MR OF CEREBRAL ASPERGILLOSIS IN PATIENTS WHO HAVE HAD BONE-MARROW TRANSPLANTATION

PURPOSE: To assess the CT and MR appearance of cerebral aspergillosis in patients who have undergone bone marrow transplantation. METHODS: T he imaging and clinical data of five patients with cerebral aspergillo sis were reviewed retrospectively and compared with autopsy findings. RESULTS: Lesions are often located in the basal ganglia and demonstrat e an intermediate signal intensity within surrounding high-signal area s on long-repetition-time MR scans. The lesions were multiple in four of the five patients and more numerous on MR images than on CT scans. The lesions (which demonstrate no parenchymal enhancement) are consist ent with acute infarcts as confirmed at autopsy. In the large lesions, there is early intravascular and meningeal enhancement, as expected i n acute infarcts involving an appreciable portion of the territory of a cerebral artery. CONCLUSION: The diagnosis of early cerebral infarct ion in a patient considered at risk for invasive aspergillosis, even w ithout overt pulmonary disease, is an indication to institute aggressi ve antifungal therapy.