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MRI pattern of progressive multifocal leukoencephalopathy (PML) in AIDS. Pathological correlations
P M Trotot1, R Vazeux, H K Yamashita
1Institut Pasteur, Hôpital, Paris.
Journal of Neuroradiology = Journal De Neuroradiologie
|January 1, 1990
Summary
Progressive multifocal leukoencephalopathy (PML) in AIDS patients primarily affects white matter, not grey matter. MRI is reliable for diagnosing PML, especially with specific imaging techniques.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a serious demyelinating disease affecting immunocompromised individuals, notably those with acquired immunodeficiency syndrome (AIDS).
- The presentation of PML can be variable, leading to diagnostic challenges, particularly in distinguishing it from other opportunistic infections in AIDS patients.
Observation:
- A review of 8 patients with PML, confirmed by biopsy and/or autopsy and MRI, was conducted.
- The study specifically investigated the presence of grey matter involvement and mass effect, which are characteristic of other conditions like toxoplasmic abscesses.
Findings:
- Contrary to some reports, no grey matter lesions or mass effect were observed in the PML patients studied.
- PML was not uniformly multifocal in all cases, and prolonged remissions were noted, indicating a variable disease course.
- Magnetic Resonance Imaging (MRI) criteria for PML are reliable when utilizing multiple T2-weighted coronal slices to visualize affected white matter fibers.
Implications:
- Accurate MRI interpretation is crucial for diagnosing PML in HIV-infected patients, differentiating it from other pathologies.
- Understanding the imaging characteristics of PML is essential for timely and appropriate patient management.
- Awareness of potential co-existing brain pathologies in immunocompromised patients is vital for comprehensive diagnosis and treatment.