Cerebral paragonimiasis

Twenty-four-year-old woman who has had a positive enzyme-linked immunosorbent assay (ELISA) reaction for Paragonimus-specific antibody in cerebrospinal fluid (CSF) since her first magnetic resonance (MR) examination.
(A) T1-weighted (500/30) axial image from initial MR study shows subacute hemorrhages of high signal intensity (arrows) in occipital lobes bilaterally, presumably due to vascular involvement of Paragonimus. No other abnormality was seen on initial study.
(B, C) Follow-up MR images obtained two months later, after no specific treatment. Contrast-enhanced T1-weighted image (B) shows multiple, conglomerated, ring-enhancing lesions with surrounding edema in right frontal lobe. On unenhanced T2-weighted (3000/80) image (C), walls of rings appear either isointense (arrow) or hypointense (arrowhead) relative to lesions. Hemorrhages in occipital lobes were markedly absorbed (not shown). Paragonimus eggs were found in a lesion of the right frontal lobe during surgery.