MR findings in AIDS-associated myelopathy

BACKGROUND AND PURPOSE: The most common cause of spinal cord disease among patients with AIDS or those infected with HIV-1 is AIDS-associated myelopat hy, The purpose of this study was to determine the MR characteristics of th e spinal cord in this patient population and to correlate these findings wi th the clinical severity of myelopathy. METHODS: MR images of the spinal cord in 21 patients with documented HIV-1 infection or AIDS and a clinical diagnosis of AIDS-associated myelopathy we re assessed retrospectively for atrophy, intrinsic signal abnormality, and abnormal enhancement. The clinical severity of myelopathy was graded by a n eurologist on the basis of physical examination, and a qualitative correlat ion was made with the MR findings. RESULTS: MR findings were abnormal in 18 of the 21 patients. The most commo n feature was spinal cord atrophy (n = 15), typically involving the thoraci c cord with or without cervical cord involvement, followed by intrinsic cor d signal abnormality (n = 6), and normal-appearing cord (n = 3), Three pati ents had both cord atrophy and intrinsic cord signal abnormality. The cord signal abnormality was diffuse, without predilection for any specific distr ibution pattern. Enhancement was not seen in any of the 10 patients who rec eived intravenous contrast material. Only one of 16 patients with moderate to severe myelopathy had normal NIR findings, as compared with two of five patients with mild myelopathy. CONCLUSION: MR findings in the spinal cord are abnormal in the majority of patients with AIDS-associated myelopathy, typically showing spinal cord atr ophy, with or without intrinsic cord signal abnormality. Patients with mode rate to severe myelopathy have an increased frequency of spinal cord abnorm alities, but a definite correlation between clinical severity of myelopathy and extent of MR abnormalities remains to be established.