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Highly Active Antiretroviral Therapy for Patients with AIDS Dementia Complex: Effect on MR Imaging Findings and Clinical Course

Majda M. ThurnherGo,a, Erwin G. Schindlera, Siegfried A. Thurnhera, Heidemarie Pernerstorfer-Schöna, Christina Kleibl-Popova and Armin Riegera

a From the Departments of Radiology (M.M.T., E.G.S., S.A.T.) and Dermatology (H.P-S., C.K-P., A.R.), University of Vienna, Austria.



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  		FIG 1. MR findings in a 56-year-old man (patient 1) with HIV-leukoencephalopathy being treated with a combination therapy of nonnucleoside analogues and protease inhibitors. He presented with impairment in concentration and memory and depressive symptoms. Neuropsychological testing was consistent with subcortical dementia.

A–C, TSE-FLAIR (7374/130, TI = 2100) images show symmetric regions of abnormally increased signal intensity (arrows, B and C) without mass effect in the periventricular white matter bilaterally. Additionally, high signal intensity was observed in the midbrain (arrow, A) and left cerebral peduncle.

D–F, Nine months after the initiation of therapy, follow-up TSE-FLAIR (7374/130, TI = 2100) images show interval increase in the hyperintense signal abnormalities (asterisks, E and F) in the periventricular white matter and progression of the cerebral atrophy, as well as almost complete resolution of the signal abnormality in the midbrain (arrow, D). Neuropsychological testing revealed an improvement in mental status.

G–I, Subsequent TSE-FLAIR (9000/105, TI = 2370) images of the brain 22 months after start of treatment show no interval change in distribution or severity of the white matter abnormalities, and complete resolution of the signal abnormality in the midbrain (arrow, G).



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  		FIG 2. MR findings in a 31-year-old woman (patient 3) with AIDS who presented initially with headache, slowing of thoughts, aphasia, and impairment in memory. HIV-1 RNA assay revealed high viral load in serum and CSF. Imaging findings were consistent with HIV encephalitis. HAART, including one protease inhibitor, was started.

A and B, Pretreatment axial FSE-FLAIR images (10000/150, TI = 2600) show areas of increased signal intensity at the anterior portions of the external capsules bilaterally, in the right caudate nucleus (curved arrow, A), and periventricular white matter in the frontal, parietooccipital, and central areas bilaterally (straight arrows). Additional lesions are present in both thalami (open arrows, A).

C and D, Six weeks after the initiation of HAART, including protease inhibitors, corresponding axial FSE-FLAIR images (7374/130, TI = 2100) show resolution of the signal intensity abnormalities in the basal ganglia and thalami (C) but progression of the white matter abnormalities (arrows). The patient had improved clinically at that time.

E and F, Seven months after the start of a potent antiretroviral therapy regimen, axial FSE-FLAIR images (7385/130, TI = 2100) at the same level show an interval decrease in the high signal abnormalities within the occipital, parietal (arrows, F), and frontal (arrows, E) white matter.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X