Value of Perfusion-Weighted MR Imaging in the Assessment of Early Cerebral Alterations in Neurologically Asymptomatic HIV-1-Positive and HCV-Positive Patients

Abstract

Background and PurposeAsymptomatic central nervous system (CNS) involvement occurs in the early stage of the human immunodeficiency virus (HIV) infection. It has been documented that the hepatitis C virus (HCV) can replicate in the CNS. The aim of the study was to evaluate early disturbances in cerebral microcirculation using magnetic resonance (MR) perfusion-weighted imaging (PWI) in asymptomatic HIV-1-positive and HCV-positive patients, as well as to assess the correlation between PWI measurements and the clinical data.Materials and MethodsFifty-six patients: 17 HIV-1-positive non-treated, 18 HIV-1-positive treated with combination antiretroviral therapy (cART), 7 HIV-1/HCV-positive non-treated, 14 HCV-positive before antiviral therapy and 18 control subjects were enrolled in the study. PWI was performed with a 1.5T MR unit using dynamic susceptibility contrast (DSC) method. Cerebral blood volume (CBV) measurements relative to cerebellum (rCBV) were evaluated in the posterior cingulated region (PCG), basal ganglia (BG), temporoparietal (TPC) and frontal cortices (FC), as well as in white matter of frontoparietal areas. Correlations of rCBV values with immunologic data and liver histology activity index (HAI) were analyzed.ResultsSignificantly lower rCBV values were found in the right TPC and left FC as well as in PCG in HIV-1-positive naïve (p = 0.009; p = 0.020; p = 0.012), HIV-1 cART treated (p = 0.007; p = 0.009; p = 0.033), HIV-1/HCV-positive (p = 0.007; p = 0.027; p = 0.045) and HCV-positive patients (p = 0.010; p = 0.005; p = 0.045) compared to controls. HIV-1-positive cART treated and HIV-1/HCV-positive patients demonstrated lower rCBV values in the right FC (p = 0.009; p = 0.032, respectively) and the left TPC (p = 0.036; p = 0.005, respectively), while HCV-positive subjects revealed lower rCBV values in the left TPC region (p = 0.003). We found significantly elevated rCBV values in BG in HCV-positive patients (p = 0.0002; p<0.0001) compared to controls as well as to all HIV-1-positive subjects. There were no significant correlations of rCBV values and CD4 T cell count or HAI score.ConclusionsPWI examination enables the assessment of HIV-related as well as HCV-related early cerebral dysfunction in asymptomatic subjects. HCV-infected patients seem to reveal the most pronounced perfusion changes.

The neuropsychiatric aspect of the HCV infection

“…However, each of these groups had lower perfusion of several cortical areas, the HCV-infected (and also HIV/HCV) patients had the highest hypo-perfusion rates. 38 These patients also showed hyper-perfusion in basal ganglia. 39 The researchers suggest it to be a marker of early-stage HCV associated inflammation in patients with mild liver disease.…”

“…37 The cerebral blood volume (CBV) measurements relative to cerebellum (rCBV) are neuroimaging parameters that are being proposed as a non-invasive tool for assessing cerebral microcirculation impairment in HIV and HCV positive patients. 38 Specific perfusion disturbances may be observed even in patients without neurological signs. 38 Bladowska et al compared cerebral perfusion alternations in HIV naive, cART treated, HIV/HCV and HCV positive naive patients.…”

“…38 Specific perfusion disturbances may be observed even in patients without neurological signs. 38 Bladowska et al compared cerebral perfusion alternations in HIV naive, cART treated, HIV/HCV and HCV positive naive patients. However, each of these groups had lower perfusion of several cortical areas, the HCV-infected (and also HIV/HCV) patients had the highest hypo-perfusion rates.…”

Application of brain multi-b-value diffusion-weighted imaging (DWI) in adolescent orphans from AIDS families

“…4 MRI technology and functional MRI technology have broad application in the diagnosis of HIV-infection-related diseases. [5][6][7][8][9][10][11][12][13] Advanced MRI techniques include perfusionweighted imaging (PWI), diffusion tensor imaging, MR spectroscopy (MRS) and diffusion-weighted imaging (DWI ) is widely used in the diagnosis, prognosis and treatment assessment of diseases. [16][17][18] Recently, scholars have studied HIV-positive patients with conventional DWI 9,11,13 and have made certain achievements.…”

“…Moreover, asymptomatic HIV infection, a group which is often neglected, is hardly taken into consideration in scientific research. 6,9,14,19 In this study, asymptomatic HIV-positive adolescent orphans, who were born with HIV owing to mother-to-child transmission, were scanned using DWI with multi-b-value. The immune system of infants was immature and immune system function was poor.…”