对脑部磁共振成像显示有正常白质的HIV患者进行扩散张量成像。
Diffusion tensor imaging of patients with HIV and normal-appearing white matter on MR images of the brain.
作者信息
Filippi C G, Ulug A M, Ryan E, Ferrando S J, van Gorp W
机构信息
Department of Radiology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York 10021, USA.
出版信息
AJNR Am J Neuroradiol. 2001 Feb;22(2):277-83.
BACKGROUND AND PURPOSE
HIV enters the CNS early in the course of infection and produces neuropsychiatric impairment throughout the course of illness, which preferentially affects the subcortical white matter. The development of a neuroimaging marker of HIV may allow for the earliest detection of cognitive impairment. The purpose of this study was to determine whether MR diffusion tensor imaging can detect white matter abnormalities in patients who have tested positive for HIV.
METHODS
Ten patients with HIV (eight men and two women; mean age, 42 years) underwent MR imaging of the brain with MR diffusion tensor imaging, which included routine fluid-attenuated inversion recovery and fast spin-echo T2-weighted imaging. Diffusion constants and anisotropy indices were calculated from diffusion tensor maps. Peripheral viral load, Centers for Disease Control staging, and cluster of differentiation 4 levels were determined.
RESULTS
All patients had normal results of MR imaging of the brain, except for mild atrophy. Four of 10 patients had undetectable viral loads. These patients were receiving highly active antiretroviral therapy. The diffusion constant and anisotropy were normal. Four of 10 patients had viral loads between 10,000 and 200,000. Diffusion anisotropy in the splenium and genu was significantly decreased (P < .02). The diffusion constant of the subcortical white matter was elevated in the frontal and parietooccipital lobes (11%). Two of 10 patients had viral loads >400,000. Anisotropy of the splenium was half normal (P < .0004) and of the genu was decreased 25% (P < .002). The average diffusion constant was diffusely elevated in the subcortical white matter.
CONCLUSION
Calculating the diffusion constant and anisotropy in the subcortical white matter and corpus callosum in patients with HIV detected abnormalities despite normal-appearing white matter on MR images and nonfocal neurologic examinations. Patients with the highest diffusion constant elevations and largest anisotropy decreases had the most advanced HIV disease. Patients with the lowest viral load levels, who had normal anisotropy and diffusion constants, were receiving highly active antiretroviral therapy.
背景与目的
HIV在感染早期即进入中枢神经系统（CNS），并在疾病全过程中导致神经精神损害，这种损害优先影响皮质下白质。HIV神经影像学标志物的出现可能有助于最早检测出认知障碍。本研究的目的是确定磁共振扩散张量成像（MR DTI）能否检测出HIV检测呈阳性患者的白质异常。
方法
10例HIV患者（8例男性，2例女性；平均年龄42岁）接受了脑部MR成像及MR DTI检查，其中包括常规的液体衰减反转恢复序列和快速自旋回波T2加权成像。从扩散张量图计算扩散常数和各向异性指数。测定外周病毒载量、疾病控制中心分期及分化抗原4水平。
结果
除轻度萎缩外，所有患者脑部MR成像结果均正常。10例患者中有4例病毒载量检测不到。这些患者正在接受高效抗逆转录病毒治疗。其扩散常数和各向异性正常。10例患者中有4例病毒载量在10,000至200,000之间。胼胝体压部和膝部的扩散各向异性显著降低（P < 0.02）。额叶和顶枕叶皮质下白质的扩散常数升高了11%。10例患者中有2例病毒载量>400,000。胼胝体压部的各向异性为正常的一半（P < 0.0004），膝部降低了25%（P < 0.002）。皮质下白质的平均扩散常数弥漫性升高。
结论
计算HIV患者皮质下白质和胼胝体的扩散常数及各向异性，尽管MR图像上白质外观正常且神经系统检查无局灶性病变，但仍检测到了异常。扩散常数升高最明显和各向异性降低最大的患者HIV疾病最严重。病毒载量水平最低且各向异性和扩散常数正常的患者正在接受高效抗逆转录病毒治疗。
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