Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Progressive Multifocal Leucoencephalopathy Isolated to Posterior Fossa in a Patient with AIDS: DWI and 1H-MRS Features

후천성면역결핍증후군 환자에게 있어서 후과에 국한된 진행다초점백질뇌병: 확산강조영상과 양성자자기공명분광술의 특징적인 소견

  • Park, Byung-Sa (Department of Radiology, Eulji University Hospital) ;
  • Yu, In-Kyu (Department of Radiology, Eulji University Hospital) ;
  • Lee, Byung-Hee (Department of Radiology, Eulji University Hospital)
  • 박병사 (대전을지대학병원 영상의학과) ;
  • 유인규 (대전을지대학병원 영상의학과) ;
  • 이병희 (대전을지대학병원 영상의학과)
  • Received : 2010.06.03
  • Accepted : 2010.07.13
  • Published : 2010.11.01
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Abstract

We report a case of progressive multifocal leukoencephalopathy (PML) isolated to the posterior fossa in a 55-year-old male with acquired immune deficiency syndrome (AIDS). Initial MR images revealed a few foci of patchy increased signal intensity (SI) on a T2-weighted image and a diffusion weighted image (DWI) at the pons, right middle cerebellar peduncle, and right cerebellar hemisphere, with no enhancement. After anti-retroviral therapy, follow-up MR images revealed the more prominent extent of previously-seen lesions and newly discovered newly developed focal increased SI on T2-weighted images located left of the inferior cerebellar hemisphere. Proton MR spectroscopy (1H-MRS) showed a slightly increased choline peak (3.2 ppm) and lactate peak (1.35 ppm), as well as a decreased N-acetylaspartate (NAA) peak (2.0 ppm), which suggests active demyelinating disease. DWI and 1H-MRS may support the diagnosis of PML in patients with AIDS.

본 연구는 후천성면역결핍증후군과 연관된 진행다초점백질뇌병에 대한 55세 남자 환자의 증례 보고로서 병변이 후과에 국한된 드문 경우이다. 초기 자기공명영상에서 뇌교, 오른쪽 중간소뇌다리(middle cerebellar peduncle), 오른쪽 소뇌반구에 T2 강조영상과 확산강조영상에서 고신호가 나타났고, 조영증강은 되지 않았다. 항레트로바이러스제 치료 후 시행한 자기공명영상 추적검사에서 침범된 병변은 이전보다 범위가 넓어졌고, 왼쪽 소뇌반구에 고신호가 새롭게 발견됐다. 양성자자기공명분광술에서는 choline peak (3.2 ppm)와 lactate peak (1.35 ppm)의 증가, N-acetylaspartate peak (2.0 ppm)의 감소가 나타나서 급성탈수초성질환에 해당하는 소견으로 생각할 수 있었다. 후천성면역결핍증후군과 연관된 진행다초점백질뇌병은 확산강조영상과 양성자자기공명분광술에서 특징적인 소견을 보인다.

Keywords

References

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