What is the role of MRI in the workup of HIV-associated vacuolar myelopathy (VM)?

Updated: May 07, 2018
  • Author: Krupa Pandey, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Answer

MRI scans serve two purposes.

  1. Like CT, to rule out alternative or coexisting conditions.
  2. Variably, MRI reveals abnormalities more specific to VM, ie, atrophy (most common) of the thoracic cord with or without cervical cord involvement. T2-weighted images often show symmetric non-enhancing high-signal areas present on multiple contiguous slices, usually symmetrical; these result from extensive vacuolation (hence the name). [6, 7, 8] Lesions may be confined to the posterior columns, especially the gracile tracts, or be diffuse (see images below).
High-intensity lesion in the C2-C5 posterior spina High-intensity lesion in the C2-C5 posterior spinal cord on T2-weighted sagittal MRI consistent with HIV myelopathy.
High-intensity lesion in the posterior cervical co High-intensity lesion in the posterior cervical cord on T2-weighted axial MRI consistent with HIV myelopathy.

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