Quantitative Serial T2 Relaxometry: A Prospective Evaluation in Solitary Cerebral Cysticercosis

Abstract

We describe the evolution of quantitative T2 relaxometry values on serial MRI in patients with a solitary cerebral cysticercal lesion (SCCL), and determine whether albendazole therapy affects T2 relaxation (T2R) values. Patients with new-onset seizures and MRI-confirmed SCCL were randomized to treatment with albendazole and antiepileptics (“treatment group”) or antiepileptics only (“controls”). Serial MRI including T2 relaxometry was performed at baseline, three, six, 12, and 24 months. Of 123 patients recruited, 81 had more than three MRI scans (treatment group: 37; controls: 44; 58 patients had five scans). The lesion wall at baseline showed a mean T2R value of 152.3 ms, centre 474.9 and perilesional parenchyma 338.5 ms. These were significantly higher than those from normal parenchyma (114 ms). Over time, most sharply in the initial three months, T2R values fell but even at 24 months, they remained above those from normal parenchyma. A slight increase in T2R values from the lesion centre at six months was thought to represent the initiation of gliosis. In the treatment group, T2R values approached normal at 24 months, while controls had persistently higher T2R values. The decline in T2R values at six months was more prominent in the treatment group. T2R values at baseline and at three months differed significantly depending on the stage of the lesion, being higher in stage 2 SCCL. T2R values from SCCL declined over 24 months, being significantly higher in earlier stages of degeneration. A mild increase after six months may be due to the initiation of gliosis. T2R values appear to decline faster in patients who receive albendazole.