White matter disease in AIDS: findings at MR imaging.
White matter disease in AIDS: findings at MR imaging.
复制标题
艾滋病中的白质疾病：磁共振成像的发现。
作者：
W. L. Olsen;F. Longo;C. Mills;D. Norman
对365例获得性免疫缺陷综合征（AIDS）患者的磁共振（MR）图像进行回顾，发现112例（31%）信号异常仅限于白色物质。观察到四种模式：（a）扩散：大面积广泛受累;（B）斑片状：边界不清的局部受累;（c）局灶性：边界清楚的受累区域;（d）点状：直径小于1 cm的小病灶。112例患者中有60例有临床或病理结果，并与MR图像上所见的白色物质模式相关。弥漫型与艾滋病痴呆综合征（ADC）相关，这是最常见的临床诊断。片状或点状病变可在ADC中见到，但不常见。ADC患者未见局灶性白色病变，但所有6例进行性多灶性白质脑病患者、2例淋巴瘤患者和1例弓形虫病患者均可见局灶性白质病变。作者得出结论，白色病变在艾滋病中很常见，通常继发于人类免疫缺陷病毒直接感染大脑，导致ADC，通常产生弥漫性白色病变。活检可能不适用于这些患者。局灶性白色病变提示局灶性感染或肿瘤，可能需要活检。
A review of the magnetic resonance (MR) images of 365 patients with acquired immunodeficiency syndrome (AIDS) revealed that 112 (31%) had signal abnormalities confined to the white matter. Four patterns were observed: (a) diffuse: widespread involvement of a large area; (b) patchy: localized involvement with ill-defined margins; (c) focal: well-defined areas of involvement; and (d) punctate: small foci less than 1 cm in diameter. Clinical or pathologic findings were available in 60 of the 112 patients and were correlated with the white matter patterns seen on MR images. The diffuse pattern correlated with AIDS dementia complex (ADC), which was the most common clinical diagnosis. Patchy or punctate lesions may be seen with ADC but are less common. Focal white matter lesions were not seen in patients with ADC but were seen in all six patients with progressive multifocal leukoencephalopathy, in both patients with lymphoma, and in one patient with toxoplasmosis. The authors conclude that white matter lesions are are common in AIDS and are often secondary to direct infection of the brain with human immunodeficiency virus, which causes the ADC and usually produces a diffuse white matter pattern. Biopsy is probably not indicated in these patients. Focal white matter lesions suggest a focal infection or tumor, and biopsy may be warranted.