Antinori A, De Rossi G, Ammassari A, Cingolani A, Murri R, Di Giuda D, De Luca A, Pierconti F, Tartaglione T, Scerrati M, Larocca L M, Ortona L
Department of Infectious Diseases, Catholic University, Rome, Italy.
J Clin Oncol. 1999 Feb;17(2):554-60. doi: 10.1200/JCO.1999.17.2.554.
To determine the diagnostic capability of thallium-201 (201Tl) single-photon emission computed tomography (SPECT) combined with Epstein-Barr virus DNA (EBV-DNA) in CSF for the diagnosis of AIDS-related primary CNS lymphoma (PCNSL).
All human immunodeficiency virus (HIV)-infected patients with focal brain lesions observed between June 1996 and March 1998 underwent lumbar puncture and 201Tl SPECT. Each CSF sample was tested with polymerase chain reaction (PCR) for EBV-DNA.
Thirty-one patients were included, 13 with PCNSL and 18 with nontumor disorders. In 11 PCNSL patients, EBV-DNA was positive. Thallium-201 uptake ranged from 1.90 to 4.07 in PCNSL cases (mean, 2.77; 95% confidence interval [CI], 2.35 to 3.19) and from 0.91 to 3.38 in nontumor patients (mean, 1.62; 95% CI, 1.30 to 1.94) (P<.0002). Using a lesion/background ratio of 1.95 as cutoff, a negative SPECT was found in one PCNSL case and 16 nonneoplastic cases. A cryptococcoma and a tuberculoma showed highly increased 201Tl uptake. Epstein-Barr virus DNA was never detected in nonneoplastic patients. For PCNSL diagnosis, hyperactive lesions showed 92% sensitivity and 94% negative predictive value (NPV), whereas positive EBV-DNA had 100% specificity and 100% positive predictive value. The presence of increased uptake and/or positive EBV-DNA had 100% sensitivity and 100% NPV.
Combined SPECT and EBV-DNA showed a very high diagnostic accuracy for AIDS-related PCNSL. Because PCNSL likelihood is extremely high in patients with hyperactive lesions and positive EBV-DNA, brain biopsy could be avoided, and patients could promptly undergo radiotherapy or multimodal therapy. On the contrary, in patients showing hypoactive lesions with negative EBV-DNA, empiric anti-Toxoplasma therapy is indicated. In patients with discordant SPECT/PCR results, brain biopsy seems to be advisable.
确定201铊（201Tl）单光子发射计算机断层扫描（SPECT）联合脑脊液中爱泼斯坦-巴尔病毒DNA（EBV-DNA）对艾滋病相关原发性中枢神经系统淋巴瘤（PCNSL）的诊断能力。
1996年6月至1998年3月间观察到的所有感染人类免疫缺陷病毒（HIV）且有局灶性脑病变的患者均接受了腰椎穿刺和201Tl SPECT检查。每份脑脊液样本均采用聚合酶链反应（PCR）检测EBV-DNA。
纳入31例患者，其中13例为PCNSL，18例为非肿瘤性疾病。11例PCNSL患者的EBV-DNA呈阳性。PCNSL病例的201Tl摄取范围为1.90至4.07（均值为2.77；95%置信区间[CI]为2.35至3.19），非肿瘤患者的摄取范围为0.91至3.38（均值为1.62；95%CI为1.30至1.94）（P<0.0002）。以病变/本底比值1.95为临界值，1例PCNSL病例和16例非肿瘤病例的SPECT结果为阴性。1例隐球菌瘤和1例结核瘤的201Tl摄取显著增加。非肿瘤患者中从未检测到EBV-DNA。对于PCNSL诊断，高活性病变的敏感性为92%，阴性预测值（NPV）为94%，而EBV-DNA阳性的特异性为100%，阳性预测值为100%。摄取增加和/或EBV-DNA阳性的存在敏感性为100%，NPV为100%。
SPECT与EBV-DNA联合检测对艾滋病相关PCNSL具有很高的诊断准确性。由于高活性病变且EBV-DNA阳性的患者患PCNSL的可能性极高，可避免脑活检，患者可立即接受放疗或多模式治疗。相反，对于病变活性低且EBV-DNA阴性的患者，建议进行经验性抗弓形虫治疗。对于SPECT/PCR结果不一致的患者，脑活检似乎是可取的。
