Imaging And Immunohistochemical Study In Cerebral Schistosomiasis Type

ObjectiveTo evaluate characteristics and diagnostic value of MRI of cerebral schistosomiasis.Materials and MethodsRoutine plain and enhanced MRI scans were performed on 66 patients with cerebral schistosomiasis which were confirmed by surgical pathology or clinic. On the base of classification of MRI performance, several aspects including the locations, numbers, signal changes of the lesion, and also the perifocal edema, enhancement of adjacent meninges and brain blood vessels in sulcus were analyzed retrospectively.Results1. In 9 cases of single nodular type, the lesions were located in cerebral hemisphere in 8 cases, in the cortex and subcortical white matter and other superficial parts in 7 cases. The lesions appeared isointensity in 4 cases, and slightly lower signal in 5 cases on T1WI; and they showed isointensity in 2 cases and slightly higher signal in 7 cases on T2WI. There were moderate perifocal edema in 7 cases, and significantly enhanced multiple small nodules consisting of large nodules in 8 cases, as well as adjacent leptomeningeal enhancement and enhanced cerebral blood vessels much more than the opposite side. 2. There was multiple nodular pattern appeared in 45 cases, in which the lesion was located in the cerebral hemisphere in 42 cases, and the cerebral cortex and subcortical areas were involved in 44 cases. Nodules showed gathering and fusion signs in all of them.16 patients had multiple lesions, in which "the main lesion" were seen. T1WI showed isointensity in 16 cases, slightly lower signal in 29 cases. T2WI showed isointensity in 11 cases, slightly higher signal in 29 cases. The moderate perifocal edema appeared in 34 patients. Multiple enhancing punctate nodules were documented in all cases.35 cases showed linear enhancement of adjacent meningeal. In 34 cases enhancement of the vasculars in adjacent sulcus appeared more than the contralateral side.3.2 cases appeared ring-like enhancement nodular type, located in cerebral hemisphere, which showed moderate perifocal edema. Enhanced scan showed multiple small ring-like enhancement. Nodules were gathering and fusing.4.8 cases appeared encephalitic type, in which 6 cases in the cerebral hemisphere,5 cases with mild perifocal edema and 3 cases with moderate edema. Enhanced scan showed weak small pieces, sticks and small point-like with fuzzy edges enhanced. In 5 cases showed linear enhancement of adjacent meningeal and enhancement of the vasculars in adjacent sulcus appeared more than the contralateral side.5.2 cases appeared cerebral infarction type, located in the cerebellum. Enhanced scan showed irregular flakes, gyrus-like enhancement.1 case showed linear enhancement of adjacent meningeal.Conclusion1. MRI patterns of cerebral schistosomiasis can be divided into single nodular type, multiple nodular type, ring enhanced nodular type, encephalitic type and cerebral infarction type.2. The MRI pattern of single and multiple nodular type is of certain characteristic and can help differentiate from other diseases.3. The MRI patterns of encephalitic type and cerebral infarction type are of no characteristic. Comprehensive analysis should be associated with clinical manifestations and laboratory examination.ObjectiveTo explore the characteristics and diagnostic value of perfusion parameters of cerebral schistosomiasis foci and perifocal edema using multiple slices CT perfusion imaging.Materials and Methods10 patients with cerebral schistosomiasis clinically or pathologically confirmed underwent conventional CT and CT perfusion imaging. The perfusion images were analysed with the cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), surface permeability (PS) of schistosomiasis foci, proximal perifocal edema, distal perifocal edema and the contralateral normal brain tissue measured respectively. To set up the contralateral normal brain as standard to calculate the relative CBF (rCBF), rCBV, rMTT and rPS value. CT perfusion parameters in different parts were compared by single factor variance analysis.Results1. In the 10 cases of cerebral schistosomiasis, there were 1 case of encephalitic type,2 cases of single nodular type and 7 cases of multiple nodular type. The mean CBF value of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (44.6±13.94), (7.82±1.79), (7.85±2.23), (11.85±2.05) (ml/100g/min) respectively. The CBF value of schistosomiasis foci was significantly higher than that of proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in CBF values between proximal and distal perifocal edema, which was lower than that of contralateral normal white matter. The rCBF value of schistosomiasis foci was significantly higher than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rCBF values between proximal perifocal edema and distal perifocal edema.2. The CBV values of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (1.99±0.59), (0.47±0.089), (0.45±0.11), (0.64±0.13) (ml/100g) respectively. The CBV values of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in CBV values between proximal perifocal edema and distal perifocal edema, which was lower than contralateral normal white matter. The rCBV value of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rCBF values between proximal perifocal edema and distal perifocal edema.3. The MTT values of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (3.17±0.74), (5.89±1.47), (5.81±2.02), (4.42±1.02) (s) respectively. The MTT values of schistosomiasis foci were significantly lower than proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in MTT values between proximal perifocal edema and distal perifocal edema, which was higher than contralateral normal white matter. The rMTT values of schistosomiasis foci were significantly lower than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rMTT values between proximal perifocal edema and distal perifocal edema.4. The PS values of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (4.86±2.36), (0.82±0.33), (0.61±0.26), (0.72±0.38) (ml/100g/min) respectively. The PS values of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema and contralateral normal white matter. There was no significant difference in MTT values between proximal perifocal edema, distal perifocal edema and contralateral normal white matter. The rPS value of schistosomiasis foci were significantly higher than proximal perifocal edema, distal perifocal edema, and there was no significant difference in rMTT values between proximal perifocal edema and distal perifocal edema.ConclusionSchistosomiasis is a lesion with highly cerebral blood flow, high surface permeability, short mean transit time, while the perifocal edema was of low blood flow, long mean transit time. The microcirculation level of cerebral schistosomiasis can be quantitativly assessed by CTPI, its perfusion parameters has some clinical application value in diagnosis and differential diagnosis.ObjectiveTo investigate the diagnostic and differential value of DWI, apparent diffusion . coefficient (ADC) value and exponential apparent diffusion coefficient (eADC) value by completing DWI examination in patients with cerebral schistosomiasis, high-grade gliomas and metastatic tumors, thus increase awareness of cerebral schistosomiasis.Materials and Methods16 cases with cerebral schistosomiasis,18 patients with high grade gliomas and 16 patients with brain metastases underwent conventional MRI scan, enhanced MRI scan and DWI examination. All cases were confirmed clinically or pathologically. DWI images were analysed and the ADC, eADC value of cerebral schistosomiasis, glioma, metastatic tumor lesions, proximal perifocal edema, distal perifocal edema and the contralateral normal brain tissue were measured respectively which were compared with each other in groups. Set contralateral normal brain tissue as a reference to calculate the rADC and reADC value of three types lesions and the corresponding edema which were compared among all groups. All data were statistically analyzed by SPSS 14.0. Differences in and between groups were analysed by single factor variance analysis.Results1. In the 16 cases of cerebral schistosomiasis, there was 3 case of encephalitic type,3 cases of single nodular type and 10 cases of multiple nodular type. In DWI map, schistosomiasis lesions in 1 case showed low signal,5 cases showed slightly higher signal and 10 cases showed equivalent signal. Edema in 11 cases showed equivalent signals,4 cases showed slightly lower signal and 2 case showed higher signal. The ADC value of cerebral schistosomiasis foci, proximal perifocal edema, distal perifocal edema and contralateral normal white matter were (12.81±1.28), (16.74±2.03), (16.97±1.37), (8.89±0.61) (×10-4 mm2/s) respectively, and eADC value were 0.28±0.034,0.19±0.040, 0.19±0.022,0.41±0.031 respectively. The ADC value of lesions were significantly higher than contralateral normal brain tissue, while the eADC value were contrary with ADC value. There was no significant difference in ADC and eADC values between proximal perifocal edema and distal perifocal edema. The ADC values of proximal perifocal edema and distal perifocal edema were significantly higher than contralateral normal brain tissue, while eADC values were significantly lower.2. In the DWI map of 18 cases with high grade gliomas, the tumor parenchyma in 8 case showed slightly higher signal,10 cases showed uneven high signal. Edema in 9 cases showed equivalent signals,3 cases showed slightly lower signal and 6 case showed slightly higher signal. The ADC value of lesions were significantly higher than contralateral normal brain tissue, and significantly lower than proximal perifocal edema, distal perifocal edema.while the eADC value were contrary with ADC value. The ADC value of proximal perifocal edema were significantly lower than distal perifocal edema, and the eADC value was significantly higher. The ADC values of proximal perifocal edema and distal perifocal edema were significantly higher than contralateral normal brain tissue, while eADC values were significantly lower.3. In the DWI map of 16 cases with brain metastases, the tumor parenchyma in 12 case showed slightly higher or high signal,4 cases showed equivalent signal. Edema in 11 cases showed equivalent signals,3 cases showed slightly lower signal and 2 case showed slightly higher signal. The ADC value of lesions were significantly higher than contralateral normal brain tissue, and significantly lower than proximal perifocal edema, distal perifocal edema, while the eADC value were contrary with ADC value. There was no significant difference in ADC and eADC values between proximal perifocal edema and distal perifocal edema. The ADC values of proximal perifocal edema and distal perifocal edema were significantly higher than contralateral normal brain tissue, while eADC values were significantly lower.4. The rADC value of cerebral schistosomiasis foci was significantly lower than the metastatic tumors, while the reADC value was significantly higher. There were no significant differences in rADC and reADC value between high-grade gliomas and brain metastases or schistosomiasis. The rADC value of proximal perifocal edema in high-grade gliomas foci was lower than the metastatic tumors and cerebral schistosomiasis, while the reADC value was higher. There were no significant differences in rADC and reADC value of proximal perifocal edema between brain metastases and schistosomiasis. There were no significant differences in rADC and reADC value of distal perifocal edema among high-grade gliomas, brain metastases and schistosomiasis.ConclusionCerebral schistosomiasis mostly showed equivalent signal in DWI maps.There was significant difference in ADC and eADC value between cerebral schistosomiasis foci and perifocal edema or contralateral normal brain tissue, which may contribute to the distinction between disease components. Compared with high-grade gliomas and brain metastases, cerebral schistosomiasis foci had lower rADC value and higher reADC value, especially with brain metastases, which may contribute to diagnosis and differential diagnosis of schistosomiasis. There was significant difference in ADC and eADC value of proximal perifocal edema between cerebral schistosomiasis foci and high grade gliomas which contribute to the differential diagnosis between them, but there was no difference with brain metastases. There was no difference in ADC and eADC value of distal perifocal edema among the three. The DWI examination and measurement of ADC, eADC value can provide more information in the diagnosis and differential diagnosis for cerebral schistosomiasis.ObjectiveTo promote the understanding of molecular pathology of cerebral schistosomiasis by detecting the expression of CD34 and Ki-67 in cerebral schistosomiasis and gliomas, and analyzing the differences of miarovessel density (MVD) and Ki-67 expression among the three types of lesions.Materials and MethodsThe positive expressions of CD34 and Ki-67 in surgical specimens of 12 cases of cerebral schistosomiasis lesions,12 cases of low-level gliomas and 12 cases of high-grade glioma were detected by immunohistochemical SP method. The expression level of Ki-67 was divided into four grades according to the expression rate of positive cells. Ki-67 positive expression rates of the three groups were calculated and compared by rank sum test. Microvessel density (MVD) expression was measured by CD34 antibody labeling, and data were presented as mean±standard deviation (x±s). ANOVA was used to compare MVD among the three groups.ResultsPositive expression rate of Ki-67 were 66.67%,41.7% and 100% in cerebral schistosomiasis group, low-grade glioma and high grade gliomas group separately. Expression levels of Ki-67 of cerebral schistosomiasis had no significant difference with low-grade gliomas, but significantly lower than that of the high-grade gliomas. The average MVD of the three groups were (16.6±7.75), (54.34±15.37) and (97.69±27.78)/field separately. MVDs of these three groups were significant differences, among which cerebral schistosomiasis group was the lowest and high-grade glioma group was the highest.ConclusionKi-67 expressing, with the positive expression rate 66.67%, in lesions of cerebral schistosomiasis indicates that the lesions has a strong cell proliferation. The lower expression level than the high grade gliomas helps to distinguish these two, but can no be used to distinguish cerebral schistosomiasis and low-grade gliomas for there are no difference between the two. MVD value of cerebral schistosomiasis foci is significant lower than low and high grade gliomas, which has important clinical value for diagnosis and differential diagnosis of cerebral schistosomiasis.