Imaging features of CNS involvement in AIDS.

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
Diagnostic and interventional radiology (Ankara, Turkey) (Impact Factor: 1.03). 09/2010; 16(3):193-200. DOI: 10.4261/1305-3825.DIR.2182-08.1
Source: PubMed

ABSTRACT Patients with acquired immunodeficiency syndrome (AIDS) are the subjects of a large part of routine neuroradiological work in the Western world currently. The World Health Organization announced that Turkish authorities had reported a cumulative total of 2544 HIV cases from 1985 to 2006, of whom 623 had developed AIDS and 140 had died. It is estimated that approximately one-third of AIDS patients develop neurological complications. The spectrum of diseases affecting the central nervous system (CNS) in AIDS patients comprises predominantly opportunistic infections and primary CNS lymphoma. Although to a lesser degree when compared with Western countries, the incidence of AIDS and related neurological diseases are on the rise also in Turkey. Therefore radiologists should recognize HIV-associated problems and their imaging features. In this review, we focus on imaging features of more common CNS diseases in HIV-seropositive patients. This essay has been prepared using radiological studies of the patients who had been managed in our hospital which is a tertiary care center with a highly motivated medical team for this peculiar disease in the years between 2002 and 2008.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: SUMMARY:Brain imaging has progressed from exclusion of rare treatable mass lesions to a specific antemortem diagnosis. MR imaging-derived hippocampal atrophy and WMH are regarded as imaging biomarkers of AD and CVD respectively. Abnormal FP-CIT SPECT or cardiac iodobenzamide SPECT is a useful supportive imaging feature in the diagnosis of DLB. Frontal and/or anterior temporal atrophy and anterior defects on molecular imaging with FDG-PET or perfusion SPECT are characteristic of FTDs. Whole-body FDG-PET may be helpful in patients with rapidly progressing "autoimmune dementias," and FLAIR and DWI are indicated in suspected CJD. A major role of imaging is in the development of new drugs and less costly biomarkers.
    American Journal of Neuroradiology 12/2011; · 3.17 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION. Primary lymphoma of the central nervous system (PLCNS) is a rare tumour whose incidence has increased substantially in immunocompetent patients. AIM. To examine the clinical and neuroimaging features in this risk group, with the aim of establishing a set of characteristics that can lead to a quick and accurate diagnosis. PATIENTS AND METHODS. The study analysed all the cases of diffuse B-cell PLCNS that had been diagnosed histologically over the past 13 years in two neurological, neurosurgical and oncological referral hospitals in the north-east of the country. RESULTS. A total of 38 patients were studied (age: 15-84 years old), 55.3% of whom were males. The most frequent clinical presentation was gait instability, speech disorders and headache. The analysis showed that 94.7% of the lesions are supratentorial, and 68% have deep-structure involvement. In magnetic resonance imaging, 50% show homogeneous lesions, 94.7% were T1 hypo/isointense and 65.8% were T2 hyperintense, the mean size being 2.97 cm. Computerised tomography showed 48% of the lesions to be hyperdense. All the patients displayed enhancement following the administration of contrast. The overall median time of survival is 209 ± 134.85 days. CONCLUSIONS. PLCNS can manifest a number of different features per image, which have gradually changed over time, and we must be familiar with them in order to establish a quick diagnosis. Intensive efforts must be made to improve sensitivity and diagnostic specificity, and to conduct research on the biological mechanisms, the possible risk factors and the prevention of iatrogenic neurotoxicity.
    Revista de neurologia 10/2012; 55(8):462-8. · 1.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The review highlights the recent advances in the pathogenesis, diagnosis and treatment of AIDS-related primary CNS lymphoma (AIDS-PCNSL). The incidence of AIDS-PCNSL has decreased in the era of highly active antiretroviral therapy (HAART). The prognosis has improved and this most probably in relation both with the HAART-induced immunologic status recovery and subsequently the possibility to use more aggressive treatment strategies. Immunomodulatory effect of HAART seems also to have an indirect antitumor activity on the disease. The treatment strategy for AIDS-PCNSL in the HAART era tends to become similar to that of the immunocompetent population. In the absence of randomized trials devoted to AIDS-PCNSL, most current national comprehensive cancer network guidelines recommend the use of high-dose methotrexate-based chemotherapy combined or not with whole-brain radiotherapy as initial treatment in addition to HAART. The objective for the future would be that prognosis of AIDS-PCNSL catch up with that of the immunocompetent patients with special attention to systemic and neurocognitive tolerance of the treatments.
    Current opinion in oncology 09/2011; 23(6):648-53. · 4.09 Impact Factor

Full-text (2 Sources)

Available from
May 21, 2014