[Magnetic resonance imaging features of Cryptococcus infection in central nervous system in patients with AIDS]

To investigate the magnetic resonance imaging (MRI) features of Cryptococcus infection in central nervous system patients with acquired immune deficiency syndrome (AIDS).
 Methods: The retrospective study on magnetic resonance imaging (MRI) and clinical data of cryptococcal meningitis (CM) was carried out between July 2011 and March 2017. These patients had not received anti-retroviral treatment. Patients with other specific or suspicious diseases in the central nervous system were not included in the analysis.
 Results: A total of 39 patients were included in the analysis, with CD4 cell counts of 13.0×106/L [(0-205)×106/L], and 94.9% (37/39) of patients with CD4 cell count <100×106/L. Of the 39 patients, 26 patients showed abnormal MRI signals in the brain, which were most frequently involved in the basal ganglia (20/26, 76.9%). The basal ganglia lesions showed dilated Virchow-Robin space (VRS)/gelatinous spseudocysts (18/20, 90%). Postcontrast T1-weighted MRI revealed no significant enhancement (3/5, 60%) and mild enhancement (2/5, 40%). The incidence of cerebral cryptococcal granuloma were 35% (7/20). Nineteen of 26 patients with lesions outside the basal ganglia, of which 13 patients also complicated with basal ganglia lesions. Postcontrast T1-weighted MRI revealed no significant enhancement. The incidence of cryptococcal granuloma and meningeal thickening were 15.7% (3/19) and 26.3% (5/19), respectively. Postcontrast T1-weighted MRI meningeal thickening revealed enhancement (5/5, 100%).
 Conclusion: The incidence of brain MRI abnormality in AIDS complicated with central nervous system Cryptococcus infection may not be low, and the lesions are mostly located in the basal ganglia. It most frequently displays the dilated VRS/gelatinous spseudocysts. It can also be showed cryptococcal granuloma. Postcontrast T1-weighted MRI often reveals no enhancement or mild enhancement.