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

Answer

MRI scans serve two purposes.

Like CT, to rule out alternative or coexisting conditions.
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 spinal cord on T2-weighted sagittal MRI consistent with HIV myelopathy.

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High-intensity lesion in the posterior cervical cord on T2-weighted axial MRI consistent with HIV myelopathy.

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Media Gallery

Spinal cord from patient with vacuolar myelopathy that shows extensive spongiform changes in the white matter (Luxol fast blue stain) (contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis, MO).
Marked vacuolation is apparent in this Luxol fast blue stained photomicrograph (contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis, MO).
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 cord on T2-weighted axial MRI consistent with HIV myelopathy.

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Author

Krupa Pandey, MD Assistant Professor of Neurology, Department of Neurology, Hackensack Meridian School of Medicine at Seton Hall University; Neurologist in Multiple Sclerosis, Neuroscience Institute at Hackensack University Medical Center; Adjunct Professor of Neurology, Multiple Sclerosis Comprehensive Care Center, NYU Langone School of Medicine

Krupa Pandey, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Biogen; Sanofi-Genzyme; Teva; Serono; Genentech<br/>Serve(d) as a speaker or a member of a speakers bureau for: Biogen; Sanofi-Genzyme; Teva; Genentech.

Coauthor(s)

Florian P Thomas, MD, PhD, MA, MS Chair, Neuroscience Institute and Department of Neurology, Director, National MS Society Multiple Sclerosis Center and Hereditary Neuropathy Foundation Center of Excellence, Hackensack University Medical Center; Founding Chair and Professor, Department of Neurology, Hackensack Meridian School of Medicine at Seton Hall University; Professor Emeritus, Department of Neurology, St Louis University School of Medicine; Editor-in-Chief, Journal of Spinal Cord Medicine

Florian P Thomas, MD, PhD, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University in St Louis School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Additional Contributors

Prityi Rani, MD General Neurologist, Headache, Stroke, and Neuromuscular, Jefferson City Medical Group

Prityi Rani, MD is a member of the following medical societies: American Academy of Neurology, Indian Medical Association, International Headache Society

Disclosure: Nothing to disclose.

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

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