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[Progressive multifocal leukoencephalopathy in patients with AIDS. Findings with computerized tomography and magnetic
T Tartaglione1, C Colosimo, A Antinori
1Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma.
Abstract:
Progressive Multifocal Leukoencephalopathy (PML) is a subacute demyelinating opportunistic infection of the central nervous system which frequently occurs in AIDS. CT and MR, together with clinical and virological findings, can suggest a correct diagnosis in most cases, thus avoiding stereotactic biopsy which is too invasive considering the lack of therapy and the poor prognosis of this disease. In this study we reviewed the CT and MR findings of 16 proved AIDS-related PML cases. PML lesions appeared as hypodense on CT, hypointense on T1w, hyperintense on PDw and T2w MR images. CT was less sensitive than T2w MR images and underestimated the number of lesions and/or disease extent. On the basis of our findings during the progression of the lesions we observed two different patterns of PML presentation and evolution i.e., "single" and "multifocal". Single lesions generally involve subcortical white matter (arcuate fibers) of parietal lobe and spread to the contralateral hemisphere across the corpus callosum; multiple "patchy" lesions can be localized variably in the cerebral hemispheres and also in the brainstem and cerebellar hemispheres.
Insights
Progressive Multifocal Leukoencephalopathy (PML) in AIDS patients can be diagnosed using CT and MR imaging. These techniques reveal specific lesion patterns, aiding diagnosis and avoiding invasive biopsies.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Context:
- Progressive Multifocal Leukoencephalopathy (PML) is a severe opportunistic infection affecting the central nervous system.
- PML commonly occurs in individuals with Acquired Immunodeficiency Syndrome (AIDS).
- Diagnosis of PML is crucial for patient management, given its poor prognosis and lack of specific therapy.
Purpose:
- To review CT and MR imaging findings in 16 confirmed cases of AIDS-related PML.
- To evaluate the diagnostic sensitivity of CT and MR imaging for PML.
- To identify distinct patterns of PML presentation and evolution.
Summary:
- PML lesions in AIDS patients exhibit characteristic imaging features: hypodense on CT, hypointense on T1w, and hyperintense on PDw/T2w MR images.
- T2w MR imaging is more sensitive than CT in detecting PML lesions and assessing disease extent.
- Two distinct patterns of PML evolution were observed: a 'single' lesion pattern, often involving subcortical white matter and spreading via the corpus callosum, and a 'multifocal' pattern with varied localization in cerebral hemispheres, brainstem, and cerebellum.
Impact:
- Accurate diagnosis of PML can be achieved through a combination of clinical, virological, and advanced neuroimaging findings.
- Neuroimaging (CT and MR) plays a vital role in diagnosing PML, potentially obviating the need for invasive stereotactic biopsy.
- Understanding PML lesion patterns aids in early detection and management strategies for this devastating opportunistic infection in AIDS patients.