title: Value of perfusion-weighted MR imaging in the assessment of early cerebral alterations in neurologically asymptomatic HIV-1-positive and HCV-positive patients.
abstract: OBJECTIVE
  Asymptomatic central nervous system (CNS) involvement occurs in the early stage of the human immunodeficiency virus (HIV) infection. It has been documented that the hepatitis C virus (HCV) can replicate in the CNS. The aim of the study was to evaluate early disturbances in cerebral microcirculation using magnetic resonance (MR) perfusion-weighted imaging (PWI) in asymptomatic HIV-1-positive and HCV-positive patients, as well as to assess the correlation between PWI measurements and the clinical data.
  
  
  METHODS
  Fifty-six patients: 17 HIV-1-positive non-treated, 18 HIV-1-positive treated with combination antiretroviral therapy (cART), 7 HIV-1/HCV-positive non-treated, 14 HCV-positive before antiviral therapy and 18 control subjects were enrolled in the study. PWI was performed with a 1.5T MR unit using dynamic susceptibility contrast (DSC) method. Cerebral blood volume (CBV) measurements relative to cerebellum (rCBV) were evaluated in the posterior cingulated region (PCG), basal ganglia (BG), temporoparietal (TPC) and frontal cortices (FC), as well as in white matter of frontoparietal areas. Correlations of rCBV values with immunologic data and liver histology activity index (HAI) were analyzed.
  
  
  RESULTS
  Significantly lower rCBV values were found in the right TPC and left FC as well as in PCG in HIV-1-positive naïve (p = 0.009; p = 0.020; p = 0.012), HIV-1 cART treated (p = 0.007; p = 0.009; p = 0.033), HIV-1/HCV-positive (p = 0.007; p = 0.027; p = 0.045) and HCV-positive patients (p = 0.010; p = 0.005; p = 0.045) compared to controls. HIV-1-positive cART treated and HIV-1/HCV-positive patients demonstrated lower rCBV values in the right FC (p = 0.009; p = 0.032, respectively) and the left TPC (p = 0.036; p = 0.005, respectively), while HCV-positive subjects revealed lower rCBV values in the left TPC region (p = 0.003). We found significantly elevated rCBV values in BG in HCV-positive patients (p = 0.0002; p<0.0001) compared to controls as well as to all HIV-1-positive subjects. There were no significant correlations of rCBV values and CD4 T cell count or HAI score.
  
  
  CONCLUSIONS
  PWI examination enables the assessment of HIV-related as well as HCV-related early cerebral dysfunction in asymptomatic subjects. HCV-infected patients seem to reveal the most pronounced perfusion changes.
authors.affiliation: Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Bladowska
authors.affiliation: Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Brygida
authors.initials: B
authors.lastname: Knysz
authors.affiliation: Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Zimny
authors.affiliation: Division of Psychotherapy and Psychosomatic Medicine, Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Małyszczak
authors.affiliation: Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Kołtowska
authors.affiliation: Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Szewczyk
authors.affiliation: Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Gąsiorowski
authors.affiliation: Regional Specialistic Hospital, Department of Cardiology, Wroclaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Furdal
authors.affiliation: Department of General Radiology, Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Marek J
authors.initials: MJ
authors.lastname: Sąsiadek
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology* / Q000821:virology; D001931:Brain Mapping; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000254:growth & development; D016174:Hepacivirus / Q000187:drug effects / Q000254:growth & development; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D008099:Liver / Q000821:virology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D055420:Perfusion Imaging
chemical_list: D000998:Antiviral Agents