Follow-up magnetic resonance imaging findings in patients with progressive multifocal leukoencephalopathy: evaluation of long-term survivors under highly active antiretroviral therapy

Abstract

Purpose: The aim of this study was to clarify the early magnetic resonance imaging (MRI) findings of progressive multifocal leukoencephalopathy (PML) and to evaluate the relations of the clinical course and serial MRI findings in patients with acquired immunodeficiency syndrome (AIDS)-related PML treated with highly active antiretroviral therapy (HAART).

Materials and methods: The clinical course and serial MRI findings in five patients with AIDS-related PML who were treated with HAART are described.

Results: Although all five patients were serologically naive to the therapy and alive at the end of the observation period, the lesions showed rapid extension on MRI for up to 3 months after the start of the therapy, and clinical symptoms progressed rapidly for a month after the start of the therapy. Newer margins in spreading lesions showed a diffuse pale hyperintensity and/or many discrete hyperintense dots on T2-weighted images

Conclusion: Early PML lesions may show a characteristic appearance on T2-weighted images. We should be aware of the progression of AIDS-related PML even under serologically effective HAART.