This study presents a systematic review of the role of imaging in the diagnosis of central nervous system toxoplasmosis, in addition to a case series from a tertiary university hospital. The review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in the International Prospective Register of Systematic Reviews (ID: CRD420251107718). Studies published after January 1, 2000 were retrieved from the PubMed, Embase, Scopus, and Latin-American and Caribbean Health Sciences Literature databases. Two authors, working independently, selected studies that met the eligibility criteria, which were organized with Rayyan software. Imaging findings were described using computed tomography (CT), conventional magnetic resonance imaging (MRI), advanced MRI sequences or nuclear imaging, focusing on single-photon-emission computed tomography, with and without thallium-201, and positron-emission tomography/CT. Extracted data focused on lesion topography, signal characteristics, enhancement, restricted diffusion, and when available, spectroscopy and perfusion MRI findings. To illustrate typical and atypical imaging features, a complementary case series was included, evaluating patients with confirmed cerebral toxoplasmosis. The review demonstrates that CT and MRI remain essential for diagnosis and follow-up, whereas advanced MRI sequences provide additional value in differentiating toxoplasmosis from other opportunistic infections and neoplastic processes.

Keywords: Toxoplasma; Toxoplasmosis, cerebral/diagnosis; Toxoplasmosis/diagnostic imaging; Neuroimaging.