Imaging findings and staging of progressive multifocal leukoencephalopathy in acquired immunodeficiency syndrome patients / 中华放射学杂志

ABSTRACT

Objective:To investigate the MRI features of progressive multifocal leukoencephalopathy (PML) in acquired immunodeficiency syndrome (AIDS) patients, and to provide evidence for clinical diagnosis, evaluation and staging.Methods:Form Janurary 2016 to April 2018, 11 AIDS patients with clinical diagnosis of PML were enrolled at Zhongnan Hospital of Wuhan University. A total of 25 MRI examination data of 11 patients (5 patients underwent multiple examinations) were reviewed. The distribution, morphology and signal characteristics of the lesions were analyzed, and the changes of the lesions between multiple MRI examinations were compared. The lesions of all 25 MR images were staged according to MR features.Results:Typical image findings of PML included confluent, bilateral but asymmetric distributed, supratentorial white matter abnormal signal lesions. The parietal lobe was most commonly involved, followed by the frontal lobe. The lesions often showed hypointensity on T 1 and hyperintensity on T 2 weighted images. No obvious mass effect or enhancement was found. In advanced stage, multifocal white matter lesions were enlarged in size and more confluent, displaying large patchy abnormal signal intensity, with gradually involving the deep white matter, and occasionally combing with gray matter and cerebellar lesions. The disease showed heterogenous signal intensity due to necrosis in the lesion. The newly appeared lesions showed obvious diffusion restriction, demonstrating high signal intensity on diffusion weighted imaing with low apparent diffusion coefficient value. The main finding of the later stage was necrosis, with focal asymmetric brain atrophy was observed. Conclusions:PML in AIDS patients has characteristic MRI findings, and MRI features varies in different stages. MRI can be helpful in clinical diagnosis, evaluation and staging of PML.