Evaluating contrast-enhancing brain lesions in patients with AIDS by using positron emission tomography

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

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Objective: To determine whether a noninvasive method for evaluating contrast-enhancing brain lesions in patients with the acquired immunodeficiency syndrome (AIDS) can accurately differentiate between lymphoma and nonlymphoma diagnoses. This method is based on Toxoplasma serologic testing and positron emission tomography. Design: Prospective, nonrandomized, criterion-standard clinical study. Setting: An academic center in the mid-southeastern United States. Patients: 20 patients with AIDS and contrast-enhancing brain lesions. Interventions: Positron emission tomographic scanning and Toxoplasma serologic testing. Main Outcome Measure: Diagnoses were confirmed by clinical response, autopsy, or brain biopsy. Results: Eight patients had a confirmed diagnosis of toxoplasmosis, six had lymphoma, four had other diagnoses, and two were not evaluable. Seven of eight patients with toxoplasmosis had positron emission tomographic scans; all of these scans showed hypo-metabolic lesions consistent with a nonlymphoma diagnosis. The six patients with lymphoma all had hyper-metabolic lesions on positron emission tomographic scans. The difference between these two sets of results was statistically significant (P < 0.001, Fisher exact test, two-tailed). The anti-Toxoplasma titer was greater than or equal to 1:4 in all patients with confirmed toxoplasmosis who had serologic testing and in three of six patients with lymphoma. Conclusions: Evaluating contrast- enhancing brain lesions in patients with AIDS by using Toxoplasma serologic testing and positron emission tomography can accurately guide therapy and obviate the need for most brain biopsies in these patients. A larger, national, multicenter study is needed to confirm our findings and to determine the effect of earlier diagnosis and treatment on morbidity and mortality in patients with AIDS and primary central nervous system lymphoma.

Original languageEnglish (US)
Pages (from-to)594-598
Number of pages5
JournalAnnals of Internal Medicine
Volume123
Issue number8
DOIs
StatePublished - Oct 15 1995
Externally publishedYes

Fingerprint

Positron-Emission Tomography
Acquired Immunodeficiency Syndrome
Brain
Toxoplasma
Lymphoma
Toxoplasmosis
Electrons
Southeastern United States
Biopsy
Multicenter Studies
Early Diagnosis
Autopsy
Central Nervous System
Outcome Assessment (Health Care)
Morbidity
Mortality
Therapeutics

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Evaluating contrast-enhancing brain lesions in patients with AIDS by using positron emission tomography. / Pierce, Mark A.; Johnson, Mahlon; Maciunas, Robert J.; Murray, Michael J.; Allen, George S.; Harbison, Mary Alice; Creasy, Jeffrey L.; Kessler, Robert M.

In: Annals of Internal Medicine, Vol. 123, No. 8, 15.10.1995, p. 594-598.

Research output: Contribution to journalArticle

Pierce, Mark A. ; Johnson, Mahlon ; Maciunas, Robert J. ; Murray, Michael J. ; Allen, George S. ; Harbison, Mary Alice ; Creasy, Jeffrey L. ; Kessler, Robert M. / Evaluating contrast-enhancing brain lesions in patients with AIDS by using positron emission tomography. In: Annals of Internal Medicine. 1995 ; Vol. 123, No. 8. pp. 594-598.
@article{3e4e3443ec5040acb8bc1d919821e967,
title = "Evaluating contrast-enhancing brain lesions in patients with AIDS by using positron emission tomography",
abstract = "Objective: To determine whether a noninvasive method for evaluating contrast-enhancing brain lesions in patients with the acquired immunodeficiency syndrome (AIDS) can accurately differentiate between lymphoma and nonlymphoma diagnoses. This method is based on Toxoplasma serologic testing and positron emission tomography. Design: Prospective, nonrandomized, criterion-standard clinical study. Setting: An academic center in the mid-southeastern United States. Patients: 20 patients with AIDS and contrast-enhancing brain lesions. Interventions: Positron emission tomographic scanning and Toxoplasma serologic testing. Main Outcome Measure: Diagnoses were confirmed by clinical response, autopsy, or brain biopsy. Results: Eight patients had a confirmed diagnosis of toxoplasmosis, six had lymphoma, four had other diagnoses, and two were not evaluable. Seven of eight patients with toxoplasmosis had positron emission tomographic scans; all of these scans showed hypo-metabolic lesions consistent with a nonlymphoma diagnosis. The six patients with lymphoma all had hyper-metabolic lesions on positron emission tomographic scans. The difference between these two sets of results was statistically significant (P < 0.001, Fisher exact test, two-tailed). The anti-Toxoplasma titer was greater than or equal to 1:4 in all patients with confirmed toxoplasmosis who had serologic testing and in three of six patients with lymphoma. Conclusions: Evaluating contrast- enhancing brain lesions in patients with AIDS by using Toxoplasma serologic testing and positron emission tomography can accurately guide therapy and obviate the need for most brain biopsies in these patients. A larger, national, multicenter study is needed to confirm our findings and to determine the effect of earlier diagnosis and treatment on morbidity and mortality in patients with AIDS and primary central nervous system lymphoma.",
author = "Pierce, {Mark A.} and Mahlon Johnson and Maciunas, {Robert J.} and Murray, {Michael J.} and Allen, {George S.} and Harbison, {Mary Alice} and Creasy, {Jeffrey L.} and Kessler, {Robert M.}",
year = "1995",
month = "10",
day = "15",
doi = "10.7326/0003-4819-123-8-199510150-00005",
language = "English (US)",
volume = "123",
pages = "594--598",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "8",

}

TY - JOUR

T1 - Evaluating contrast-enhancing brain lesions in patients with AIDS by using positron emission tomography

AU - Pierce, Mark A.

AU - Johnson, Mahlon

AU - Maciunas, Robert J.

AU - Murray, Michael J.

AU - Allen, George S.

AU - Harbison, Mary Alice

AU - Creasy, Jeffrey L.

AU - Kessler, Robert M.

PY - 1995/10/15

Y1 - 1995/10/15

N2 - Objective: To determine whether a noninvasive method for evaluating contrast-enhancing brain lesions in patients with the acquired immunodeficiency syndrome (AIDS) can accurately differentiate between lymphoma and nonlymphoma diagnoses. This method is based on Toxoplasma serologic testing and positron emission tomography. Design: Prospective, nonrandomized, criterion-standard clinical study. Setting: An academic center in the mid-southeastern United States. Patients: 20 patients with AIDS and contrast-enhancing brain lesions. Interventions: Positron emission tomographic scanning and Toxoplasma serologic testing. Main Outcome Measure: Diagnoses were confirmed by clinical response, autopsy, or brain biopsy. Results: Eight patients had a confirmed diagnosis of toxoplasmosis, six had lymphoma, four had other diagnoses, and two were not evaluable. Seven of eight patients with toxoplasmosis had positron emission tomographic scans; all of these scans showed hypo-metabolic lesions consistent with a nonlymphoma diagnosis. The six patients with lymphoma all had hyper-metabolic lesions on positron emission tomographic scans. The difference between these two sets of results was statistically significant (P < 0.001, Fisher exact test, two-tailed). The anti-Toxoplasma titer was greater than or equal to 1:4 in all patients with confirmed toxoplasmosis who had serologic testing and in three of six patients with lymphoma. Conclusions: Evaluating contrast- enhancing brain lesions in patients with AIDS by using Toxoplasma serologic testing and positron emission tomography can accurately guide therapy and obviate the need for most brain biopsies in these patients. A larger, national, multicenter study is needed to confirm our findings and to determine the effect of earlier diagnosis and treatment on morbidity and mortality in patients with AIDS and primary central nervous system lymphoma.

AB - Objective: To determine whether a noninvasive method for evaluating contrast-enhancing brain lesions in patients with the acquired immunodeficiency syndrome (AIDS) can accurately differentiate between lymphoma and nonlymphoma diagnoses. This method is based on Toxoplasma serologic testing and positron emission tomography. Design: Prospective, nonrandomized, criterion-standard clinical study. Setting: An academic center in the mid-southeastern United States. Patients: 20 patients with AIDS and contrast-enhancing brain lesions. Interventions: Positron emission tomographic scanning and Toxoplasma serologic testing. Main Outcome Measure: Diagnoses were confirmed by clinical response, autopsy, or brain biopsy. Results: Eight patients had a confirmed diagnosis of toxoplasmosis, six had lymphoma, four had other diagnoses, and two were not evaluable. Seven of eight patients with toxoplasmosis had positron emission tomographic scans; all of these scans showed hypo-metabolic lesions consistent with a nonlymphoma diagnosis. The six patients with lymphoma all had hyper-metabolic lesions on positron emission tomographic scans. The difference between these two sets of results was statistically significant (P < 0.001, Fisher exact test, two-tailed). The anti-Toxoplasma titer was greater than or equal to 1:4 in all patients with confirmed toxoplasmosis who had serologic testing and in three of six patients with lymphoma. Conclusions: Evaluating contrast- enhancing brain lesions in patients with AIDS by using Toxoplasma serologic testing and positron emission tomography can accurately guide therapy and obviate the need for most brain biopsies in these patients. A larger, national, multicenter study is needed to confirm our findings and to determine the effect of earlier diagnosis and treatment on morbidity and mortality in patients with AIDS and primary central nervous system lymphoma.

UR - http://www.scopus.com/inward/record.url?scp=0028849154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028849154&partnerID=8YFLogxK

U2 - 10.7326/0003-4819-123-8-199510150-00005

DO - 10.7326/0003-4819-123-8-199510150-00005

M3 - Article

VL - 123

SP - 594

EP - 598

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 8

ER -