To evaluate the CT and MR findings of cerebral paragonimiasis (PW) and to assess the diagnostic value of the specific antibody test by enzyme-linked immunosorbent assay (ELISA) for PW, 55 CT scans and 13 MR images of 57 patients with cerebral PW were reviewed retrospectively, and correlated with the serum/CSF anstage (n=4), on the basis of CT/MR findings. In the group of early active stage the most common and characteristic finding was seen in 52% on CT and 44% on MR.Other non-specific findings included a solitary ring-like or irregular enhancing lesions, ill- defined low density lesions without enhancement, localized hemorrhage with or without enhancing lesions. In the group of chronic stage there were multiple calcifications of various shapes, most commonly 1-2cm sized round shape, and associated encephalomalacia. MR was superior to CT in detecting hemorrhage and in characterizing the central contents of ring-shaped calcifications, while it was inferior to CT in detecting hemmonly 1-2cm sized round shape, and associated encephalomalacia. MR was superior to CT in detecting hemorrhage and in characterizing the central contents of ring-shaped calcifications, while it was inferior to CT in identifying small calcifications. Antibody levels of serum and CSF were positive in 86% and 82% in early active group, and in 48% and 31% in chronic sgage, respectively. The positive rate was significantly different between the two groups (p=0.001). CT/MR findings were characteristic in only approximately half the cases in early active cerebral PW which can be cured by Praziquantel therapy. Therefore, antibody test by ELISA is recommended as a complementary tool, Particularly in patients with non-specific imaging findings.