Imaging hiv

Imaging cns hiv
Dr. Rahi Kiran.B
Senior Resident, Neurology
Govt Medical College, Kota

1. Radiology of Neurological Manifestations of HIV Dr. Rahi kiran.B SR Neurology GMC, KOTA

2. HIV Encephalitis 60% of AIDS patients develop neurologic disease HIV encephalitis (HIVE) and HIV leukoencephalopathy (HIVL)- direct result of HIV infection of the brain. HIV-associated neurocognitive disorders (HANDs) - most frequent neurologic manifestations of HIVE and HIVL. The term "acquired immunodeficiency dementia complex” refers specifically to HIV-associated dementia.

3. HIV Encephalitis

4. HIV Encephalitis Diffuse,confluent , bilaterally symmetric hyperintensity in the cerebral white matter with sparing of the subcortical U-fibers, no parenchymal or meningeal enhancement, Axial DWI shows no evidence of restricted diffusion

5. Toxoplasma most commonly involves the basal ganglia, thalami, CMJ and cerebellum Multifocal lesions > solitary average SIZE 2-3 cm in diameter.

6. Toxoplasma NECT – hypodense in left BG and frontal lobe with marked peripheral edema.T2WI- three separate heterogeneous masses surrounded by marked edema, T1 C+ -eccentric "target" sign lesion with a peripheral rim of enhancement

7. Cryptococcosis Meningeal disease T1 C+ ( Gd ): can show leptomeningeal enhancement Cryptococcomas variable density masses on CT T1: low signal T2 / FLAIR: high signal T1 C+ ( Gd ): variable, ranging from no enhancement to peripheral nodular enhancement(depends on immunity as capsule is non-immunogenic) No DWI

8. Immunocompetent - more likely to present with cryptococcomas . Enhancement of these lesions might occur as a result of an immunologic reaction by the host. Immediate and delayed imaging with a double dose of contrast has been reported to reduce the false negative studies by showing meningeal enhancement in immunocompromised patients.

9. Axial T1 post-gadolinium image shows typical cryptococcal meningitis with ventricular wall enhancement and subtle frontal and occipital leptomeningeal enhancement.

10. Gelatinous pseudocysts Tend to give a "soap bubble" appearance. low-density lesions on CT T1: low to intermediate (from mucin ) signal , no T1C+ ( avascular ) T2: hypointense ring surrounding a hyperintense center FLAIR: low signal DWI - may or may not Hydrocephalus is the most common, although nonspecific finding.

11. Progressive Multifocal Leukoencephalopathy

12. c Progressive Multifocal Leukoencephalopathy clinically deteriorating 46y HIV-positive patient with a CD4 count < 10 cells/ μL confluent assymetric nonenhancing left occipital lesion that crosses the corpus callosum

13. iPML T1 & T2 -Characteristic involvement of both MCP, T1 C+ very faint rim enhancement, the right MCP lesion restricts strongly

14. Cytomegalovirus periventricular ependymal enhancement- ventriculitis periventricular restricted diffusion.

15. PCNSL 2-6% of HIV patients. 70% of all solitary brain parenchymal lesions in HIV/AIDS patients. 90% are supratentorial - BG and deep white matter cross the corpus callosum highly specific - Linear enhancement at the margins of a lesion, tracking along Virchow-Robin spaces

16. PCNSL hypointense nodular lesions on axial T2 Nodular enhancement accompanied by linear enhancement at the margins of a lesion, tracking along perivascular spaces restricted diffusion

17. PCNSL vs Toxoplasma PCNSL single lesion subependymal spread solid enhancement no hemorrhage before treatment thallium SPECT positive MRS: increased choline MR perfusion: increased rCBV Toxoplasma multiple lesions basal ganglia and CMJ ring or nodular enhancement hemorrhage occasionally occurs mostly in the periphery thallium SPECT negative MRS: decreased choline MR perfusion: decreased rCBV

18. Tuberculosis Hypointense center surrounded by hyperintense capsule that enhances peripherally on contrast meningeal enhancement in the basal cisterns and hydrocephalus

19. HIV-Associated Vacuolar Myelopathy slowly progressive, painless spastic paraparesis with sensory loss, imbalance, and sphincter dysfunction. Relapsing-remitting courses have been described. High-intensity lesion in the C2-C5 posterior spinal cord

20. Toxoplasma T1 C+ -eccentric "target" sign lesion with a peripheral rim of enhancement Large, heterogeneously hyperintense lesions but numerous smaller foci scattered throughout the brain in the cortex, BG and subcortical white matter A 45-year-old male with CD4+ < count 100/ mL , hemiparesis , and GTCS

21. Multiple gelatinous pseudocysts and HIVE Multiple pseudocysts and hyperintensity in the cerebral white matter

22. PML-IRIS Baseline MRI Repeat MRI 5 weeks after deterioration Bifrontal hyperintense subcortical non-enhancing white matter lesions New lesions and enhancing A 55-year-old female with, hemiparesis and GTCS-started on ART

23. Cytomegalovirus periventricular ependymal enhancement- ventriculitis periventricular restricted diffusion. A 35-year-old male with CD4+ < count 50/ mL and GTCS

24. HIV Encephalitis Diffuse,confluent , bilaterally symmetric hyperintensity in the cerebral white matter with sparing of the subcortical U-fibers, no parenchymal or meningeal enhancement, Axial DWI shows no evidence of restricted diffusion A 32 yr female with cognitive, behavioral and motor dysfunction

25. PCNSL hypointense nodular lesions on axial T2 Nodular enhancement accompanied by linear enhancement at the margins of a lesion, tracking along perivascular spaces restricted diffusion A 54-year-old male with left-sided weakness

26. toxoplasma abscess "Eccentric target sign“, less prominent choline peak and reduced NAA, large lipid lactate peak 51-year-old male, known HIV sero -positive, initially asymptomatic, came with complaints of generalized weakness since 2 months   lymphoma vs toxoplasma abscess

27. Tuberculosis Hypointense center surrounded by hyperintense capsule that enhances peripherally on contrast meningeal enhancement in the basal cisterns and hydrocephalus A 34-year-old male with seizures

28. THANK YOU