Imaging manifestation of cerebral gumma: report of 3 cases

Objective: To evaluate the imaging manifestations of cerebral gumma. Methods: Three cases of surgically proved cerebral gumma were analyzed. All patients had history of ultra-marriage sexual life, and the laboratory tests, including the serums and/or the cerebrospinal fluid test, highly indicated the diagnosis of syphilis. Pathological results demonstrated cerebral gumma after operation. Results: On CT scan, case 1 showed a 5.0 cm x 3.5 cm hypo-density area at left temporal lobe with obvious mass effect, and post-contrast CT scan revealed a rim enhancement. MR scanning was not performed. In case 2, a mixture lesion was detected on right frontal lobe on pre-contrast CT scan, and spot-like central enhancement and mild mass effect were demonstrated on postcontrast CT scan. Pre-contrast T1WI showed 2 round lesions situated at right frontal lobe (1.5 cm in diameter) and right periventricular areas (1.0 cm in diameter), separately, which showed iso-signal on T1WI and hyper-signal on T2WI, and ring-like enhancement with slight compression of the right lateral ventricle. In case 3, CT plain scan demonstrated multiple hypo-dense lesions, most of the lesions located on both frontal lobe and left temporal lobe, and enhanced CT scan was not performed. MR imaging revealed many nodule and mass lesions with hypo-signal on T1WI and hyper-signal on T2WI, located on both hemispheres with nodular or circular enhancement after injection of contrast media. Conclusion: The imaging manifestations of cerebral gumma were nonspecific. Thus, the preoperational diagnosis should be made combining the clinical, laboratory, and imaging data