Pierce M A, Johnson M D, Maciunas R J, Murray M J, Allen G S, Harbison M A, Creasy J L, Kessler R M
Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Ann Intern Med. 1995 Oct 15;123(8):594-8. doi: 10.7326/0003-4819-123-8-199510150-00005.
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.
Prospective, nonrandomized, criterion-standard clinical study.
An academic center in the mid-southeastern United States.
20 patients with AIDS and contrast-enhancing brain lesions.
Positron emission tomographic scanning and Toxoplasma serologic testing.
Diagnoses were confirmed by clinical response, autopsy, or brain biopsy.
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 hypometabolic lesions consistent with a nonlymphoma diagnosis. The six patients with lymphoma all had hypermetabolic 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.
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.
确定一种用于评估获得性免疫缺陷综合征（AIDS）患者脑内强化病变的非侵入性方法能否准确区分淋巴瘤诊断与非淋巴瘤诊断。该方法基于弓形虫血清学检测和正电子发射断层扫描。
前瞻性、非随机、标准对照临床研究。
美国东南部中部的一个学术中心。
20例患有脑内强化病变的AIDS患者。
正电子发射断层扫描和弓形虫血清学检测。
通过临床反应、尸检或脑活检确诊诊断。
8例患者确诊为弓形虫病，6例为淋巴瘤，4例为其他诊断，2例无法评估。8例弓形虫病患者中有7例进行了正电子发射断层扫描；所有这些扫描均显示代谢减低病变，符合非淋巴瘤诊断。6例淋巴瘤患者在正电子发射断层扫描上均有代谢增高病变。这两组结果之间的差异具有统计学意义（P < 0.001，Fisher确切概率检验，双侧）。所有经血清学检测确诊为弓形虫病的患者以及6例淋巴瘤患者中的3例，其抗弓形虫滴度大于或等于1:4。
利用弓形虫血清学检测和正电子发射断层扫描评估AIDS患者脑内强化病变可准确指导治疗，并避免对这些患者进行大多数脑活检。需要进行一项更大规模的全国性多中心研究来证实我们的发现，并确定早期诊断和治疗对AIDS和原发性中枢神经系统淋巴瘤患者发病率和死亡率的影响。
