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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 20:1896-1906 (11 1999)
© 1999 American Society of Neuroradiology

ARTICLE

Progressive Multifocal Leukoencephalopathy in AIDS: Are There Any MR Findings Useful to Patient Management and Predictive of Patient Survival?

M. Judith Donovan Post^,a, Constantin Yiannoutsos^a, David Simpson^a, John Booss^a, David B. Clifford^a, Bruce Cohen^a, Justin C. McArthur^a and Colin D. Hall^athe AIDS Clinical Trials Group, 243 Team

^a From the Department of Radiology, Section of Neuroradiology, University of Miami School of Medicine/Jackson Memorial Medical Center, Miami (M.J.D.P.); the Harvard School of Public Health, Statistical & Data Analysis Center, AIDS Clinical Trials Group, Boston (C.Y.); the Department of Clinical Neurophysiology, Mount Sinai School of Medicine, New York (D.S.); the Department of Neurology and Laboratory Medicine, Yale University School of Medicine and Department of Veterans Affairs Medical Center, New Haven (J.B.); the Department of Neurology, Washington University School of Medicine, St Louis (D.B.C.); the Department of Neurology Northwestern University School of Medicine, Chicago (B.C.); the Departments of Neurology and Epidemiology, Johns Hopkins University, Baltimore (J.McA.); and the Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (C.D.H.).

BACKGROUND AND PURPOSE: While MR findings in progressive multifocal leukoencephalopathy (PML) have been described previously, usually in retrospective studies with limited sample size, what has not been well addressed is whether any are predictive of longer survival. Our participation in a large prospective clinical trial of AIDS patients with biopsy-proved PML and MR correlation allowed us to test our hypothesis that certain MR features could be found favorable to patient survival.

METHODS: The patient cohort derived from a randomized multicenter clinical trial of cytosine arabinoside for PML. Pretreatment T1- and T2-weighted noncontrast images (n = 48) and T1-weighted contrast-enhanced images (n = 45) of 48 HIV-positive patients with a PML tissue diagnosis as well as the follow-up images in 15 patients were reviewed to determine signal abnormalities, lesion location and size, and the presence or absence of mass effect, contrast enhancement, and atrophy, and to ascertain the frequency of these findings. A statistical analysis was performed to determine if any MR abnormalities, either at baseline or at follow-up, were predictive of patient survival.

RESULTS: No MR abnormalities either on univariate or multivariate analysis significantly correlated with patient survival, with the exception of mass effect, which was significantly associated with shorter survival. The mass effect, however, always minimal, was infrequent (five of 48). More severe degrees of cortical atrophy and ventricular dilatation, lesion location and size, and other MR variables were not predictive of outcome.

CONCLUSION: Except for mass effect, we found no MR findings predictive of the risk of death in patients with PML. The mass effect, however, was so infrequent and minimal that it was not a useful MR prognostic sign.

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