Cerebral aspergillosis: comparison of radiological and neuropathologic findings in patients with bone marrow transplantation

Thirty-six lesions in six patients who died from cerebral As pergillus infe ction after bone marrow transplantation (BMT) were studied with regard to s ignal intensity, contrast enhancement, size, and location. The diagnosis wa s confirmed in all cases by autopsy. Retrospective correlation of histopath ological and radiological findings was possible for 14 lesions. Most of the lesions (22/36) had isointense to low signal intensity on T2-weighted imag es (T2WI). Histopathologically, hemorrhagic necrosis was determined in thre e of them. Areas of high signal intensity on T1-weighted images (T1WI) were related to gross hemorrhage. Two infarctions showed intravascular accumula tion of fungal hyphae with secondary thrombosis of the vessel. The remainin g 12 lesions had high signal intensity on T2WI and low on T1WI. Histopathol ogically, four were infectious and four were unspecific demyelinated lesion s. In conclusion, cerebral aspergillosis typically presented with large les ions showing isointense to low signal intensity on T2WI that could have are as of high signal on T1WI. Contrast enhancement was only visible in 15 lesi ons, and the predominant locations were the subcortical white matter, the c erebellum, and the basal ganglia. Small lesions with high signal on T2WI an d low signal on T1WI could not necessarily be related to Aspergillus infect ion.