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. 2017 Aug 23;7(1):9184.
doi: 10.1038/s41598-017-09694-0.

Choroid Plexitis and Ependymitis by Magnetic Resonance Imaging are Biomarkers of Neuronal Damage and Inflammation in HIV-negative Cryptococcal Meningoencephalitis

Dima A Hammoud  1 , Eman Mahdi  2 , Anil A Panackal  3   4 , Paul Wakim  5 , Virginia Sheikh  6 , Irini Sereti  6 , Bibi Bielakova  7 , John E Bennett  3 , Peter R Williamson  3
Affiliations

Choroid Plexitis and Ependymitis by Magnetic Resonance Imaging are Biomarkers of Neuronal Damage and Inflammation in HIV-negative Cryptococcal Meningoencephalitis

Dima A Hammoud et al. Sci Rep. .

Abstract

CNS cryptococcal meningoencephalitis in both HIV positive (HIV+) and HIV negative (HIV-) subjects is associated with high morbidity and mortality despite optimal antifungal therapy. We thus conducted a detailed analysis of the MR imaging findings in 45 HIV- and 11 HIV+ patients to identify imaging findings associated with refractory disease. Ventricular abnormalities, namely ependymitis and choroid plexitis were seen in HIV- but not in HIV+ subjects. We then correlated the imaging findings in a subset of HIV- subjects (n = 17) to CSF levels of neurofilament light chain (NFL), reflective of axonal damage and sCD27, known to best predict the presence of intrathecal T-cell mediated inflammation. We found that ependymitis on brain MRI was the best predictor of higher log(sCD27) levels and choroid plexitis was the best predictor of higher log(NFL) levels. The availability of predictive imaging biomarkers of inflammation and neurological damage in HIV- subjects with CNS cryptococcosis may help gauge disease severity and guide the therapeutic approach in those patients.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Examples of parenchymal involvement in CNS cryptococcosis: (A) Abnormally enlarged perivascular spaces in the basal ganglia bilaterally (white arrows) on T2-weighted image; (B) Abnormal enhancing lesions in the basal ganglia (white arrows) in the same patient as A on enhanced T1-weighted image; (C) Superficial focal parenchymal enhancing lesions (white arrows) adjacent to sulcal meningeal enhancement.
Figure 2
Figure 2
Examples of ventricular involvement in CNS cryptococcosis: (A) Abnormal ependymal enhancement along the occipital horns of the lateral ventricles bilaterally (white arrows) on enhanced T1-weighted image; (B) Abnormal ependymal enhancement along the posterior aspect of the fourth ventricle with probable associated choroid plexitis (white arrows); (C) Choroid plexitis of the right lateral ventricle (white arrow) with hydrocephalus; (D) Left lateral ventricular choroid plexitis (white arrow).
Figure 3
Figure 3
Examples of meningeal involvement in CNS cryptococcosis: (A) Abnormal meningeal enhancement along the cerebellar folia as well as along the sulci within the middle cranial fossae (white arrow) on enhanced T1-weighted image; (B and C) Sulcal meningeal enhancement especially delineating the central (white arrows) and postcentral sulci on enhanced T1-weighted and enhanced FLAIR images obtained near the convexity.
Figure 4
Figure 4
Box plots showing the distribution of log(sCD27) with respect to the presence of ependymitis and log(NFL) with respect to the presence of choroid plexitis.
See this image and copyright information in PMC

References

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