Evaluating Contrast-Enhancing Brain Lesions in Patients with AIDS by Using Positron Emission Tomography

Pierce, Mark A.; Johnson, Mahlon D.; Maciunas, Robert J.; Murray, Michael J.; Allen, George S.; Harbison, Mary Alice; Creasy, Jeffrey L.; Kessler, Robert

doi:10.7326/0003-4819-123-8-199510150-00005

Cited by 96 publications

(38 citation statements)

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“…Higher uptake of fluorodeoxyglucose (FDG) is seen with positron emission tomography (PET) in intracranial lymphomas, compared with infections [45,46]. Similar results have been obtained with thallium-201 with single positron emission tomography (SPECT) [47••].…”

Section: Non-hodgkin Lymphomas: Pathologic and Clinical Featuressupporting

confidence: 53%

HIV-Associated lymphomas

Straus

2001

Curr Oncol Rep

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Intermediate and high-grade non-Hodgkin lymphomas (NHL) with a B-cell phenotype are AIDS-defining illnesses. The incidence of systemic NHL is over 100 times increased, primary central nervous system NHL is over 3000 times increased, and Hodgkin's disease is approximately 10 times increased in the HIV-infected population. Unusual extranodal presentations of NHL and Hodgkin's disease are seen in HIV-infected individuals. High-grade histologies are common for both NHL and Hodgkin's disease in the HIV setting. Treatment approaches may be changing with the advent of highly active antiretroviral therapy, which may allow patients to tolerate more intensive treatment.

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Section: Non-hodgkin Lymphomas: Pathologic and Clinical Featuressupporting

confidence: 53%

HIV-Associated lymphomas

Straus

2001

Curr Oncol Rep

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“…Controls included patients with and without focal brain disorders, but no patients without TE had detectable 7: gondii DNA in CSF. Therefore, the assay is a helpful tool for the differential diagnosis of focal brain lesions, particularly when performed in combination with assays for EBV or JCV DNA in CSF-as markers of primary brain lymphoma and PML, respectively [ 13, 141-01-new neuroradiological approaches such as positron emission tomography [22]. Patients with enhancing lesions and a doubtful picture-especially when tests for EBV DNA in CSF are negative or anti-Toxoplusmu prophylaxis has been administered-may represent the ideal target population for the assay.…”

Section: Discussionmentioning

confidence: 99%

PCR detection of Toxoplasma gondii DNA in CSF for the differential diagnosis of AIDS-related focal brain lesions

Cingolani

Luca

Ammassari

et al. 1996

Journal of Medical Microbiology

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To evaluate whether the detection of Toxoplasma gondii DNA in CSF could contribute to the differential diagnosis of AIDS-related focal brain lesions, CSF samples from 88 HIVinfected patients (56 with focal brain lesions and 32 without) were tested prospectively by a nested PCR for the B1 gene of T. gondii. The assay had a detection limit of 10 trophozoite equivalents. Six of 18 patients with toxoplasmic encephalitis, but none of the 70 patients with other disorders, were PCR-positive (33.3% sensitivity and 100% specificity). Considering only those patients with cerebral toxoplasmosis from whom CSF was collected before or during the first week of antitoxoplasmic therapy, sensitivity rose to 50%. This was higher than the sensitivity in patients whose CSF was collected after the first week of treatment (odds ratio (OR) of 7.0; 95% CI: 0.46-218.2). The administration of antitoxoplasmic prophylaxis did not affect the PCR results. Patients with a poor response to therapy had a higher probability of detectable T. gondii DNA in their CSF (OR of 5.0; 95% CI: 0.37-86.6). All patients with other central nervous system disorders were PCR-negative. Despite the moderate sensitivity, the high specificity and positive predictive value (100%) make this assay a useful tool in the differential diagnosis of AIDS-related focal brain lesions as part of a series of CSF and neuroradiological examinations.

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“…86 Limited studies using positron emission tomography (PET) have been performed with high sensitivity but the specificity of this modality is not yet sufficiently clear to use routinely. [87][88][89][90] Historically, the prognosis for AIDS-related PCNSL has been poor. Whole-brain radiotherapy has been used for palliation, with most patients ultimately dying from OIs.…”

Section: Primary Cns Lymphomamentioning

confidence: 99%