Neuroradiology (1992) 35:75-78 Neuro-- radiology 9 Springer-Verlag 1992 CT and MRI: prognostic tools in patients with AIDS and neurological deficits A. Mundinger 1 , T. Adam 2, D. Ott 2 , E. Dinkel 1 , A. Beck 1 , H. H. Peter 3, B. Volk 4, and M. Schumacher 2 Departments of 1Diagnostic Radiology, 2Neuroradiology, 3Rheumatology and Clinical Immunology, 4Neuropathology, University of Freiburg, Freiburg, Federal Republic of Germany Received: 28 September 1991 Summary. To determine the prognostic value of CT and MRI in AIDS we studied the survival of patients with neurological involvement, in relation to the initial im- aging results. Twenty-six initial CT and 15 MRI examin- ations of 41 patients were reviewed for the presence of cerebral atrophy and/or focal lesions. The mean survival time of patients with initially normal imaging was longer (700 _+ 89 days) than that of patients with isolated cerebral atrophy (326 + 65) or isolated focal lesions (202 _+ 97). The shortest survival (78 + 44 days) was found in patients with both cerebral atrophy and focal lesions. The risk of death in patients with atrophy alone was 3.6 times higher, that in patients with focal lesions alone 6.4 times higher, and in patients with both changes 19.3 times higher than in pa- tients with initially normal imaging. Cerebral imaging with CT and/or MRI thus allows identification of AIDS- related cerebral changes and may contribute to assess- ment of prognosis. Key words: AIDS - Encephalopathy - Computed tomog- raphy- Magnetic resonance imaging first examined by CT, 15 by MRI. CT studies were performed after intravenous injection of contrast media. MR images were obtained on a 0.23T resistive magnet or a 2T superconductive magnet system using a 256 x 256 pixel matrix. Axial Tl-weighted (500/40) and proton density- and T2-weighted (3000/30 .... 120) spin-echo images using a Carr-Purcell-Meiboom-Gill multislice-multiecho se- quence were routinely acquired. Additional coronal or sagittal im- ages and gradient echo or RARE (rapid acquisition with relaxation enhancement) images were obtained according to the pathological findings. Three experienced neuroradiologists operating without clinical data except for sex and age defined the presence or absence of cere- bral atrophy and diffuse or focal lesions. Considerable loss of grey and white matter, and widening of cerebrospinal fluid spaces, as compared to age-related normals, were the criteria used to define cerebral atrophy. Dehydration or obstructive hydrocephalus as possible alternative causes of widened cerebral ventricles were ex- cluded in our study before the diagnosis of cerebral atrophy was ac- cepted. Kaplan-Meier plots were used to illustrate the survival times of different groups of patients depending on the results of the initial imaging examination: normal, atrophy only, focal lesion(s) only, both atrophy and focal lesion(s). A stepwise Cox regression model was used to determine the relative hazard associated with these imaging results. As usual in survival analysis, 2 patients lost during follow-up were included with the date of the last observation. The central nervous system is frequently involved in human immunodeficiency virus (HIV) infection [1, 2]. In patients with AIDS neurological symptoms and signs can develop due to opportunistic infection or malignancy as well as to the neuropathic effects of HIV [3-6]. Patients with AIDS who display any neurological symptoms or signs are reported to have a reduced probability of sur- vival [7]. The purpose of our study was to determine whether CT and/or MRI can be of more prognostic value than the clinical status in patients with AIDS and neuro- logical symptoms or signs. Materials and methods Survival times were related to the initial CT and/or MRI findings in 41 patients with proven HIV infection fulfilling the CDC criteria for AIDS and neurological symptoms or signs. Twenty-six patients were Results The survival times of patients with AIDS and neurological symptoms or signs were significantly different depending on the initial CT and/or MRI findings. The mean sur- vival time of patients with initially normal findings was 700.5 _+89.2 days, patients with isolated cerebral atrophy 326.5 _+64.9 days, and patients with isolated focal lesions 202.5 + 97.4 days. The shortest survival time (77.6 _+ 42.7 days) was in patients with both cerebral atrophy and focal lesions (Fig. 1). The most important factor for a poor prognosis was any pathological finding on CT or MRI. Compared to patients with normal imaging results, pa- tients with atrophy alone had a relative hazard of x 3.6, those with only focal lesions x 6.4, and those with both atrophy and focal lesions x 19.3.