Progressive multifocal leukoencephalopathy in 47 HIV-seropositive patients: neuroimaging with clinical and pathologic correlation.

Abstract

The authors investigated the spectrum of radiologic findings in a large series (n = 47) of patients seropositive to human immunodeficiency virus (HIV) 1 and with pathologically proved progressive multifocal leukoencephalopathy, to determine the characteristic imaging pattern of the disease. Thirty-six computed tomographic (CT) scans and 29 magnetic resonance (MR) imaging studies obtained in the 47 patients were retrospectively reviewed and correlated with pathologic and clinical findings. Contrast agents were used in 32 CT procedures and 13 MR imaging studies. Lesions typically were hypoattenuating on CT scans and were characterized by areas of increased signal intensity without mass effect on dual-echo MR images. Lesions most often involved periventricular and subcortical white matter in parietooccipital or frontal lobes. Fifteen patients had posterior fossa lesions, and disease was limited to the posterior fossa in two. Lesions were also in the corpus callosum (seven patients), thalamus (eight patients), and basal ganglia (seven patients). In comparison with CT, MR imaging demonstrated greater sensitivity for the extent and number of lesions.

Clinical and Radiological Characterization of Progressive Multifocal Leukoencephalopathy in HIV-Infected Patients: A Retrospective Analysis and Review of the Literature

“…5 Typically, PML is a confluent, bilateral but asymmetric, supratentorial white matter disease. 8,42 However, it can be unilateral, infratentorial, and there may be a single lesion. Lesions are usually hypointense on T1-weighted images (T1WI) and hyperintense on T2-weighted images (T2WI) involving the subcortical u-fibers and usually sparing the cortex and deep gray matter structures (Fig.…”

“…Neurological signs are present in almost 80% of the patients, which is helpful in the distinction from HIV-associated encephalopathy. 8 An inflammatory form of PML may occur after the introduction of antiretroviral therapy (ART) -the immune reconstitution inflammatory syndrome (IRIS) associated with JCV infection. It may present either as an exacerbation of established PML (i.e., 'paradoxical' IRIS) or as a first presentation of PML (i.e.…”

“…6,11 Before the introduction of HAART, PCR for JCV-DNA was 72% -92% sensitive and 92% -100% specific for the diagnosis of PML. 8 Recently, however, it has become common to have negative CSF molecular results in patients with AIDS with clinical and imaging presentations indistinguishable from those of PML. This may be due to the immune restoration with antiretroviral therapy leading to a decreased viral replication and increased clearance of JCV-DNA from the CSF.…”

Progressive multifocal leukoencephalopathy, a possible complication in a patient with bladder cancer

“…Lesions have a decreased signal on T1-weigthed images and an increased signal on T2-weighted images. There is normally no mass effect [10]. In the case of our patient the cerebral MRI imposed two diagnostic hypotheses.…”

A New Therapeutic Option for Progressive Multifocal Leukoencephalopathy after Allogeneic Hematopoietic Cell Transplantation

“…In some cases, PML lesions can also be found in grey matter structure such as the basal ganglia or the thalamus, because there are myelinated fibers in these structures. In classic PML lesions, edema, mass effects, or contrast enhancement on imaging usually is not observed [19].…”