Hussain Fadilah S, Hussain Namath S
Radiology, Wayne State University School of Medicine.
Department of Neurosurgery, Penn State Hershey Medical Center.
Cureus. 2016 May 10;8(5):e606. doi: 10.7759/cureus.606.
To determine the diagnostic efficiency of thallium-201 single photon emission computed tomography (SPECT) and Epstein-Barr virus (EBV) polymerase chain reaction (PCR) in the differentiation of primary central nervous system lymphoma (PCNSL) from other central nervous system processes in patients with HIV/AIDS.
DESIGN/METHODS: Over 10 years, 68 thallium-201 SPECT scans were performed on neurologically symptomatic HIV+ patients with focal lesions on CT or MRI at the Johns Hopkins Hospital. Diagnoses were then established by either autopsy, biopsy, or clinical response to anti-toxoplasmosis therapy. Patients were categorized prior to a prospective clinical reading of the SPECT scans by nuclear medicine physicians.
In our patient sample overall, the diagnostic efficiency of thallium-201 SPECT was 79%. The diagnostic accuracy of EBV PCR testing alone in a subset of 22 patients in our study that had CSF analyzed was 73%. However, when both positive EBV PCR and positive thallium-201 SPECT results were used together, the diagnostic accuracy improved to 100% based on a sample of 13 patients where EBV PCR and SPECT imaging results were concordant.
Thallium-201 SPECT has a relatively high positive predictive value with regards to the diagnosis of PCNSL, which suggests that patients with positive results could undergo empiric radiation treatment without resorting to brain biopsy. However, the predictive value can be increased by testing for CSF EBV using PCR. Alternatively, if CSF cannot be safely obtained because of mass effect, we believe that these data still suggest that empiric radiation treatment should be considered when discussing treatment options with patients with a positive thallium-201 SPECT.
确定201铊单光子发射计算机断层扫描（SPECT）和爱泼斯坦-巴尔病毒（EBV）聚合酶链反应（PCR）在鉴别HIV/AIDS患者的原发性中枢神经系统淋巴瘤（PCNSL）与其他中枢神经系统病变中的诊断效率。
设计/方法：在10多年间，约翰霍普金斯医院对68例有神经系统症状、CT或MRI显示局灶性病变的HIV阳性患者进行了201铊SPECT扫描。随后通过尸检、活检或抗弓形虫治疗的临床反应来确立诊断。在核医学医师对SPECT扫描进行前瞻性临床解读之前，对患者进行分类。
在我们的总体患者样本中，201铊SPECT的诊断效率为79%。在我们研究的22例分析了脑脊液的患者亚组中，单独EBV PCR检测的诊断准确性为73%。然而，当EBV PCR阳性和201铊SPECT结果均为阳性时，基于13例EBV PCR和SPECT成像结果一致的患者样本，诊断准确性提高到了100%。
201铊SPECT在PCNSL诊断方面具有相对较高的阳性预测价值，这表明结果阳性的患者可接受经验性放射治疗而无需进行脑活检。然而，通过PCR检测脑脊液EBV可提高预测价值。或者，如果由于占位效应无法安全获取脑脊液，我们认为这些数据仍表明，在与201铊SPECT结果阳性的患者讨论治疗方案时，应考虑经验性放射治疗。
