Imaging
CNS Toxoplasmosis
- Preliminary Diagnosis: Central Nervous System Toxoplasmosis
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosis of CNS toxoplasmosis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of CNS toxoplasmosis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Central Nervous System Toxoplasmosis
I. What imaging technique is first-line for this diagnosis?
MRI of the brain with IV contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of CNS toxoplasmosis.
Advantages
Very suggestive of the diagnosis given the appropriate clinical scenario
Able to localize the anatomic area of abnormality and the extent of edema, thus predicting any specific neurological compromise
Able to evaluate for secondary complications such as cerebral mass effect, midline shift, or hemorrhage
Does not use any ionizing radiation
Disadvantages
Expensive
Time-consuming imaging modality
Requires significant patient cooperation to minimize motion artifact
MRI with IV contrast requires that the patient has good renal function (i.e., GFR >30).
III. What are the contraindications for the first-line imaging technique?
MRI is contraindicated in patients with non-MR-compatible metallic hardware or foreign bodies.
Decreased renal function (GFR <30); caution in patients with GFR between 30 and 60.
IV. What alternative imaging techniques are available?
CT with and without intravenous contrast
Thallium-201 SPECT nuclear medicine imaging
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of CNS toxoplasmosis.
CT with and without intravenous contrast
Advantages
May be performed more quickly than MRI, requires less patient cooperation, and is less susceptible to motion artifact than MRI
More specific than MRI with respect to diagnosis of lymphoma, a common mimicker of CNS toxoplasmosis
Disadvantages
CT exposes the patient to nonionizing radiation.
CT has less anatomic detail and contrast resolution than MRI.
Thallium-201 SPECT Imaging
Advantages
Useful tool in differentiating CNS toxoplasmosis from lymphoma due to high specificity in detecting lymphoma
Can be used in patients with contraindications to MRI
Disadvantages
Available only in specialized centers
Provides limited anatomic detail
Primarily used as a supplement to CT/MRI when distinction is uncertain
VI. What are the contraindications for the alternative imaging techniques?
CT with and without contrast
CT is contraindicated in a pregnant patient, especially during the first two trimesters.
Thallium-201 SPECT
None known
Copyright © 2017, 2014 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Related Resources
Sign Up for Free e-newsletters
Regimen and Drug Listings
GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION
Bone Cancer | Regimens | Drugs |
Brain Cancer | Regimens | Drugs |
Breast Cancer | Regimens | Drugs |
Endocrine Cancer | Regimens | Drugs |
Gastrointestinal Cancer | Regimens | Drugs |
Gynecologic Cancer | Regimens | Drugs |
Head and Neck Cancer | Regimens | Drugs |
Hematologic Cancer | Regimens | Drugs |
Lung Cancer | Regimens | Drugs |
Other Cancers | Regimens | |
Prostate Cancer | Regimens | Drugs |
Rare Cancers | Regimens | |
Renal Cell Carcinoma | Regimens | Drugs |
Skin Cancer | Regimens | Drugs |
Urologic Cancers | Regimens | Drugs |
Cancer Therapy Advisor Articles
- Patient-Reported Outcomes in Oncology Expected to Make Regulatory Waves
- Metastatic Prostate Cancer Responds to Novel Radiation Therapy
- FDA Provides Update on Breast Implant-Associated Anaplastic Large Cell Lymphoma
- Investigational Antiandrogen Drug Delays Metastasis in CRPC
- Q&A With Mark B. Gerstein, PhD, on Diagnostic Genomic vs Exomic Sequencing
- Tivozanib Offers Superior Outcomes in Refractory Metastatic Renal Cell Carcinoma
- First-Line Pembrolizumab Shows Promise in Non-Clear Cell RCC
- Early Tumor Shrinkage With Cabozantinib Improves Survival in Renal Cell Carcinoma
- Combo Superior to Sunitinib in Advanced Renal Cell Carcinoma
- Nivolumab-Ipilimumab Survival Benefit in Advanced RCC Confirmed