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Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Spinal tract pathology in AIDS: postmortem MRI correlation with neuropathology
C G Santosh1, J E Bell, J J Best
1MRI Unit, City Hospital, Edinburgh, Scotland.
Abstract:
Vacuolar myelopathy (VM) and tract pallor are poorly understood spinal tract abnormalities in patients with the acquired immunodeficiency syndrome (AIDS). We studied the ability of magnetic resonance imaging (MRI) to detect these changes in spinal cord specimens postmortem and whether criteria could be formulated which would allow these conditions to be differentiated from other lesions of the spinal cord in AIDS, such as lymphoma, cytomegalovirus (CMV) and human immunodeficiency virus (HIV) myelitis. We imaged 38 postmortem specimens of spinal cord. The MRI studies were interpreted blind. The specimens included cases of VM myelin pallor, CMV myeloradiculitis, HIV myelitis, lymphoma as well as normal cords, both HIV+ve and HIV-ve. MRI showed abnormal signal, suggestive of tract pathology, in 10 of the 14 cases with histopathological evidence of tract changes. The findings in VM and tract pallor on proton-density and T2-weighted MRI were increased signal from the affected white-matter tracts, present on multiple contiguous slices and symmetrical in most cases. The pattern was sufficiently distinct to differentiate spinal tract pathology from other spinal cord lesions in AIDS.
Insights
Magnetic resonance imaging (MRI) can detect spinal cord abnormalities like vacuolar myelopathy (VM) and tract pallor in acquired immunodeficiency syndrome (AIDS) patients. Specific MRI signal patterns help differentiate these VM changes from other spinal cord lesions in AIDS.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Vacuolar myelopathy (VM) and tract pallor are poorly understood spinal cord abnormalities in patients with acquired immunodeficiency syndrome (AIDS).
- Differentiating these conditions from other spinal cord lesions in AIDS, such as lymphoma, cytomegalovirus (CMV), and human immunodeficiency virus (HIV) myelitis, is clinically important.
Purpose of the Study:
- To evaluate the ability of magnetic resonance imaging (MRI) to detect VM and tract pallor in postmortem spinal cord specimens.
- To formulate MRI criteria for differentiating VM and tract pallor from other spinal cord lesions in AIDS.
Main Methods:
- 38 postmortem spinal cord specimens were imaged using MRI.
- MRI studies were interpreted by blinded readers.
- Specimens included cases of VM, CMV myeloradiculitis, HIV myelitis, lymphoma, and normal cords (HIV+ve and HIV-ve).
Main Results:
- MRI detected abnormal signals suggestive of tract pathology in 10 out of 14 cases with histopathological evidence of tract changes.
- Findings in VM and tract pallor included increased signal on proton-density and T2-weighted MRI in affected white matter tracts.
- These signal changes were typically present on multiple contiguous slices and were symmetrical in most cases.
Conclusions:
- The distinct MRI signal pattern of VM and tract pallor allows differentiation from other spinal cord lesions in AIDS.
- MRI shows potential for diagnosing VM and tract pallor in AIDS patients.
