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Proton magnetic resonance spectroscopy pattern of progressive multifocal leukoencephalopathy in AIDS
1Department of Neurology, Santa Creu i Sant Pau Hospital, Autonomous University of Barcelona, Spain.
Abstract:
The objective was to determine whether the use of intermediate echo times (135 ms) in proton magnetic resonance spectroscopy (1H-MRS) detects a homogenous pattern in progressive multifocal leukoencephalopathy (PML) in HIV-1 infected people, and to confirm the results of previous studies. Six patients infected with HIV-1, with PML established by biopsy, and six healthy age and sex matched volunteers were evaluated to define their spectroscopic pattern. 1H-MRS spectra performed at 1.5 T were obtained with the STEAM sequence: TE/TM/TR, 20 ms/13.7 ms/2000 ms; 2500 Hz, size 2048 points, 256 acquisitions (STEAM-20) and with the PRESS sequence; TE/TR, 135 ms/2000 ms; 2500 Hz, size 2048 points, 256 acquisitions (PRESS-135). A single voxel was placed on the lesions and on the parieto-occipital white matter of controls. The peaks of N-acetylaspartate (NAA), choline (Cho), myoinositol (mI), lactate, and lipids were considered, and the results were expressed using creatine as reference. Spectra of PML lesions were characterised by significantly reduced NAA, lactate presence, and by significantly increased Cho and lipids compared with control group values. These results indicate that 1H-MRS detects a homogenous pattern in PML lesions. Recent studies, together with this, suggest that 1H-MRS may help in the diagnostic approach to patients with suspected PML lesions associated with AIDS.
Insights
Proton magnetic resonance spectroscopy (1H-MRS) with intermediate echo times reveals a consistent pattern in progressive multifocal leukoencephalopathy (PML) lesions in HIV-1 patients. This technique may aid in diagnosing PML, especially in AIDS-associated cases.
Area of Science:
- Neuroimaging
- Biochemistry
- Infectious Diseases
Background:
- Progressive multifocal leukoencephalopathy (PML) is a serious opportunistic infection in HIV-1 patients.
- Accurate and early diagnosis of PML is crucial for patient management.
- Proton magnetic resonance spectroscopy (1H-MRS) offers a non-invasive method for characterizing brain lesions.
Purpose of the Study:
- To evaluate if intermediate echo times (135 ms) in 1H-MRS reveal a homogenous pattern in PML lesions in HIV-1 infected individuals.
- To confirm findings from previous studies on 1H-MRS in PML.
- To assess the utility of 1H-MRS in the diagnostic approach to suspected PML.
Main Methods:
- Six HIV-1 positive patients with biopsy-confirmed PML and six healthy controls were studied.
- 1H-MRS was performed at 1.5 T using STEAM (20 ms echo time) and PRESS (135 ms echo time) sequences.
- Spectra were acquired from PML lesions and control white matter, analyzing metabolites like NAA, Cho, mI, lactate, and lipids relative to creatine.
Main Results:
- PML lesions showed significantly reduced N-acetylaspartate (NAA).
- Lactate was present in PML lesions.
- Choline (Cho) and lipid levels were significantly elevated in PML lesions compared to controls.
- The 1H-MRS pattern in PML lesions was found to be homogenous.
Conclusions:
- 1H-MRS with intermediate echo times effectively detects a homogenous metabolic pattern in PML lesions.
- The characteristic spectral changes in PML support the use of 1H-MRS as a diagnostic tool.
- 1H-MRS may assist in the diagnosis of PML in patients with suspected lesions, particularly those with AIDS.