What is the role of imaging in the workup of cytomegalovirus (CMV) encephalitis in HIV?

Updated: Jan 08, 2020
  • Author: Regina Krel, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Computed tomography (CT) and magnetic resonance imaging (MRI) can aid in the diagnosis and can exclude other diagnostic considerations (eg, absence of parenchymal enhancement, evidence of increased intracranial pressure [ICP]). Head CT and MRI findings include encephalitis involving the cerebral hemispheres and brainstem, ventriculitis, meningitis, and infarcts. Hydrocephalus and cerebral atrophy have been reported. Periventricular calcification, a marker of congenital CMV infection, is not seen.

Mass lesions due to CMV have been reported but are rare. T2-weighted MRI may show diffuse white matter hyperintensity similar to that seen in HIV encephalopathy and other HIV-associated central nervous system (CNS) disorders. Gadolinium contrast MRI may reveal meningeal and ependymal enhancement, as well as ring enhancing lesions.

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