Progressive multifocal leukoencephalopathy in AIDS: Are there any MR findings useful to patient management and predictive of patient survival?

BACKGROUND AND PURPOSE: While MR findings in progressive multifocal leukoen cephalopathy (PML) have been described previously, usually in retrospective studies with limited sample size, what has not been well addressed is whet her any are predictive of longer survival, Our participation in a large pro spective clinical trial of AIDS patients with biopsy-proved PML and MR corr elation allowed us to test our hypothesis that certain MR features could be found favorable to patient survival. METHODS: The patient cohort derived from a randomized multicenter clinical trial of cytosine arabinoside for PML. Pretreatment T1- and T2-weighted non contrast images (n = 48) and T1-weighted contrast-enhanced images (n = 45) of 48 HIV-positive patients with a PML tissue diagnosis as well as the foll ow-up images in 15 patients were reviewed to determine signal abnormalities , lesion location and size, and the presence or absence of mass effect, con trast enhancement, and atrophy, and to ascertain the frequency of these fin dings, A statistical analysis was performed to determine if any MR abnormal ities, either at baseline or at follow-up, were predictive of patient survi val. RESULTS: No MR abnormalities either on univariate or multivariate analysis significantly correlated with patient survival, with the exception of mass effect, which was significantly associated with shorter survival. The mass effect, however, always minimal, was infrequent (five of 48), More severe d egrees of cortical atrophy and ventricular dilatation, lesion location and size, and other MR variables were not predictive of outcome. CONCLUSION: Except for mass effect, we found no MR findings predictive of t he risk of death in patients with PML. The mass effect, however, was so inf requent and minimal that it was not a useful MR prognostic sign.