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Imaging of the central nervous system in HIV infection

N A Sibtain, MRCP and R J S Chinn, MRCP, FRCR

Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK



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  		Figure 1. (a) Coronal T1 weighted and (b) axial T2 weighted images of a patient with HIV encephalopathy. The images demonstrate diffuse cerebral atrophy. In addition, confluent high T2 signal change is seen in the periventricular white matter of the frontal and parieto-occipital regions.

 


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  		Figure 2. (a) Axial T2 weighted and (b) coronal T1 weighted images in a patient with progressive multifocal leucoencephalopathy. There is high T2 and low T1 signal white matter abnormality in the right frontal region that extends along the gyral core, with preservation of the grey matter. (c) Coronal T1 weighted image of the same patient shows the low T1 signal to extend along the white matter tracts, through theright internal capsule to the cerebral peduncle. Incidental note is made of agenesis of the corpus callosum.

 


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  		Figure 3. Coronal T1 weighted enhanced images. (a) Ring enhancement in two lesions in the grey–white matter junction of the right cerebral hemisphere, and in a third in the region of the right basal ganglia. Each lesion shows associated local oedema with mass effect. (b) 3 weeks after anti-toxoplasma therapy, there has been resolution of the local mass effect. One lesion has disappeared. The lesion in the basal ganglia has shrunk and there is only a small residual focus of enhancement in the insular cortex.

 


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  		Figure 4. Coronal T1 weighted (a) pre-contrast and (b) post-contrast images of a patient with lymphoma. There is a solitary large mass in the left parietal region that abuts the meningeal surface, with associated nodular rim enhancement, mass effect and oedema.

 


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  		Figure 5. Coronal T1 weighted enhanced image demonstrating a subependymal lesion with an enhancing rim, partially effacing the frontal horn of the left lateral ventricle. There are further smaller foci of enhancement in the right head of caudate and left lentiform nucleus. The subependymal nature is very typical for lymphoma, which need not be solitary.

 


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  		Figure 6. (a) Axial T2 weighted and (b) coronal T1 weighted enhanced images of a patient with cryptococcosis. The images demonstrate enlargement of the perivascular spaces in the basal ganglia. These are expanded by jelly-like hyphal material and do not enhance.

 


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  		Figure 7. Coronal T1 weighted enhanced image demonstrating widespread meningeal enhancement in a patient with cryptococcal meningitis.

 


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  		Figure 8. Coronal T1 weighted enhanced image demonstrating an enhancing meningeal plaque and multiple meningeal nodules of secondary CNS lymphoma.

 




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