Role of Magnetic Resonance Imaging and Spectroscopy in Evaluation of CNS Abnormalities Associated with HIV Infection


Pravinkumar Bharde*, Srujana Pilli, Jayalatha Nethagani, Praveenkumar Gorrela VD and Adepu Ankita


Human Immunodeficiency Virus (HIV) infections of the central nervous system can cause a variety of neurological complications, including opportunistic brain infections and neurocognitive deficits. Characterizing and distinguishing pathological changes in the Central Nervous System (CNS) helps proper diagnosis and treatment.


Present study aimed to assess role of MRI and spectroscopy in evaluation of CNS abnormalities associated with HIV infection.


The study included 54 patients diagnosed as HIV positive by enzyme-linked immunosorbent assay. Brain Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS) of all the patients were carried out on 1.5 Tesla BRIVO MR355 whole body scanners (GE medical systems, Milwaukee, WI) equipped with echo-speed gradients. Slice thickness will be 4–5 mm, with an inter slice gap of 0.5 mm. MR spectroscopy was performed on patients in whom the lesions could not be definitively characterized using basic MRI sequences.


The frontal lobe was the most commonly affected area, with tuberculosis (38.8%) accounting for the majority of cases. Bacterial abscesses showed restriction on diffusion weighted imaging and amino acid peaks on magnetic resonance spectroscopy. Herpes encephalitis is most specifically diagnosed by MRI and DWI images help locate the pathology. MRI, especially T2W, FLAIR, and diffusion weighted imaging sequences are more sensitive than CT, and magnetic resonance spectroscopy is useful for early diagnosis of some clinical conditions.


MRI can be used to distinguish and characterize various brain lesions in HIV infected patients. Contrast enhanced MRI provided invaluable clues in diagnosing localized lesions and detecting patterns of meningeal and lining enhancement. MRI sequences like DWI and MRS in selected cases proved to be the specific studies of choice when correlating with CSF analysis, CD4+ count, and treatment response.