WHITE-MATTER LESIONS AND CEREBRAL ATROPHY ON MR-IMAGES IN PATIENTS WITH AND WITHOUT AIDS DEMENTIA COMPLEX

OBJECTIVE. The objective of this study was threefold: to determine if the frequency of deep white matter changes and cerebral atrophy seen o n MR images is significantly different between patients with and witho ut AIDS dementia complex, to determine if certain patterns of white ma tter changes are more closely associated with AIDS dementia complex, a nd to determine if focal lesions within the white matter of the spleni um are more common in AIDS dementia complex. MATERIALS AND METHODS. Fo rty-five patients with AIDS were clinically examined for AIDS dementia complex. MR images from these patients were retrospectively reviewed without knowledge of the clinical results. The presence or absence of white matter abnormalities and cerebral atrophy was evaluated by using graded scales and correlated with the presence or absence of AIDS dem entia complex. RESULTS. Ten patients met the criteria for AIDS dementi a complex. Eight of 25 patients in whom MR images showed abnormal sign al intensity in deep white matter had dementia compared with two of 20 in whom MR showed no changes in deep white matter. The presence of th ese deep white matter abnormalities was not significantly different be tween groups with and without dementia (p = .08), although higher grad es of deep white matter abnormality were more likely to be associated with AIDS dementia complex. Nine of 19 patients in whom MR images show ed atrophy had dementia compared with one of 26 in whom MR showed no a trophy. Atrophy was significantly associated with AIDS dementia comple x (p = .001). Eight of 15 patients in whom MR images showed abnormal s ignal intensity within the white matter of the splenium had dementia c ompared with two of 30 in whom MR showed normal signal intensity in th is area. The degree of abnormality in the splenium was weakly associat ed with AIDS dementia complex (Kendall's tau = .471, p = .001). CONCLU SION. MR findings of cerebral atrophy and abnormal signal intensity in the splenium are associated with AIDS dementia complex. The presence of generalized deep white matter abnormalities does not differ signifi cantly between patients with and without dementia, although more sever e grades of white matter abnormality are more likely to be seen in pat ients with AIDS dementia complex.