D). European Journal of Radiology Open 2018 5, 45-51DOI: (10.1016/j.ejro.2018.03.004) Copyright © 2018 Terms and Conditions

Fig. 6 Numerous ring enhancing lesions in a 39 year old patient with toxoplamosis. Many of the larger lesions (curved arrow, A) demonstrated intralesional susceptibility signal foci (curved arrow, B), while some of the smaller lesions did not (straight arrows, A). European Journal of Radiology Open 2018 5, 45-51DOI: (10.1016/j.ejro.2018.03.004) Copyright © 2018 Terms and Conditions