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AJNR - American Journal of Neuroradiology

Published ahead of print on September 26, 2007
doi: 10.3174/ajnr.A0718

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American Journal of Neuroradiology 28:1988-1990, November-December 2007
© 2007 American Society of Neuroradiology

BRAIN

Outcome in AIDS-Related Systemic Non-Hodgkin Lymphoma and Leptomeningeal Disease Is Not Predicted by a CT Brain Scan

C.L. Davies^a, R. Chinn^a, M. Nelson^a, M. Rasanesan^a, B. Gazzard^a, T. Powles^a, M. Bower^a and J. Stebbing^a

^a From the Department of Oncology, Imperial College School of Science, Medicine and Technology, Chelsea and Westminster Hospital, London, United Kingdom

Please address correspondence to J. Stebbing, PhD, MRCP, Department of Oncology, Imperial College School of Science, Medicine and Technology, Charing Cross Hospital, London W6 8RF UK; e-mail: j.stebbing{at}imperial.ac.uk

BACKGROUND AND PURPOSE: AIDS-related systemic non-Hodgkin lymphoma (ARL) remains a significant cause of morbidity and mortality in patients infected with the human immunodeficiency virus (HIV-1), and leptomeningeal disease in this setting has a dismal prognosis. We investigated the utility of brain CT in determining the outcome of leptomeningeal disease, despite MR imaging being the gold standard.

MATERIALS AND METHODS: From a cohort of 9621 HIV-1-seropositive individuals, we identified those diagnosed with ARL in the highly active antiretroviral therapy (HAART) era who had both a lumbar puncture and central nervous system imaging using a CT brain scan at the time of initial diagnosis, and we compared survival parameters between those with and without leptomeningeal disease.

RESULTS: In a cohort of 82 individuals with ARL treated in the era of HAART, we found that the survival of individuals with leptomeningeal disease defined as the presence of cells in the CSF was worse compared with that of other patients (P = .0026). However, when defined by the presence of abnormal enhancement or parenchymal lesions on a CT scan, the outcome was not significantly different.

CONCLUSION: A CT brain scan appears not to offer additional prognostic information following a lumbar puncture in patients with ARL.