Hongsakul Keerati, Laothamatas Jiraporn
Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2008 Jun;91(6):895-907.
To determine the underlying cause of the brain lesions in adult HIV patients referred for CT scan at Ramathibodi Hospital and to evaluate accuracy of CT for the diagnosis of the brain lesion.
Data from first CT scan of the brain of 195 adult HIV patients at Ramathibodi Hospital were reviewed The final diagnoses from medical records were assessed followed by CSF analysis, pathological report, and therapeutic treatment. The accuracy of the CT brain was evaluated using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
One hundred ninety five adult seropositive patients for HIV underwent CT scan of the brain, 59% were HIV encephalopathy (HIVE), 22% toxoplasmosis, 9% cryptococcoma, 5% tuberculous meningitis, 4% tuberculoma, 3% progressive multifocal leukoencephalopathy (PML), 2% lymphoma, and 1% normal. In non-specified causes (from CT scan), 33% were meningitis, 4% cerebritis, and 5% infarction. CT was found to have high sensitivity, specificity, PPV, and NPV for toxoplasmosis (92%, 96%, 86%, and 98%, respectively).
HIV encephalopathy was the most common finding of adult HIV brains. Toxoplasmosis was the most common opportunistic parenchymal brain lesion in adult HIV brains. CT was the modality of choice for diagnosis and exclusion of toxoplasmosis, but it cannot determine the cause of disease showing meningitis pattern.
确定转诊至拉玛蒂博迪医院进行CT扫描的成年HIV患者脑病变的潜在病因，并评估CT对脑病变诊断的准确性。
回顾了拉玛蒂博迪医院195例成年HIV患者首次脑部CT扫描的数据。根据病历评估最终诊断结果，随后进行脑脊液分析、病理报告和治疗。使用敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）评估脑部CT的准确性。
195例成年HIV血清阳性患者接受了脑部CT扫描，其中59%为HIV脑病（HIVE），22%为弓形虫病，9%为隐球菌瘤，5%为结核性脑膜炎，4%为结核瘤，3%为进行性多灶性白质脑病（PML），2%为淋巴瘤，1%正常。在未明确病因（根据CT扫描）中，33%为脑膜炎，4%为脑炎，5%为梗死。发现CT对弓形虫病具有高敏感性、特异性、PPV和NPV（分别为92%、96%、86%和98%）。
HIV脑病是成年HIV患者脑部最常见的表现。弓形虫病是成年HIV患者脑部最常见的机会性实质性脑病变。CT是诊断和排除弓形虫病的首选方式，但它无法确定表现为脑膜炎模式的疾病病因。
