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Progressive multifocal leukoencephalopathy and human immunodeficiency virus-associated white matter lesions in AIDS:
Purpose:
To determine the magnetization transfer features of progressive multifocal leukoencephalopathy (PML) and human immunodeficiency virus (HIV)-associated white matter lesions (WML) (hereafter, HIV-WML) on magnetic resonance (MR) images obtained in patients with acquired immunodeficiency syndrome (AIDS).
Materials And Methods:
Conventional MR imaging and magnetization transfer MR imaging were performed in 21 AIDS patients with 42 areas of white matter hyperintensity on MR images (13 patients had 25 PML lesions, eight patients had 17 WML). The magnetization transfer ratio was calculated for each lesion.
Results:
Compared with normal-appearing white matter (magnetization transfer ratio = 47.9%), both PML and HIV-WML showed reduced magnetization transfer ratio. The magnetization transfer ratio was significantly lower in PML lesions (magnetization transfer ratio = 26.1%) than in HIV-WML (magnetization transfer ratio = 38.0%, P < .0001), and there was no overlap in the magnetization transfer ratio between PML lesions and HIV-WML. The separation in magnetization transfer ratio between the two lesion types was valid for lesion as small as 0.5 cm2.
Conclusion:
The larger reduction in magnetization transfer ratio for PML lesions is most likely due to demyelination, whereas the reduction in HIV-WML may be associated primarily with gliosis. PML lesions appear to cause strong reductions in magnetization transfer ratio early in the course of disease. Magnetization transfer MR imaging is a noninvasive tool that improves the differentiation between PML and HIV-WML in patients with AIDS.
Insights
Magnetization transfer MRI can differentiate progressive multifocal leukoencephalopathy (PML) from HIV-associated white matter lesions in AIDS patients. PML lesions show a significantly lower magnetization transfer ratio, indicating demyelination, compared to HIV-WML, which suggest gliosis.
Area of Science:
- Neuroimaging
- Radiology
- Infectious Diseases
Background:
- Acquired immunodeficiency syndrome (AIDS) patients often develop white matter lesions (WML).
- Differentiating progressive multifocal leukoencephalopathy (PML) from human immunodeficiency virus (HIV)-associated WML is clinically important.
- Conventional MRI may not reliably distinguish between these lesion types.
Purpose of the Study:
- To investigate the utility of magnetization transfer (MT) magnetic resonance (MR) imaging in characterizing PML and HIV-WML in AIDS patients.
- To determine if MT parameters can differentiate between PML and HIV-WML.
Main Methods:
- Conventional and MT MR imaging were performed on 21 AIDS patients with 42 white matter hyperintensities.
- Magnetization transfer ratio (MTR) was calculated for each lesion and compared to normal-appearing white matter.
- Lesion size was considered for diagnostic validity.
Main Results:
- Both PML and HIV-WML demonstrated reduced MTR compared to normal white matter.
- PML lesions exhibited significantly lower MTR (26.1%) than HIV-WML (38.0%), with no overlap.
- This MTR differentiation was effective for lesions as small as 0.5 cm².
Conclusions:
- The pronounced MTR reduction in PML lesions suggests demyelination, while the lesser reduction in HIV-WML is likely due to gliosis.
- MT MR imaging is a valuable noninvasive tool for distinguishing PML from HIV-WML in AIDS patients.
- PML lesions cause substantial MTR reductions early in disease progression.