Imaging spectrum of neurocysticercosis

Neurocysticercosis Prevalence and Characteristics in Communities of Sinda District in Zambia: A Cross-Sectional Study

BACKGROUND

This study aimed at describing the epidemiology of (neuro)cysticercosis as well as its clinical and radiological characteristics in a Taenia solium endemic district of Zambia.

METHODS

This was part of a cross-sectional community-based study conducted in Sinda district to evaluate an antibody-detecting T. solium point-of-care (TS POC) test for taeniosis and (neuro)cysticercosis. All TS POC cysticercosis positive (CC+) participants and a subset of the TS POC cysticercosis negative (CC-) received a clinical evaluation and cerebral computed tomography (CT) examination for neurocysticercosis (NCC) diagnosis and staging.

RESULTS

Of the 1249 participants with a valid TS POC test result, 177 (14%) were TS POC CC+ . Cysticercosis sero-prevalence was estimated to be 20.1% (95% confidence intervals [CI] 14.6-27.0%). In total, 233 participants received a CT examination (151 TS POC CC+ , 82 TS POC CC-). Typical NCC lesions were present in 35/151 (23%) TS POC CC+ , and in 10/82 (12%) TS POC CC- participants. NCC prevalence was 13.5% (95% CI 8.4-21.1%) in the study population and 38.0% (95% CI 5.2-87.4%) among people reporting epileptic seizures. Participants with NCC were more likely to experience epileptic seizures (OR = 3.98, 95% CI 1.34-11.78, p = 0.01) than those without NCC, although only 7/45 (16%) people with NCC ever experienced epileptic seizures. The number of lesions did not differ by TS POC CC status (median: 3 [IQR 1-6] versus 2.5 [IQR 1-5.3], p = 0.64). Eight (23%) of the 35 TS POC CC+ participants with NCC had active stage lesions; in contrast none of the TS POC CC- participants was diagnosed with active NCC.

CONCLUSION

NCC is common in communities in the Eastern province of Zambia, but a large proportion of people remain asymptomatic.

Pediatric and adult meningeal, parenchymal, and spinal tuberculosis: A neuroimaging review

Neurotuberculosis is defined as a tuberculous infection of the meninges, brain parenchyma, vessels, cranial and spinal nerves, spinal cord, skull, and spine that can occur either in a localized or in a diffuse form. It is a heterogeneous disease characterized by many imaging appearances and it has been defined as "the great mimicker" due to similarities with many other conditions. The diagnosis of central nervous system (CNS) tuberculosis (TB) is based on clinical presentation, neuroimaging findings, laboratory and microbiological findings, and comprehensive evaluation of the response to anti-TB drug treatment. However, the absence of specific symptoms, the wide spectrum of neurological manifestations, the myriad of imaging findings, possible inconclusive laboratory results, and the paradoxical reaction to treatment make the diagnosis often challenging and difficult, potentially delaying adequate treatment with possible devastating short-term and long-term neurologic sequelae. Familiarity with the imaging characteristics helps in accurate diagnosis and may prevent or limit significantly morbidity and mortality. The goal of this review is to provide a comprehensive up-to-date overview of the conventional and advanced imaging features of CNS TB for radiologists, neuroradiologists, and pediatric radiologists. We discuss the most typical neurotuberculosis imaging findings and their differential diagnosis in children and adults with the goal to provide a global overview of this entity.

Polymorphous Low-Grade Neuroepithelial Tumor of the Young (PLNTY): A Newly Described Entity of Special Radiological Significance

Intracranial granulomas are a major cause of seizures in India, the most common etiologies being neurocysticercosis and tuberculosis. However, other pathologies including rare low-grade tumors may mimic these granulomas on imaging. In this article, we presented the case of a young woman patient with drug-resistant epilepsy. On imaging, there was a small calcified lesion in the brain parenchyma. In view of concordant electroclinical and imaging data on presurgical evaluation, the lesion was excised and the patient was seizure free. On histopathological evaluation, it was found to be a polymorphous low-grade neuroepithelial tumor of the young (PLNTY) - a rare, recently reported entity that can mimic an intracranial granuloma on imaging.

Severe neurocysticercosis in a quaternary hospital from Mozambique: Case series analysis

BACKGROUND

Neurocysticercosis (NCC) is severe and leading global cause of morbidity and mortality. The disease presents with a variety of clinical presentations from focal to diffuse neurological symptoms. Despite being an endemic country, there are no studies describing the clinico-epidemiological characteristics of NCC in Mozambique. Herein, we describe a consecutive cases series of NCC from the national reference Hospital in Maputo, capital of Mozambique.

METHODS

Consecutive cases of NCC diagnosed during a 3-year period (January/2020-December/2022) were retrieved from the institutional clinical files and imaging database.

RESULTS

Six cases of NCC were identified, with mean age of 43.1 years (range 26-66). Four were males (66.6 %). The median time from the beginning of clinical manifestations to the diagnosis was 6 months (range 3-18 months). All patients presented with severe parenchymal NCC, with seizures (n = 5, 83 %) being the most common manifestation. Other clinical manifestations were dementia (n = 1) and hydrocephalus (n = 1). The imaging showed multiple lesions at different stages, with half (n = 3) of them showing the coexistence of nodular calcified lesions at earlier stages (vesicular, colloidal and granular stages). Patients were treated with anthelminthic drugs, corticosteroids and anticonvulsants and no deaths to report. The 3rd month modified Rankin scale was ≤ 2 in 83 % of patients.

CONCLUSION

In our case series, patients with NCC presented very late, with severe advanced stage disease, with multiple coexistent short and long-term brain lesions. These findings can be explained eventually because of the Maputo Central Hospital being national referral center receiving commonly more severe cases. Studies aiming to clarify the diagnosis pathways/barriers and NCC awareness among medical doctors working at primary and secondary health care level is mandatory to assess the real burden of NCC and implement timely diagnosis and care of patients affected by this neglected disease.

Severe Neurocysticercosis in an Immunocompetent Male Without Travel to an Endemic Region: A Case Report

Neurocysticercosis is a neglected parasitic cause of seizures in the United States. It can have a wide array of presentations depending on the location and number of cysticercoids. The severity of symptoms varies with the location of the lesion in the brain and to the extent of the number of neurocysticercoids and host immune response. In the severe form of neurocysticercosis, it can present as an acute encephalitic picture. We present a case of severe neurocysticercosis in a patient without any significant travel history. Neurocysticercosis in nonendemic areas can be diagnostically challenging, given the lack of travel history as in our patient. Neurocysticercosis should be kept as a differential in all cases of seizures without prior history of seizure episodes.

Neuroimaging Patterns of Intracranial Infections: Meningitis, Cerebritis, and Their Complications

Neuroimaging provides rapid, noninvasive visualization of central nervous system infections for optimal diagnosis and management. Generalizable and characteristic imaging patterns help radiologists distinguish different types of intracranial infections including meningitis and cerebritis from a variety of bacterial, viral, fungal, and/or parasitic causes. Here, we describe key radiologic patterns of meningeal enhancement and diffusion restriction through profiles of meningitis, cerebritis, abscess, and ventriculitis. We discuss various imaging modalities and recent diagnostic advances such as deep learning through a survey of intracranial pathogens and their radiographic findings. Moreover, we explore critical complications and differential diagnoses of intracranial infections.

Neurocysticercosis: A Review into Treatment Options, Indications, and Their Efficacy

Neurocysticercosis, due to the localization of Taenia solium larvae in the Central Nervous System, is a neglected tropical disease still endemic in much of Latin America, Asia and sub-Saharan Africa. The therapeutic management of NC has gradually improved with the establishment of neuroimaging studies (CT and MRI) in endemic countries and with the demonstration of the efficacy of albendazole and praziquantel in the 1980s. But the morbidity and mortality of this preventable disease remain an unacceptable fact. In this scoping review, we will revise the different treatment options and their indications.

THE EFFICACY AND SAFETY OF THREE 30-DAY COURSES OF ALBENDAZOLE IN PATIENTS WITH NEUROCYSTICERCOSIS

Albendazole is one of the drugs indicated for the treatment of neurocysticercosis. However, data on the treatment outcome of a long course of this drug is scarce. This study aims to investigate the efficacy and safety of three 30-day courses of albendazole in patients with neurocysticercosis. Methods: The diagnosis of neurocysticercosis was based on epidemiological, clinical and laboratory criteria as guided by the Vietnamese Ministry of Health. Sixty patients with a mean age of 50.17 10.03 years old, with 86.7% (95% CI: 77.8 95.5%) men, were involved in this study. Patients received three 30-day courses of albendazole with an intermittence of 20 days. Additional treatment included steroids, anticonvulsants or analgesics. Based on brain magnetic resonance imaging 6 months after the therapy, the efficacy was classified as cure (viable cysts not discernible), improvement (50% or more cysts disappeared or calcified) or inefficacy (changes in less than 50% of the cysts). The safety was determined based on the changes of biochemical parameters after each treatment course. Results: The most common clinical presentations were headache (90.0%, 95% CI: 82.2 97.8) and/or seizure (68.3%, 95% CI: 56.2 70.4), followed by other symptoms such as fainting, memory loss, and limb numbness. Active cysts were discovered in all cases and located mainly in the parenchymal region. After therapy, the rates of cure, improvement or inefficacy were 43.3% (95% CI: 30.4 56.2%), 51.7% (95% CI: 38.7 64.7%) and 5.0% (95% CI: 0 10.7%), respectively. Liver enzymes were slightly higher compared to those before therapy and mostly returned to normal ranges after drug interruption. Alanine aminotransferase levels before the 3rd course were higher than values before the first and second courses. No abnormalities in blood urea or creatinine after therapy were reported. Conclusions: Three 30-day cycles of albendazole appear to have good efficacy and tolerability in patients with neurocysticercosis.

Endoscope-assisted far lateral craniotomy for resection of posterior fossa neurocysticercosis: illustrative case

BACKGROUND

Neurocysticercosis is a parasitic infection that commonly affects the ventricles, subarachnoid spaces, and spinal cord of the central nervous system. The authors report an unusual manifestation of purely posterior fossa neurocysticercosis treated with endoscope-assisted open craniotomy for resection.

OBSERVATIONS

A 67-year-old male presented with 2 months of progressive dizziness, gait ataxia, headaches, decreased hearing, and memory impairment. Imaging revealed an extra-axial cystic lesion occupying the foramen magnum and left cerebellopontine angle with significant mass effect and evidence of early hydrocephalus. Gross-total resection was accomplished via a left far lateral craniotomy with open endoscopic assistance, and pathological findings were consistent with neurocysticercosis. Postoperatively, he was noted to have a sixth nerve palsy, and adjuvant therapy included albendazole. By 9 months postoperatively, he exhibited complete resolution of an immediate postoperative sixth nerve palsy in addition to all preoperative symptoms. His hydrocephalus resolved and did not require permanent cerebrospinal fluid (CSF) diversion.

LESSONS

When combined with traditional skull base approaches, open endoscopic techniques allow for enhanced visualization and resection of complex lesions otherwise inaccessible under the microscope alone. Recognition and obliteration of central nervous system neurocysticercosis can facilitate excellent neurological recovery without the need for CSF diversion.

Neurocysticercosis in a Japanese woman with lung cancer who repeatedly visited endemic countries

Background

Taenia solium, present in most developing countries, infects many individuals and may result in their death. Neurocysticercosis (NCC) develops after invasion of the brain by parasitic larvae. It is the most common parasitic disease of the human central nervous system. On imaging scans it can be similar to brain tumors. We report a patient with a metastatic brain tumor and NCC. The co-presence of NCC was diagnosed based on specific neuroimaging- and epidemiologic findings.

Case presentation

A 36-year-old non-smoking Japanese woman with a history of non-small-cell lung cancer had undergone resection of the lower lobe followed by cytotoxic chemotherapy 2 years before apparently suffering recurrence. A positron emission computed tomography (PET) scan incidentally revealed multiple intracranial cold spots exhibiting differences in their shape and size. On brain magnetic resonance imaging (MRI) scans we observed many different patterns of peripheral edema and gadolinium-enhancing effects. As she had often visited Latin America and Southeast Asia and had eaten raw pork and Kimchi, we suspected that the brain lesions were due to NCC rather than metastatic brain tumors. However, serum immunoblotting assay and DNA analysis were negative for T. solium. Rather than performing resection, we administered albendazole (ABZ) and dexamethasone because her earlier cytotoxic chemotherapy had elicited severe pancytopenia. Except for a single large lesion in the left frontal lobe, this treatment resulted in a significant reduction in the size of these lesions and a decrease in perilesional edema. She underwent resection of the residual lesion 10 months later. Histology revealed it to be a metastatic tumor. Polymerase chain reaction (PCR) assay for NCC was negative. In the course of 11-months follow-up there has been no recurrence.

Conclusion

This is the first presentation of NCC in a Japanese woman with a metastatic brain tumor. NCC was incidentally discovered on PET scans and, based on her travel history and epidemiological findings; it was diagnosed and successfully treated with ABZ. NCC is endemic in most developing countries and as visits to such countries have increased, NCC must be ruled out in patients with multiple cystic nodular brain lesions.

Cysticercal brain abscess: a distinct entity mimicking pyogenic brain abscess in the colloidal vesicular stage

Cysticercal brain abscess is a rare entity with the clinical presentation and radiological findings closely mimicking a pyogenic abscess. We report three cases of cysticercal abscess presenting as solitary lesion in the brain with radiological appearance like an abscess. All the patients underwent excision of the lesion with histopathological diagnosis of cysticercal brain abscess with evidence of cysticerci in the colloidal vesicular stage. The clinical outcome was satisfactory after surgical excision. Cysticercal abscess, though rare, should be considered as a differential diagnosis of a solitary rim-enhancing lesion, mainly if the patients belong to the endemic zone of neurocysticercosis. Surgical excision with or without a short course of the anti-parasitic agent is the treatment of choice for the intracranial mass lesion with evidence of mass effect For the small lesion of cysticercal brain abscess or early stage of abscess, anti-parasitic medication and steroids can be considered.

Subarachnoid racemose neurocysticercosis with cerebellar involvement: an old friend in an infrequent location?

Taenia solium is the most common parasitic infection of the central nervous system and it can cause parenchymal or extra-parenchymal lesions. Subarachnoid cysticercosis is a type of extra-parenchymal infection in which the prevalence is not known and racemose NC with cerebellar involvement has been rarely reported. The diagnosis is challenging because of its similarity to other infectious diseases or to subarachnoid involvement of systemic malignancies. Treatment usually requires cysticide drugs, however, there are no randomized studies concerning the anti-parasitic treatment in subarachnoid NC. We present a case of racemose NC in the cerebellar hemisphere to draw attention to this pathology, endemic in many parts of the world; and highlight all the current gaps in our understanding of this entity.

Neurocysticercosis: Current Perspectives on Diagnosis and Management

Porcine cysticercosis, human taeniasis, and (neuro)cysticercosis are endemic in many low- and middle-income countries (LMIC) where they present a significant health burden to affected communities. Neurocysticercosis (NCC) is one of the leading causes of human epilepsy in many hyperendemic regions in Latin America, Asia, and sub-Saharan Africa. The World Health Organization (WHO) reports an estimated 2.5-8.3 million cases of NCC annually with a disability-adjusted life year (DALY) burden of 2.8 million, but as for all neglected tropical diseases (NTDs), these values are likely to be underestimated. Diagnosis of NCC is complex and most accurately diagnosed using clinical neuroimaging that is unavailable in most hyperendemic regions in LMIC. On January 28, 2021, WHO will launch its road map for the NTDs' "Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021-2030." Taeniasis/cysticercosis is targeted for control success considered as steady increase in the number of countries with intensified control in hyperendemic areas [increasing from 2 (3%) in 2020 to 4 (6%) in 2023, to 9 (14%) by 2025, and to 17 (27%) by 2030]. Cross-cutting targets that include 100% access to at least basic water supply, sanitation, and hygiene in areas endemic for NTDs and 75% integrated treatment coverage for preventative chemotherapy will additionally impact on the taeniasis/cysticercosis/NCC complex. With no vaccine available for humans, prevention of infection depends on communication to the public of the life cycle of a complex zoonosis to promote behavior change, underpinned by practical control measures including treatment of human taeniasis and (neuro)cysticercosis with albendazole and praziquantel [widely used as part of the mass drug administration (MDA) deworming programs], surgery where appropriate, and effective vaccination and deworming for pigs supported by meat inspection. Here, we review recent advances in tools and implementation for Taenia solium taeniasis/(neuro)cysticercosis (TSTC) control and milestones on the onward path to elimination.

Neurocysticercosis presented as a solitary cystic parenchymal lesion mimicking primary brain tumor: A case report

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Neurocysticercosis (NCC) is an endemic zoonotic infection in pork-eating region, including Bali.

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Despite its high prevalence, diagnosing an NCC can be challenging due to the protean clinical manifestations.

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Herein we describe an NCC case mistakenly diagnosed as a brain tumor, only later that we discovered the active larvae of Taenia solium, the pathogen which causes NCC.

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A high index of suspicion towards NCC should always be maintained, particularly among patients originated from endemic area.

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Appropriate treatment with anthelminthic may result in full disease resolution, thus precluding unnecessary invasive approach.

Introduction

Neurocysticercosis (NCC) is an infection of the central nervous system by the larval stage of pork tapeworm (Taenia solium/T. solium). Diagnosing NCC can be challenging, particularly among those who reside in areas with rare occurrence of NCC and atypical manifestation such as a solitary parenchymal lesion. We treated a patient whose initially was diagnosed with brain abcess and later, brain tumor, only finally revealed to be an NCC case.

Case report

A 25-year old male suffered from multiple focal-to-bilateral tonic clonic seizures, was initially diagnosed as brain abscess. He was given antibiotics and anti-seizure medication but the seizure relapsed with a typical semiology. Physical examination demonstrated grade I papilledema, grade 4+ hemiparesis, and headache of vascular origin. Patient was suspected to have oligodendroglioma after underwent head MRI examination and subsequent tumor resection was performed. Pathological anatomy evaluation demonstrated multiple cystic segments containing larva of tapeworm, supporting a diagnosis of active NCC infection. After 14-day course of antheminthic treatment and resumed AED, patient was seizure-free and NCC was not found upon follow-up CT scan.

Conclusion

NCC, with respect to clinical and radiological manifestations, can be protean. A high index of suspicion towards NCC should always be maintained, particularly among patients originated from endemic area. Appropriate treatment with anthelminthic may result in full disease resolution, thus precluding unnecessary invasive approach.

Parasitic infections of the spine: case series and review of the literature

OBJECTIVEAlthough parasitic infections are endemic to parts of the developing world and are more common in areas with developing economies and poor sanitary conditions, rare cases may occur in developed regions of the world.METHODSArticles eligible for the authors' literature review were initially searched using PubMed with the phrases "parasitic infections" and "spine." After the authors developed a list of parasites associated with spinal cord infections from the initial search, they expanded it to include individual diagnoses, using search terms including "neurocysticercosis," "schistosomiasis," "echinococcosis," and "toxoplasmosis."RESULTSTwo recent cases of parasitic spinal infections from the authors' institution are included.CONCLUSIONSKey findings on imaging modalities, laboratory studies suggestive of parasitic infection, and most importantly a thorough patient history are required to correctly diagnose parasitic spinal infections.

Neurocysticercosis cases identified at Sanglah Hospital, Bali, Indonesia from 2014 to 2018

Neurocysticercosis (NCC) was first reported in the province of Bali, Indonesia in 1975. Since this time, sporadic cases have been reported annually. This study reports information on 29 NCC cases (20 males and 9 females) admitted to a referral hospital in Denpasar, Bali from 2014 until 2018. Twenty-four cases were from Bali, 2 were from the province of East Nusa Tenggara, and 3 were from the Democratic Republic of Timor-Leste. Mean patient age was 37.2 years and 69.0% (20/29) were male. Epileptic seizures were the most common clinical manifestation (65.5%, 19/29). Serology (ELISA) was used in 14 cases (48.2%, 14/29), but only 6 cases, including one case with an inactive calcified lesion, were positive (42.9%, 6/14). Two cases underwent surgical resection after their lesions were initially misdiagnosed as brain tumors. These hospital-based findings are discussed along with the present status of NCC in Bali.

Neurocysticercosis of the fourth ventricle associated with hydrocephalus

Neurocysticercosis is a parasitic infection of the central nervous system with the cysts of Taenia solium, the pig tapeworm. Infection presents with a pleomorphic picture depending on the stage and location of the infection and the immune response of the infected host. Historically confined to the developing world, neurocysticercosis is no longer limited to endemic regions, as globalization, travel, and immigration permit the spread of the infection. We report a young Hispanic patient who was diagnosed with neurocysticercosis of the fourth ventricle and subsequent hydrocephalus.

Isolated brainstem tuberculomas

BACKGROUND

Isolated brainstem tuberculomas are rare lesions and account for up to 5% of all intracranial tuberculomas in endemic areas. The difficulties in diagnosis and management of this condition are sparsely reported. The aim of this study is to illustrate the nuances in managing brainstem tuberculomas, define prognosis, and demonstrate a shift in management strategies with newer imaging modalities.

METHOD

A retrospective review of 14 patients diagnosed and treated with a diagnosis of 'isolated brainstem tuberculoma' between 2011 and 2015 was done. Diagnosis was made after combining the findings at clinical history, examination, as well as imaging features. Patients were treated with steroids for 6 weeks or until they made a meaningful clinical recovery, and antitubercular therapy (ATT) for a minimum of 18 months or until there was resolution of the tuberculoma. Confirmation of tubercular pathology was done by observing if response to treatment resulted in clinical improvement, which happened in all of our cases.

RESULTS

Mean age at diagnosis was 24.7 years and nine were males. Twelve patients had a combination of cranial nerve deficits with pyramidal weakness or sensory symptoms. Mean duration of symptoms was 4.7 months and tests for human immunodeficiency virus (HIV) infection were negative in all patients. Only two patients had a previous history of tubercular meningitis. Most lesions were located in the pons with size ranging from 1 to 22.2 cm³. Eight patients showed complete resolution of the lesion at latest follow-up and the rest were still on ATT. Mean duration of ATT received for resolution of the lesion was 22 months. Almost all of our patients improved clinically on steroids and ATT.

CONCLUSIONS

Intracranial tuberculomas may present with or without meningitis. A high index of suspicion is essential, especially in endemic areas. A combination of clinical symptoms, investigations, and imaging features help in coming to a diagnosis. Biopsy of a brainstem lesion is fraught with complications. Antitubercular therapy has a very good prognosis, though the duration of therapy required may be longer.

[Racemose neurocysticercosis: Neuroimaging guides the diagnosis]

Neurocysticercosis is the leading cause of parasitosis of the central nervous system and acquired epilepsy in developing countries. The clinical manifestations of neurocysticercosis, especially its racemose variant, are pleomorphic and unspecific, characteristics that hinder the diagnosis and make it a challenge for the clinician.The objective of this report was to describe two cases of racemose neurocysticercosis in which neuroimaging led to the definitive diagnosis. The first case involved a patient with persistent headache and focal neurological signs. She required multiple paraclinical tests that led to the definitive diagnosis of racemose neurocysticercosis with secondary cerebral vasculitis. Despite medical and surgical treatment the patient died after multiple complications.The second case involved a patient with a history of neurocysticercosis, who consulted for chronic intractable vomiting. She required multiple paraclinical tests that led to the diagnosis of vomiting of central origin secondary to racemose neurocysticercosis and entrapment of the fourth ventricle. After medical and surgical treatment the patient showed slight improvement. In these two cases it was evident how proper interpretation of neuroimages is essential for the diagnosis of racemose neurocysticercosis.

Nonsubsampled rotated complex wavelet transform (NSRCxWT) for medical image fusion related to clinical aspects in neurocysticercosis

Neurocysticercosis (NCC) is a parasite infection caused by the tapeworm Taenia solium in its larvae stage which affects the central nervous system of the human body (a definite host). It results in the formation of multiple lesions in the brain at different locations during its various stages. During diagnosis of such symptomatic patients, these lesions can be better visualized using a feature based fusion of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This paper presents a novel approach to Multimodality Medical Image Fusion (MMIF) used for the analysis of the lesions for the diagnostic purpose and post treatment review of NCC. The MMIF presented here is a technique of combining CT and MRI data of the same patient into a new slice using a Nonsubsampled Rotated Complex Wavelet Transform (NSRCxWT). The forward NSRCxWT is applied on both the source modalities separately to extract the complementary and the edge related features. These features are then combined to form a composite spectral plane using average and maximum value selection fusion rules. The inverse transformation on this composite plane results into a new, visually better, and enriched fused image. The proposed technique is tested on the pilot study data sets of patients infected with NCC. The quality of these fused images is measured using objective and subjective evaluation metrics. Objective evaluation is performed by estimating the fusion parameters like entropy, fusion factor, image quality index, edge quality measure, mean structural similarity index measure, etc. The fused images are also evaluated for their visual quality using subjective analysis with the help of three expert radiologists. The experimental results on 43 image data sets of 17 patients are promising and superior when compared with the state of the art wavelet based fusion algorithms. The proposed algorithm can be a part of computer-aided detection and diagnosis (CADD) system which assists the radiologists in clinical practices.