Document 0440
 DOCN  M9620440
 TI    [The diagnosis of primary cerebral lymphoma in AIDS. The contribution of
       imaging]
 DT    9602
 AU    Laissy JP; Lebtahi R; Cordoliani YS; Henry-Feugeas MC; Schouman-Claeys
       E; Services de Radiologie, Hopital Bichat, Paris.
 SO    J Neuroradiol. 1995 Sep;22(3):207-17. Unique Identifier : AIDSLINE
       MED/96043318
 AB    Apart from the very frequent HIV encephalitis, which lays the foundation
       for opportunistic infections, the most common diseases encountered in
       HIV-infected patients are toxoplasmosis and lymphoma; the percentage of
       cases of other diseases is very small. It is capital to diagnose
       cerebral lymphoma at an early stage in these patients who already are in
       a precarious general and neurological state since this type of lesion
       usually occurs late in the natural course of AIDS. In the differential
       diagnosis between toxoplasmosis and lymphoma only stereotaxic biopsy
       enables a positive diagnosis to be made, but imaging methods, such as CT
       and MRI, provide data that help guide to a diagnosis which sometimes may
       be definitive. Suggestive of lymphoma is a single infiltrating lesion
       wider than 4 cm, which is paraventricular or located in the posterior
       fossa, has little perilesional alteration and a short tumoral doubling
       time during the imaging follow-up. Suggestive of toxoplasmosis are
       multiple, small, annular or nodular lesions with an important
       perilesional inflammation and usually located in basal ganglia. In
       addition, in MRI the kinetics of enhancement after contrast injection is
       intense and occurs early in lymphoma, in contrast with the toxoplasmic
       abscesses, and this should provide a more specific differential
       diagnosis. Scintigraphic studies with somatostatin or positron emission
       tomography, using fluorodeoxyglucose (FDG-PET scintigraphy), also seem
       to be an interesting mean of making a specific diagnosis of cerebral
       lesion, according to a principle that is close to dynamic MRI. In
       lymphoma, capturing of the tracer is about 3 times greater than in
       infective lesions, notably the toxoplasmic ones. Imaging, therefore, is
       provided with tools which permit an increasingly specific approach to
       the primary cerebral lymphoma of AIDS, the definitive diagnosis of which
       rests on stereotaxic biopsy. This high specificity facilitates a better
       selection of patients requiring this procedure and shortens the delay in
       its execution.
 DE    AIDS-Related Opportunistic Infections/DIAGNOSIS  Biopsy  Brain
       Neoplasms/*DIAGNOSIS  Diagnosis, Differential  *Diagnostic Imaging
       Encephalitis, Viral/DIAGNOSIS  English Abstract  Follow-Up Studies
       Human  Lymphoma, AIDS-Related/*DIAGNOSIS  Magnetic Resonance Imaging
       Stereotaxic Techniques  Tomography, Emission-Computed  Tomography, X-Ray
       Computed  Toxoplasmosis, Cerebral/DIAGNOSIS  JOURNAL ARTICLE  REVIEW
       REVIEW, TUTORIAL

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