SPINAL TRACT PATHOLOGY IN AIDS - POSTMORTEM MRI CORRELATION WITH NEUROPATHOLOGY

Vacuolar myelopathy (VM) and tract pallor are poorly understood spinal tract abnormalities in patients with the acquired immunodeficiency sy ndrome (AIDS). We studied the ability of magnetic resonance imaging (M RI) to detect these changes in spinal cord specimens postmortem and wh ether criteria could be formulated which would allow these conditions to be differentiated from other lesions of the spinal cord in AIDS, su ch as lymphoma, cytomegalovirus (CMV) and human immunodeficiency virus (HIV) myelitis. We imaged 38 postmortem specimens of spinal cord. The MRI studies were interpreted blind. The specimens included cases of V M myelin pallor, CMV myeloradiculitis, HIV myelitis, lymphoma as well as normal cords, both HIV+ve and HIV-ve. MRI showed abnormal signal, s uggestive of tract pathology, in 10 of the 14 cases with histopatholog ical evidence of tract changes. The findings in VM and tract pallor on proton-density and T-2-weighted MRI were increased signal from the af fected white-matter tracts, present on multiple contiguous slices and symmetrical in most cases. The pattern was sufficiently distinct to di fferentiate spinal tract pathology from other spinal cord lesions in A IDS.