On MRI, it appears as a hypointense lesion on the T1-weighted image and hyperintense on T2-weighted image with similar intensity to CSF; this lesion may or may not enhance with contrast media and may be associated with surrounding edema (Figs.7.20-7.25).

Commonly, on MRI a central or mural nodule is identified representing the scolex, which is isointense on T1- and T2-weighted images and measures approximately 1-2 mm in diameter (Figs. 7.21-7.25, 7.28).

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Fig. 7.20 A-D. Cysticercosis, vesicular stage, right parietal area. MRI. A Axial T1-weighted image showing a hypointense lesion. B, C On axial and coronal T2-weighted images, the lesion is hyperintense and associated with surrounding edema. D Coronal T1-weighted image, postcontrast, showing peripheral enhancement of the lesion (arrow). (Courtesy of Dr. Enrique Palacios, Berwyn).

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Fig. 7.21 A-C. Neurocysticercosis, vesicular stage, in a Mexican adult. A T1-weighted MRI sequence before and after gadolinium enhancement. There is a low signal intensity zone of edema surrounding a single cysticercus, which shows ring enhancement after gadolinium injection. B T2-weighted MR image shows intense high-signal edema around the cysticercus. The tiny 2-mm scolex of the cysticercus is visible within the cyst. C Cysticercus of T. solium with scolex (top). (A, B courtesy of Dr. George Leopold, San Diego.

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Fig. 7.22 A-D. Single cysticercus, vesicular stage, right temporal cortex. MRI. A Axial T1-weighted, B axial T2-weighted, C coronal TI-weighted, postcontrast, and D sagittal, postcontrast images. Note scolex within the cyst. (Courtesy of Dr. Enrique Palacios, Berwyn).

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Fig. 7.23A-D. Cysticercosis, vesicular stage. MRI axial images showing multiple bilateral lesions, including one in the superior fourth ventricle. A, B T1-weighted images show scolices within the lesions. C, D T2-weighted images reveal cystic lesions. (Courtesy of Dr. Enrique Palacios, Berwyn).

Fig. 7.24. Parenchymal cysticercosis, multiple lesions. Pathological specimen in coronal plane. The cysticerci in the vesicular stage are scattered in both gray and white matter, including the right thalamus. (Courtesy of Dr. Enrique Palacios, Berwyn).

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Fig. 7.25 A-D. Neurocysticercosis with numerous cystic parenchymal lesions, vesicular stage, throughout the brain of a middle-aged Norwegian sailor who had traveled throughout the world. He was admitted to Queen's Medical Center in Honolulu, Hawaii for evaluation of multiple neurological symptoms. T1-weighted coronal (A) and axial (B) MR images reveal multiple small cysts approximately 1-cm in size scattered throughout the cerebral hemispheres and basal ganglia. Some cysticerci are in paraventricular locations and others contain a well-defined 2-mm scolex within the cyst contents (arrow in B). (C) Coronal image obtained after gadolinium injection shows ring enhancement of many cysticerci. The cerebellum and midbrain are involved as well as the cerebral hemispheres. Note the paraventricular cysticercal nodules. (D) T2-weighted axial view shows numerous cysticercal cysts containing high signal intensity fluid, as well as intense high-signal edema surrounding many cysts in the brain parenchyma. (Courtesy of Drs. Stephen Holmes and Michael Meagher, Honolulu).