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Proton MRS and quantitative MRI assessment of the short term neurological response to antiretroviral therapy in AIDS
  1. Iain D Wilkinsona,
  2. Sarah Lunnb,
  3. Katherine A Miszkielc,
  4. Robert F Millerd,
  5. Martyn N J Paleye,
  6. Ian Williamsd,
  7. Roger J S Chinnc,
  8. Margaret A Hall-Craggsc,
  9. Stanton P Newmanb,
  10. Brian E Kendallc,
  11. Michael J G Harrisone
  1. aDepartment of Medical Physics and Bioengineering, The Middlesex Hospital, University College London Hospitals NHS Trust, Mortimer Street, London, bDepartment of Psychiatry, University College London Medical School, London, cDepartment of Radiology, The Middlesex Hospital, University College London Hospitals NHS Trust, Mortimer Street, London, dDivision of Pathology and Infectious Diseases, University College London Medical School, London, eDepartment of Neurology, University College London Medical School, London
  1. Dr Iain Wilkinson, MRI Umit, The Middlesex Hospital, Mortimer Street, London W1N 8AA, UK.

Abstract

OBJECTIVE To investigate MRI and proton spectroscopy changes in five patients with HIV associated dementia complex (HADC) treated with antiretroviral therapy.

METHODS Three markers were evaluated: (1) CSF/intracranial volume ratio; (2) T2 weighted signal ratio between parieto-occipital white and subcortical grey matter; and (3) metabolite ratios from long echo time (TE=135 ms) single voxel proton spectra of parieto-occipital white matter.

RESULTS Spectroscopic changes indicated initial increases in N-acetyl/(N-acetyl + choline + creatine) ratio (NA/(NA+ Cho+Cr)) and progression of atrophy after initiation of antiretroviral therapy in four of five patients. When the neurological status of the patients subsequently deteriorated (two of five patients), the NA/(NA+Cho+Cr) ratio also declined.

CONCLUSIONS spectroscopic changes mirror reversible neuronal dysfunction. These objective, non-invasive techniques may be used for monitoring the neurological effects of antiretroviral drug therapy in patients with HADC.

  • magnetic resonance spectroscopy
  • human immunodeficiency virus
  • zidovudine

https://doi.org/10.1136/jnnp.63.4.477

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