 Good evening everyone, myself Dr. Yash Sriman Kumar Nagaraya, I am first year resident from D.I. Patil Hospital, Kholapur. I would like to thank IRIA for giving me this opportunity to present my paper in the 21st MRI conference. I also like to thank my mentor, Dr. Pradeep Patil Sir, a professor in the Department of Rated Diagnosis and the Pramul Naguri Sir, a senior resident in the Department of Rated Diagnosis. My paper presentation topic is CNS Infection associated with HIV Infection with MRI Correlation. Introduction for Introduction. This is a central nervous system in patient infected with the human immunodeficiency virus can result directly from HIV itself or from a variety of autonomic agents. These infections can include progressive multiple multifocal leukemia, toxoplasmosis, and cryptococcuses. Mass lesion, manumuncipleitis, and demyelination, pedrophil, and vascular lesions are commonly encountered in imaging findings. The introduction of highly active re-entered trial therapy has improved both the clinical and the radiologic findings in the HIV patients and reduced the number of opportunity infection. First is neurotoxoplasmosis. It is also known as cerebral toxoplasmosis. It is an opportunity infection caused by the parasite toxoplasma gondai. It typically affects patients with the AIDS, and it is the most common cause of cerebral abscess in these patients. Epidermology. In the most cases, the infection is asymptomatic. However, the immunocompromised patient, especially the HIV or AIDS infection, can become established. The infection likely to occur once the CD4 count is less than 200 cells per mm. Pathologic features. The macroscopic appearance of CNS is in this type of patients. This poorly circumscribed necrotizing abscess with the hypermete border and soft yellowish content. Microscopic features include coagulative necrosis, insistered toxo-organisms, numerous tachyzoids, and minimum in post-inflammatory response. Patients generally came with a complaint of global encephalopathy, such as headache, confusion, lethargy. My lab is the most common focal abnormality. Porea is rare in these type of patients. Now the MRI feature on T1 weighted imaging. It is a typically iso-intense or a hypo-intense. Occasionally shows mild peripheral hyperintensity due to coagulative necrosis. On T2 weighted imaging, intensity is variable, from hyperintense to iso-intense. On hyperintense, generally representing the necrotizing encephalitis, iso-intense represent the organic organizing abscess. Concentric alternating zone of hypo-hyper and iso-intense signals, generally known as concentric target sign. Legions are generally surrounded by the perillational edema. On T1 contrast, legions often demonstrate the ring enhancement or the nodular enhancement. For this pathology, it is also typically centric target sign or the on post-contrast images. Here is the first case. The 42-year male patient, known case of HIV, came with a complaint of headache, confusion and hemiparesis. There are three images. On the first, axial T1 weighted images shows the area of hyperintense lesion in the basal ganglia region and the left-corded nucleus. Left-corded nucleus and the internal capsule. On axial T2 weighted MRI image, there is a concentrated alternating zone of hypo-hyper or iso-intense known as concentrated ring sign, surrounding by edema. On axial T1, post-contrast shows the perillational edema ring enhancement, perillational ring enhancement. In the second case or the known case of topsoflasmosis, a 20-year-old patient with HIV infection, on axial T2 weighted image demonstrated the involving the right basal ganglia, that is iso-intense to hyper-intense, related to gray matter. Lesion is surrounded by the high signal intensity, that is vasogenic edema. The smaller lesions are also present in the left basal ganglia. On axial post-contrast, multiple enhancing lesions is seen, CNS cryptococcus. It results from the infection of the CNS with the east-like fungus known as cryptococcus newformins. It is the most common fungal infection and the third most common opportunity infection on the central nervous system. Pathology, there are three dominant CNS forms to the disease, depending on which part of the brain is affected. First the mangers, then it causes meningitis. If it affects the brain perenchyma, that is known as cryptococomas, perivascular spaces known as gelatinous pseudosus. Meningitis and cryptococcus are seen in the immunocompetent host, usually, and gelatinous pseudosus, which are more common in the patient with HIV or AIDS. The most common site for the cryptococcus are the basal ganglia, thalamus, and cerebellum. The MRI features are included and dilated perivascular space can pull us into gelatinous pseudosus that tend to give so bubble appearance. On T1, it shows the hyper-intense lesion. On T2, it is hyper-intense lesion follows the CSR signal intensity. On flare, there are variable signal ranging from full suppression to persistent high signal. Cryptocococomas appears low signal on the T1 and on high signal on the T2 and the flare images. On T1 contrast, the variable ranging from no enhancement to peripheral nodular enhancement. Here is the case of 42-3 year male came with a complain of fever, malice, headache, and is also on the heart therapy since one month. On axial T1 weighted image, there are areas of the hypo-intensities on the bilateral basal ganglia and internal capsule. On the axial T2 weighted images, we can see the hyper-intensity lesion polices to form the soap, giving the soap bubble appearance on the region of the basal ganglia or the corded nucleus of bilateral. On flare areas, there are shows of variable signs of variable areas of hyper-intensities. Here is another case of 25-year HIV patient who presented with the increasing headache, nausea, and vomiting. On T1 weighted axial image, there is a cerebellar, right-sided cerebellar hemisphere shows the hypo-intense lesion. On T2 weighted image, we can see the hyper-intense lesion, surrounded by the perillational edema. On T1 post contrast, it shows the perigodal ring enhancement scene. Next is progressive multifocal nicoencephalopathy. It is a demyelinating disease which results from the reactivation of the JC virus, infecting the oligodendrocyte in patients with compromised gimming system. Classically, PML occurred in the patient with the AIDS, typically developing patient with the CD4 count of 50 to 100 cells per microeutone. Astrology reveals the demyelating plaques involving the white matter and the sub-quarticle u-fibers. Other findings included infected oligodendrocytes with enlarged hemophilic nuclei located at the periphery of the lesion. Clinically presentation and sight, the lesion stands to have confine bilateral but asymmetrical supra-tentorial white matter and thalamic involvement. However, the basal ganglia, brain stem and cerebellum can also be involved. Sub-quarticle frontal and the paraito-occipital regions are the common locations. The most frequently encountered symptoms include the altered mental status, motor deficits, limb and gait adexia, visual symptoms such as dyplopia, hemianopia, seizures, as PML involves the gray matter in the later stages. MRI feature is generally seen as a multifocal asymmetric, periventricular and sub-quarticle involvement. There is a little or no mass effect or the enhancement and the sub-quarticle u-fibers are commonly involved. On T1 weighted image, involved regions usually are hypo intense. On T2, regions are generally hyper intense. Multiple puncted high T2 signal lesion surrounding the main area gives the milky way sign. Barbell sign, paraito-occipital signal are normally crossing the spleenium. On T1 contrast imaging, there is no enhancement. On DWI or ADC, peripheral patchy diffusion restriction seen in DWI at the leading edge. Here is a case of 34-year-old male patient came with the company of dyplopia, adexia, altered mental status and known case of HIV positive. On the axial T1 T2 weighted image, we can see the hyper intense lesion, hyper intense lesion in the sub-quarticle fibres, crossing the spleenium shows barbell sign. On similar the flare imaging, it shows the hyper intense lesion in the same areas and it shows in the T2 weighted images. On DWI, we can also see the diffuse somewhat diffuse restriction in the same areas, but not proper diffuse restriction. Here is another case of a PML in a 30-year-old woman with HIV infection. On axial T2 images, we can see the hyper intensity involving the white matter on the right hemisphere including the sub-quarticle u-fibres. On the same, axial post-quantus T1 image demonstrate the hyper intensity and there is no evidence of associated enhancement. Conclusion, the neuro-magic binding of CNS infection disease in a patient with HIV infection are varied including the mass-esion, atrophy, demyelination, vascular complication and many wins applied there. Heart therapy will lead to the improvement of the many of the imaging findings, but it can occasionally result in iris which has atypical imaging findings. Knowledge of the imaging finding of the infectious CNS disease in HIV infected patients as well as impact of heart is important in the patient treatment. These are my references. Thank you.