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Mangnetic Resonance Patterns of Brain Involvement With Pathologic Correlation

Jeffrey G. Jarvik, MD; John R. Hesselink, MD; Caroline Kennedy, MD; Ronald Teschke, MD; Clayton Wiley, MD, PhD; Stephen Spector, MD; Douglas Richman, MD; J. Allen McCutchan, MD

Arch Neurol. 1988;45(7):731-736.

Abstract
• Magnetic resonance brain scans of 30 patients with either acquired immunodeficiency syndrome (AIDS) or AIDS-related complex were reviewed. Twenty patients had focally abnormal neurological examination results at the time of scanning. Pathological diagnosis was available in nine. Four patterns of abnormality were observed on T₂-weighted images. Multiple discrete high-signal foci (pattern A) were found in patients with toxoplasmosis and progressive multifocal leukoencephalopathy. Large, bilateral patchy to confluent high-signal areas within the white matter (pattern B) represented a white matter encephalitis secondary to cytomegalovirus or human immunodeficiency virus. Generalized enlargement of the cortical sulci and ventricles (pattern C) probably reflected atrophic changes from the chronic human immunodeficiency virus infection and prolonged debilitating illness. Solitary high-signal-intensity lesions (pattern D) suggested a nonviral opportunistic infection. Differential diagnosis of brain abnormalities in patients with AIDS can be assisted by recognition of these characteristic patterns.

Author Affiliations
From the Departments of Radiology (Drs Jarvik and Hesselink), Medicine (Drs Kennedy, Richman, and McCutchan), Neurology (Dr Teschke), Pathology (Drs Wiley and Richman), and Pediatrics (Dr Spector), and the Magnetic Resonance Institute, University of California, San Diego (Dr Hesselink); and the California Collaborative Treatment Group, San Diego, Calif (Drs Kennedy, Spector, Richman, and McCutchan).

Footnotes
Accepted for publication Feb 8, 1988.

Presented at the Third International Conference on Acquired Immunodeficiency Syndrome, Washington, DC, June 1-5, 1987.

Reprint requests to Department of Radiology, University of California, San Diego Medical Center, 225 Dickinson St, San Diego, CA 92103 (Dr Hesselink).

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