MRI of infections and neoplasms of the spine and spinal cord in 55 patients with AIDS

Our purpose was to describe the range of MRI findings in infectious and neo plastic involvement of the spine and spinal cord in symptomatic patients wi th the acquired immunodeficiency syndrome (AIDS). MRI studies in 55 patient s with AIDS and neurological signs and symptoms thought to be related to th e spine or spinal cord were reviewed. We categorized the findings according to the spinal compartment involved. There were 29 patients with extradural , 11 with intradural-extramedullary and 9 with intramedullary disease. In 6 patients more than one compartment was involved simultaneously, and patien ts presented with multiple lesions in the same compartment. The most common causes of extradural disease were bone lesions (28); an epidural mass was seen in 14 and spondylodiscitis in 4 patients. Cytomegalovirus polyradiculi tis was the most common cause of intradural-extramedullary disease (in 10 c ases); herpes radiculitis was seen in two, and tuberculous infection in ano ther two. In three cases leptomeningeal contrast enhancement was due to lym phoma. Human immunodeficiency virus (HIV) myelitis was seen in two patients , presumed vacuolar myelopathy in two, toxoplasma myelitis in four, intrame dullary lymphoma in one, and herpes myelitis in one. Familiarity with the v arious potential pathological entities that can affect the spine and spinal cord in the AIDS population and their imaging characteristics is crucial f or initiation of further diagnostic tests and appropriate medical or surgic al treatment.