White matter disease in AIDS: findings at MR imaging.

Abstract

A review of the magnetic resonance (MR) images of 365 patients with acquired immunodeficiency syndrome (AIDS) revealed that 112 (31%) had signal abnormalities confined to the white matter. Four patterns were observed: (a) diffuse: widespread involvement of a large area; (b) patchy: localized involvement with ill-defined margins; (c) focal: well-defined areas of involvement; and (d) punctate: small foci less than 1 cm in diameter. Clinical or pathologic findings were available in 60 of the 112 patients and were correlated with the white matter patterns seen on MR images. The diffuse pattern correlated with AIDS dementia complex (ADC), which was the most common clinical diagnosis. Patchy or punctate lesions may be seen with ADC but are less common. Focal white matter lesions were not seen in patients with ADC but were seen in all six patients with progressive multifocal leukoencephalopathy, in both patients with lymphoma, and in one patient with toxoplasmosis. The authors conclude that white matter lesions are are common in AIDS and are often secondary to direct infection of the brain with human immunodeficiency virus, which causes the ADC and usually produces a diffuse white matter pattern. Biopsy is probably not indicated in these patients. Focal white matter lesions suggest a focal infection or tumor, and biopsy may be warranted.

Effective use of JC virus PCR for diagnosis of progressive multifocal leukoencephalopathy

“…This low detection rate may be due to non-specificity of radiological findings (Antinori et al, 1997) or insensitivity of PCR, or perhaps due to highly active antiretroviral therapy (HAART) re-establishing host immune function and reducing JCV below detectable levels (Koralnik, 2006). These possibilities are supported by the findings that PML is often difficult to distinguish radiographically from lesions caused by HIV encephalopathy (Olsen et al, 1988;Koralnik et al, 1999) and that the sensitivity of JCV PCR dropped from 89.5 % in the pre-HAART era (1992)(1993)(1994)(1995) to 57.5 % in the HAART era (1996)(1997)(1998)(1999)(2000)(2001)(2002) (Marzocchetti et al, 2005). Interestingly, JCV PCR was also positive in 19 % of patients with abnormal white matter radiology findings suggestive of infection but not characteristic of PML.…”

Assessing the Chronic Neuropsychologic Sequelae of Human Immunodeficiency Virus–Negative Cryptococcal Meningitis by Using Diffusion Tensor Imaging

“…[19][20][21][22] Meningitis also could lead to periventricular WM injury by glial cell infiltration. 15 The spectrum of abnormalities on MR imaging reflected potential anatomies of fungal invasion.…”

The Role of Medical Imaging in Defining CNS Abnormalities Associated with HIV-Infection and Opportunistic Infections

“…The most common findings included regional gray matter atrophy, particularly in the basal ganglia [4][5][6], Electronic supplementary material The online version of this article (doi:10.1007/s13311-010-0010-4) contains supplementary material, which is available to authorized users. white matter lesions [7,8], ventricular expansion [9], and global cerebral atrophy [7,[10][11][12]. More recent studies have further elucidated these effects using more advanced image acquisition and volumetric measurement techniques.…”