[The role of brain magnetic resonance studies in the diagnostics of central nervous system lesions in HIV-1 positive patients].

UNLABELLED: Approximately 10% of persons infected with human immunodeficiency virus (HIV) and 75-90% patients with acquired immunodeficiency syndrome (AIDS) present neurological symptoms. This group causes the greatest diagnostic difficulties among AIDS patients. The purpose of the study was to demonstrate the usefulness of the magnetic resonance imaging (MR) of the central nervous system (CNS) in the diagnosis and differentiation of primary and secondary lesions.

MATERIAL AND METHODS: Fifty one patients with the symptoms suggesting CNS involvement were enrolled into the study. In 40 of them AIDS diagnosis was established based on the picture of CNS lesions. MR studies were performed using EDGE-ECLIPSE 1.5 T unit with FSE sequences, T1- and T2-weighted images, before and after paramagnetic contrast agent injection, in sagittal, coronal and transverse planes. In almost all cases FLAIR technique was also used. Thirteen persons were examined several times. Altogether we executed 62 studies. Magnetic resonance results were compared with the results of laboratory tests and sometimes histopathological examination at autopsy.

RESULTS: Pathological findings were visible on MR of CNS in 37 (92.5%) of 40 patients with AIDS. In 8 (20%) cases the diagnosis of AIDS dementia complex (ADC) was established. Toxoplasmosis was diagnosed in 9 (22.5%) cases, tuberculosis in 6 (15%), cryptococcosis in 5 (12.5%) patients, progressive multifocal leukoencephalopathy (PML) in 3 (7.5%) patients, primary lymphoma also in 3 (7.5%), and atypical mycobacteriosis in 2 patient. In 1 (2.5%) case we could not establish the final diagnosis. We described the patterns of MR appearance in the different types of lesions mentioned above based on our findings and the literature review.

CONCLUSIONS: Magnetic resonance imaging has a high sensitivity in identifying lesions of the central nervous system. It is very useful, together with the results of other tests, in the final diagnosis of the lesions in the CNS. Magnetic resonance plays also an important role in the treatment planning and monitoring of the efficacy of therapy used in AIDS patients.