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Human Immunodeficiency Virus (HIV)

Andrew E. Auber¹, Clifford Belden¹

¹Brooke Army Medical Center, San Antonio, Texas

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A4.3

DOI:

10.1002/0471142719.mia0403s02

Online Posting Date:

November, 2001

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Abstract

Magnetic Resonance Imaging (MRI) for the evaluation of patients infected with human immunodeficiency virus (HIV), as with most other forms of intracranial inflammatory or infectious diseases, is a powerful though largely nonspecific diagnostic tool. For imaging of these complex patients with the varied and numerous pathologies they may harbor, the standard protocol is utilized to include gadolinium-enhanced sequences. This unit presents optional imaging sequences, including magnetic resonance diffusion (dMRI), magnetic resonance perfusion (pMRI), and magnetic resonance spectroscopy (MRS), that can be employed should patient tolerance allow and if specific the clinical situation requires further clarification.

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Unit Introduction
Basic Protocol: Imaging of HIV
Alternate Protocol: Special Situations
Commentary
Bibliography
Figures
Tables

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Materials

Basic Protocol: Imaging of HIV

Materials

Extravascular contrast agent (e.g., 0.1 mmol/kg patient body weight of gadolinium chelate from Mangevist, Omniscan, or Prohance)
Normal saline (0.9% NaCl) sterile

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Figures

Figure A4.3.1

This T₂-weighted (T_R = 2500 msec, T_E = 80 msec, N_acq = 0.75) transverse image at the basal ganglia level demonstrates a cluster of rounded lesions (arrowheads) in the left globus pallidus and posterior limb of the internal capsule with mild increased T₂ signal in adjacent brain. Minimal mass effect is present. The CSF disclosed cryptococcal infection, and “gelatinous pseudocysts” within the perivascular spaces of Virchow-Robin were diagnosed.

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Figure A4.3.2

A coronal (A) FSE T₂ image through the third ventricle (T_R = 5600 msec, T_E = 105 msec, N_acq = 2; echo train length = 8) discloses abnormal increased T₂ signal in the subependymal and immediate periventricular white matter (arrowheads). The corresponding post-contrast T₁-weighted (B) coronal image (T_R = 500 msec, T_E = 12 msec, N_acq = 1) shows linear ependymal enhancement (arrowheads) compatible with presumed CMV ventriculitis and ependymitis. This diagnosis was supported in this 33-year-old female with AIDS by a concurrent CMV retinitis. The authors utilized the additional coronal FSE sequence (A) in this patient primarily as a means of evaluating the optic pathways in this patient with CMV retinitis.

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Figure A4.3.3

This 9-year-old boy with congenitally acquired HIV infection began complaining of headaches. The proton-density T₂-weighted (A) transverse image (T_R = 2500 msec, T_E = 30 msec, N_acq = 0.75) shows prominent fusiform aneurysmal dilatation of the anterior cerebral artery (arrow). A subsequent cerebral angiogram (B) reveals diffuse aneurysmal involvement of the supraclinoid internal carotid artery (ICA), as well as the A1 (asterisk) and M1 (arrowhead) portions of the ICA branch vessels. The child was treated conservatively, but several months later experienced severe subarachnoid hemorrhage and died.

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Literature Cited

Literature Cited
	Chang, L., Miller, B.L., McBride, D., Cornford, M., Oropilla, G., Buchtal, S., Chiang, F., Aronow, H., and Ernst, T. 1995. Brain lesions in patients with AIDS: H-1 MR spectroscopy. Radiology 197:525-531.
	Donovan-Post, M.J., Yiannoutsos, C., Simpson, D., Booss, J., Clifford, D.B., Cohen, B., McArthur, J.C., Hall, C.D., and the AIDS Clinical Trials Group, 243 Team. 1999. Progressive multifocal leukoencephalopathy in AIDS: Are there any MR findings useful to patient management and predictive of patient survival. A.J.N.R. 20:1896-1906.
	Ernst, T.M., Chang, L., Witt, M.D., Aronow, H.A., Cornford, M.E., Walot, I., and Goldberg, M.A. 1998. Cerebral toxoplasmosis and lymphoma in AIDS: Perfusion MR experience in 13 patients. Radiology 208:663-669.
	Fauci, A.S. 1999. The AIDS epidemic: Considerations for the 21st century. N. Engl. J. Med. 341:1046-1050.
	Harris, D.E. and Enterline, D.S. 1997. Fungal infections of the central nervous system. Neuroimaging Clin. N. Am. 7:187-198.
	Pomper, M.G., Miller, T.J., Stone, J.H., Tidmore, W.C., and Hellmann, D.B. 1999. CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography. A.J.N.R. 20:75-85.
	Shah, S.S., Zimmerman, R.A., Rorke, L.B., and Vezina, L.G. 1996. Cerebrovascular complications of HIV in children. A.J.N.R. 17:1913-1917.
	Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
	Taveras, J.M. and Pile-Spellman, J. 1996. Inflammatory diseases. In Neuroradiology, 3rd edition pp. 259-326. Williams and Wilkins, Baltimore.
	Walot, I., Miller, B.L., Chang, L., and Mehringer, C.M. 1996. Neuroimaging findings in patients with AIDS. Clin. Infect. Dis. 22:906-919.
	Wong, J. and Quint, D.J. 1999. Imaging of central nervous system infections. Semin. Roentgenol. 34:123-143.
Key Reference
	Walot et al., 1996. See above.
Presents a directed and concise summary of the myriad imaging appearances encountered in this complex patient population.