Pediatric AIDS: comparative cranial MRI and CT scans

Fourteen consecutive children (age range: 4 months to 11 years; median: 4 years) with acquired immunodeficiency syndrome (AIDS) were studied prospectively with cranial magnetic resonance imaging (MRI) and unenhanced computed tomography (CT). In 4 children, human immunodeficiency virus infection was transfusion-related, while in 10, transplacental transmission occurred. Twelve children had abnormal neurologic examinations; of these, 10 had developmental delay and 2 were normal by developmental history and neurologic examination. Standardized neuropsychologic tests were given to all children; 5 were in the normal range and 9 demonstrated significant delays in verbal or motor/perceptual development. All children with abnormal neuropsychologic results were developmentally delayed; however, in 2 infants with normal neuropsychologic assessments, developmental delay and abnormal neurologic examinations were documented. Brain parenchymal volume loss (8 patients) and cervical lymphatic hypertrophy (4 patients) were demonstrated equally well by MRI and CT. CT alone demonstrated striatal-thalamic calcification (1 patient), whereas MRI alone demonstrated delayed myelination (1 patient). The extent of focal white matter lesions in 1 patient was demonstrated better by MRI than by CT. No intracranial mass lesions were demonstrated; however, significant correlations were found between peripheral volume loss imaged by either MRI or CT and both verbal and performance scores. In our small series, MRI offered no apparent advantage over CT in evaluating children with AIDS. We suggest that CT alone is sufficiently sensitive in evaluating pediatric AIDS-related brain abnormalities.