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1996-02-26
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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
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).