SPECT Thallium-201 Combined with Toxoplasma Serology for the Presumptive Diagnosis of Focal Central Nervous System Mass Lesions in Patients with AIDS

doi:10.1053/jinf.2000.0664

Journal of Infection

Volume 40, Issue 3, May 2000, Pages 274-281

https://doi.org/10.1053/jinf.2000.0664 Get rights and content

Abstract

Objective: To determine the utility of brain thallium-201 single photon emission computerized tomography (Tl-201 SPECT) combined with Toxoplasma serology for the diagnosis of focal CNS lesions in patients with AIDS.

Methods: Sixty-one consecutive HIV-infected patients with focal CNS lesion(s) on head computed tomography (CT) or MRI scan who underwent brain Tl-201 SPECT and serum Toxoplasma serology were evaluated, retrospectively. Thallium-201 uptake ratios were calculated by comparing lesion activity to contralateral scalp activity. Diagnoses were made by a combination of histology, serology, PCR, and empirical response to therapy. Toxoplasma serologies (IgG IFA) were compared in the patients with central nervous system (CNS) toxoplasmosis and those without CNS toxoplasmosis.

Results: Fifty-six patients were evaluable and a definitive diagnosis was made in 38 patients: toxoplasmosis (17), lymphoma (14), PML (three),Aspergillus (one), tuberculoma (one), Cryptococcus (one), varicella-zoster virus (one). Patients with lymphoma had significantly higher lesion/contralateral scalp ratios compared to patients without lymphoma: 1.03 vs. 0.67,P <0.05. Using a cut-off of 0.90 for the lesion/scalp uptake ratios (based on analysis of ROC curves) the sensitivity and specificity for the diagnosis of lymphoma were 86% and 83%, respectively. Serum Toxoplasma IgG titres were significantly higher in patients diagnosed with toxoplasmosis compared to those with a diagnosis other than toxoplasmosis, 1:5444 vs. 1:15, P<0.05. Only one patient with confirmed toxoplasmosis had a Toxoplasma serology <1:256, while no patients without toxoplasmosis (including all lymphoma patients) had serologies >1:256.

Conclusions: In a series of HIV-infected patients, Tl-201 SPECT was able to accurately differentiate primary brain lymphoma from other causes of focal CNS lesions in most patients; however, both false positive and false negative results occurred. By combining Tl-201 SPECT with serumToxoplasma IgG, diagnostic accuracy was improved.

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^☆: Presented in part at the Sixth Conference on Retroviruses and Opportunistic Infections, Chicago, IL, U.S.A., 1999.

^f2: Address correspondence to: Daniel J. Skiest, Division of Infectious Diseases, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9133, U.S.A.

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Regular ArticleSPECT Thallium-201 Combined with Toxoplasma Serology for the Presumptive Diagnosis of Focal Central Nervous System Mass Lesions in Patients with AIDS☆

Abstract

The neuropathology of human immunodeficiency virus infection

Arch Pathol Lab Med

Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): Experience at UCSF and review of the literature

J Neurosurg

AIDS Commentary: toxoplasmic encephalitis

J Infect Dis

Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients

J Neurosurg

Primary central nervous system lymphoma in Acquired Immune Deficiency Syndrome: a clinical and pathological study

Ann Neurol

Central nervous system toxoplasmosis in AIDS

N Engl J Med

High predictive value of Toxoplasma gondii IgG antibody levels in HIV-infected patients for diagnosis of cerebral toxoplasmosis

Eur J Clin Microbiol Infect Dis

Toxoplasma gondii serology in HIV-infected patients: the development of central nervous system toxoplasmosis in AIDS

AIDS

Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome

Medicine

Central-Nervous-System toxoplasmosis in homosexual men and parenteral drug abusers

Ann Intern Med

Thallium-201 single photon emission computed tomography in the management of contrast-enhancing brain lesions in a patient with AIDS

Clin Infect Dis

Clinical features, outcome and survival from cerebral toxoplasmosis in Edinburgh AIDS patients

Int J STD AIDS

Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome

New Engl J Med

Diagnostic accuracy and predictive value of 201-Tl SPECT for the differential diagnosis of cerebral lesions in AIDS patients

Nucl Med Commun

Rapid differential diagnosis of cerebral toxoplasmosis and primary central nervous systemlymphoma by Thallium-201 SPECT

J Nuc Med

Regular Article
SPECT Thallium-201 Combined with Toxoplasma Serology for the Presumptive Diagnosis of Focal Central Nervous System Mass Lesions in Patients with AIDS☆