Magnetic Resonance Imaging Evaluation of Central Nervous System Manifestations in Patients Infected with Human Immunodeficiency Virus

Abstract

Introduction: Involvement of Central Nervous System (CNS) occurs early in Human Immunodeficiency Virus (HIV) infection resulting in significant morbidity and mortality. In these patients, neuroimaging is the modality of choice and Magnetic Resonance Imaging (MRI) is the preferred imaging modality for brain as it helps in the diagnosis, deciding appropriate therapy and follow up. Aim: To evaluate features of brain parenchymal involvement on MRI in HIV patients. Materials and Methods: The study was a retrospective study conducted over a period of two years from February 2014 to September 2016 at a tertiary care hospital in Delhi, India. A total of 400 new cases of HIV/AIDS were registered in the immunodeficiency center during this period. Out of these cases, 107 patients presented with predominantly CNS symptoms and underwent MRI of the brain. Imaging was performed on GE Wipro Sigma 1.5 Tesla machine using standard sequences with pre-contrast and post-contrast acquisition. The patients with positive findings (n=75) were followed up. Laboratory and HPE correlation were carried out. Results: MRI Brain was performed in 107 cases, out of which 75 cases had radiological findings. The study finally included 75 patients who had positive findings on MRI brain. There were 61 (81.3%) males and 14 (18.7%) females with mean age of 38.3 years range (4–60 years). Twenty-seven had Tuberculosis (TB), 26 HIV encephalitis (15 HIV encephalitis, 11 in addition had other brain pathology), 12 toxoplasmosis, four cryptococcal meningitis, three Primary CNS Lymphoma (PCNSL), nine Progressive Multifocal Leukoencephalopathy (PML) and one HIV vasculitis. Conclusion: Classic CNS infections in the setting of Acquired Immunodeficiency Syndrome (AIDS) include toxoplasmosis, CNS TB, cryptococcosis, PML, cytomegalovirus encephalitis, and neurosyphilis. In our study, we included neuroimaging in our institutional protocol and it was a crucial component of the diagnostic work-up in our study population. MRI proved to be the preferred imaging modalities for brain and spine in confirming the diagnosis due to its multiplanar capability and excellent soft tissue resolution. Findings of TB, HIV encephalopathy and toxoplasma were the most common on evaluating HIV patients with CNS symptoms.

Keywords

• acquired immunodeficiency syndrome
• hiv encephalitis
• toxoplasma
• tuberculosis