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: 1.43). 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.

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    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.
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    ABSTRACT: Purposes Primary central nervous system lymphoma (PCNSL) is a rare tumour with poor prognosis. Due to the increased number of patients with acquired immunodeficiency, our purposes are to describe epidemiological and imaging findings in immunodeficient patients with PCNSL of the brain and to study the differences between HIV-positive and HIV-negative patients with PCNSL. Materials and methods A retrospective, descriptive study was performed with immunodeficient patients diagnosed of PCNSL of the brain during the last 13 years in two reference hospitals. Twenty-one patients fulfilled the inclusion criteria. Multiple variables were evaluated. Significance was defined as p<0.05. Results HIV-positive group was a mean age of 36,82 ± 5,4 years and the mean age in HIV-negative group was 55,60 ± 21,43 years (p < 0,022). The mean number of lesions was 1,27 ± 0,65 in HIV-positive group and 2,60 ± 1,78 in HIV-negative group (p < 0,039). The lesions were homogeneous in 18,2% (n = 2) HIV-positive group and 80% (n = 8) in HIV-negative group (p < 0,005). No HIV-positive patient and 50% (n = 5) of HIV-negative patients showed corpus callosum involvement (p < 0,012). Conclusions PCNSL in immunodeficient patients is associated with a large spectrum of radiological findings. There were differences between HIV-positive and HIV-negative patients, is important recognize these differences as the therapeutic management of these two groups vary.
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