Cordes M, Henkes H, Hunger J, Jochens R, Heise W, Felix R; International Conference on AIDS.

Int Conf AIDS. 1989 Jun 4-9; 5: 459 (abstract no. Th.B.P.260).

Department of Radiology, University Clinic Rudolf Virchow / Charlottenburg, Free University Berlin

Although CT and MR imaging have demonstrated a high sensitivity in detecting brain lesions, determination of the etiology causing the lesion is still poor. However, specificity is crucial for prognosis and therapy. OBJECTIVE: To determine the diagnostic value of HM-PAO SPECT in patients with intracranial AIDS manifestations, which had been confirmed by MR. In addition, the incidence, the localization as well as the degree of altered brain profusion in AIDS-patients with clinical symptoms of CNS disease and a normal MR examination was investigated. METHODS: Eleven male patients (age median: 37 years) with proved HIV-1 infection, CDC IV, were examined. Clinical and/or histologic diagnoses were toxoplasmosis (6 patients), lymphoma (2 patients), meningitis (1 patient), and HIV-encephalitis (2 patients). SPECT examinations were performed using a rotating gamma camera after i.v. application of 555 MBq 99mTc-HM-PAO. Axial, coronal and sagittal slices were generated. MR studies (0.5 T Magnetom) were performed using T2-weighted images (SE 1600/30,70) and unenhanced as well as Gd-DTPA enhanced T1-weighted sequences (FLASH 315/14, theta=90 degrees). RESULTS: MR imaging demonstrated 20 lesions in 6 patients with cerebral manifestation of toxoplasmosis. SPECT demonstrated focally altered brain profusion in all patients. Twelve of the 20 lesions showed hypoperfusion, 5 lesions were hyperperfused, one patient of this group had multiple perfusion deficits. In one patient with 3 cerebral lymphomas, all lesions were hypoperfused. In one patient with meningitis - as demonstrated by MR - perfusion was reduced in the adjacent brain tissue. In 2 patients with HIV-encephalitis and negative MR, SPECT detected multiple perfusion deficits. CONCLUSION: The sensitivity of SPECT in detecting focal lesions is inferior to MR. At present, HM-PAO SPECT does not provide differentiation between toxoplasmosis and lymphoma. However, SPECT demonstrates altered brain perfusion in areas larger than the corresponding focal lesion detected by MR imaging. SPECT appears thus potentially useful in AIDS-patients with symptomatic brain disease and a negative MR who may have altered brain perfusion. HM-PAO SPECT is a helpful diagnostic method complementary to CT and MR imaging in patients with AIDS-related brain disease evaluating the brain perfusion pattern.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Brain
• Brain Diseases
• HIV-1
• Humans
• Magnetic Resonance Spectroscopy
• Male
• Meningitis
• Tomography, Emission-Computed, Single-Photon
• Toxoplasmosis
• radionuclide imaging

Other ID:

• 00236689

UI: 102178270

From Meeting Abstracts