title: MRI signal changes of the bone marrow in HIV-infected patients with lipodystrophy: correlation with clinical parameters.
abstract: OBJECTIVE
  To assess the prevalence, imaging appearance, and clinical significance, of bone marrow MR signal changes in a group of human immunodeficiency virus (HIV)-infected patients with lipodystrophy syndrome.
  
  
  METHODS
  Twenty-eight HIV-infected patients with lipodystrophy syndrome treated with highly active antiretroviral therapy, and 12 HIV-negative controls underwent MRI of the legs. Whole-body MRI, SPECT/CT, and a complete radiographic skeletal survey were obtained in subjects with signal changes in bone marrow. MRI and clinical evaluations were reviewed 6 months after baseline to determine changes after switching from thymidine analogs (TA) to tenofovir-DF (TDF). MRI results correlated with clinical parameters.
  
  
  RESULTS
  We observed foci of a serous-like pattern (low signal and no enhancement on T1-weighted, high signal on T2-weighted images) in 4 out of 28 patients (14.3%) and an intermediate signal on T1-weighted images in 4 out of 28 patients (14.3%). Serous-like lesions were located in the lower limbs and scattered in the talus, calcaneus, femurs, and humeral bones; they showed slight uptake on SPECT bone scans and were normal on CT and radiographs. Patients with serous-like lesions had significantly lower peripheral and total fat at baseline than other groups (P < 0.05). No changes at 6 months were observed on MRI, and the serous-like lesion group showed good peripheral fat recovery after changing drug treatment.
  
  
  CONCLUSIONS
  A serous-like MRI pattern is observed in the peripheral skeletons of HIV-infected patients with lipodystrophy, which correlates with peripheral lipoatrophy, and should not be misdiagnosed as malignant or infectious diseases. Although the MR lesions did not improve after switching the treatment, there was evidence of lipoatrophy recovery.
authors.affiliation: Department of Radiology, Hospital Clinic, Villarroel 170, Barcelona 08036, Spain. aigarcia@clinic.ub.es
authors.forename: Ana I
authors.initials: AI
authors.lastname: García
authors.forename: Ana
authors.initials: A
authors.lastname: Milinkovic
authors.forename: Xavier
authors.initials: X
authors.lastname: Tomás
authors.forename: José
authors.initials: J
authors.lastname: Rios
authors.forename: Iñaki
authors.initials: I
authors.lastname: Pérez
authors.forename: Sergi
authors.initials: S
authors.lastname: Vidal-Sicart
authors.forename: Jaume
authors.initials: J
authors.lastname: Pomés
authors.forename: Montserrat
authors.initials: M
authors.lastname: Del Amo
authors.forename: Josep
authors.initials: J
authors.lastname: Mallolas
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged