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 The imaging and clinical data of five patients with cerebral aspergillosis were reviewed retrospectively and compared with autopsy findings. RESULTS Lesions are often located in the basal ganglia and demonstrate an intermediate signal intensity within surrounding high-signal areas 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 consistent with acute infarcts as confirmed at autopsy. In the large lesions, there is early intravascular and meningeal enhancement, as expected in acute infarcts involving an appreciable portion of the territory of a cerebral artery. CONCLUSION The diagnosis of early cerebral infarction in a patient considered at risk for invasive aspergillosis, even without overt pulmonary disease, is an indication to institute aggressive antifungal therapy.