Metabolic characterization of AIDS dementia complex by spectroscopic imaging

Prospective proton chemical shift imaging (CSI) of the brain was performed in 30 HIV-1-seropositive patients and 11 healthy controls. Significant (P < 0.05) reductions in the N-acetyl-L-aspartate (NAA)/total creatine (Cr), an d NAA/total choline (Cho) ratios and significant increases in Cho/Cr occurr ed in patients with 1) AIDS-defining diagnoses; 2) <200 CD4 lymphocyte coun ts/mu l; 3) neurological evidence for an AIDS dementia complex (ADC); 4) ma gnetic resonance imaging (MRI) signs of cerebral atrophy. The basal ganglia and the insula were affected to approximately the same extent and without indications of spatial variations within these areas. Reduced NAA seems to indicate progressive neuronal injury or loss due to productive HIV infectio n in the brain and its clinical picture ADC, Spectroscopic abnormalities we re, however, also observed in neurologically normal HIV patients or those w ith normal MRI results. Proton CSI may therefore serve as an early quantita tive marker of central nervous system involvement in AIDS, J, Magn, Reson, Imaging 1999;9:10-18. (C) 1999 Wiley-Liss, Inc.