Cerebral Blood Flow in AIDS- Related Neurotoxoplasmosis: A Preliminary 99mTc-HMPAO SPECT Study

F. Pigorini; C. L. Maini; F. M. Pau; S. Galgani; V. Volpini; C. Leonetti; P. Narciso; M. A. Rosci

doi:10.1055/s-0038-1629548

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 1991; 30(01): 13-17
DOI: 10.1055/s-0038-1629548

ÜBersichtsartikel - Review Articles

Schattauer GmbH

Cerebral Blood Flow in AIDS- Related Neurotoxoplasmosis: A Preliminary ^99mTc-HMPAO SPECT Study

Zerebraler Blutfluss bei AIDSRelated Neurotoxoplasmose: Ein vorläufiges ^99mTc-HMPAO SPECT-Studie

F. Pigorini

¹From the Department of Nuclear Medicine, “C. Forlanini” Hospital, Rome, Italy

,

C. L. Maini

²From the Chair of Nuclear Medicine, State University, Ancona, Italy

,

F. M. Pau

¹From the Department of Nuclear Medicine, “C. Forlanini” Hospital, Rome, Italy

,

S. Galgani

³From the Department of Neurology, “S. Camillo” Hospital, Rome, Italy

,

V. Volpini

⁴From the Department of Neuroradiology, “S. Camillo” Hospital, Rome, Italy

,

C. Leonetti

¹From the Department of Nuclear Medicine, “C. Forlanini” Hospital, Rome, Italy

,

P. Narciso

⁵From the Department of Infectious Diseases, “L. Spallanzani” Hospital, Rome, Italy

,

M. A. Rosci

⁵From the Department of Infectious Diseases, “L. Spallanzani” Hospital, Rome, Italy

› Author Affiliations

Abstract

Cerebral blood flow (CBF) was evaluated by gamma camera ^99mTc-HMPAO SPECT in 11 patients with AIDS-related neurotoxoplasmosis and correlated with neurological findings and the results of CT and MRI. Evident CBF abnormalities were observed in all patients with involvement of at least two cerebral lobes. In 10 patients the abnormalities were bilateral and in 8 patients basal ganglia were involved; no specific hypoperfusion pattern was however evident. Focal lesions were found in 7 patients by CT (sensitivity: 63.6%) and in 10 patients by MRI (sensitivity: 90.9%). It may be concluded that neurotoxoplasmosis in AIDS patients is associated with a high prevalence of focal cortical and subcortical hypoperfusion but that the scintigraphic findings are not specific; that HMPAO SPECT may show focal hypoperfusion in patients with normal CT studies and/or non-focal MRI abnormalities; that the hypoperfusion may be more extensive than the corresponding MRI lesion(s) and that it may be present even in areas with normal MRI signals; and that more experience and longitudinal studies are needed to assess the possible impact of HMPAO SPECT on follow-up and therapy monitoring.

Zusammenfassung

Bei elf Patienten mit AIDS-bezogener Neurotoxoplasmose wurde die Hirndurchblutungsverteilung mit der ^99mTc-HMPAO-SPECT (Gammakamera) untersucht. Die Ergebnisse wurden mit neurologisch-klinischen, CT- und MRI-Befunden verglichen. Eindeutige Abweichungen der Hirndurchblutung wurden bei allen Patienten mit Befall mindestens zweier zerebraler Lappengebiete beobachtet. Bei zehn Patienten waren die Veränderungen beidseitig, bei acht Patienten waren die basalen Ganglien betroffen, jedoch fand sich kein spezifisches Niederflußmuster. Im CT zeigten sich fokale Läsionen bei sieben Patienten (Sensitivität 63,6%), im KST bei zehn Patienten (Sensitivität 90,9%). Diese Ergebnisse lassen schließen, daß die Neurotoxoplasmose bei AIDS-Patienten häufig mit fokalen kortikalen oder subkortikalen Perfusionsdefiziten verknüpft ist, wobei die szintigraphischen Befunde jedoch unspezifisch sind; daß die ^99mTc-HMPAO-SPECT fokale Perfusionsdefekte auch bei Patienten mit normalem CT-Befund oder bei nichtfokalen Veränderungen im KST zeigt; daß die Minderperfusion entsprechende KST-Läsionen größenmäßig überschreiten kann und sich auch in KST-normalen Regionen nachweisen läßt; und daß weitere Erfahrungen und Längsschnitt-Untersuchungen notwendig sind, um den möglichen Einfluß der Befunde der ^99mTc-HMPAO-SPECT auf Verlauf und Therapiekontrolle festzustellen.

Full Text

References

REFERENCES
1 Brunetti A, Berg G, DiChiro G. et al. Reversal of brain metabolic abnormalities following treatment of AIDS dementia complex with 3’-azido-2’,3’-dideoxythymi- dine (AZT, Zidovudine): a PET-FDG study. J Nucl Med 1989; 30: 581-90.
2 Costa DC, Ell PJ, Burns A, Philipot M, Levry R. CBF tomograms with 99mTc-HMPAO in patients with dementia (Alzheimer type and HIV) and Parkinson’s disease. Initial results. J Cerebr Blood Flow Metab 1988; 08: S109-15.
3 De La RPaz, Enzmann D. Neuroradiology of acquired immunodeficiency syndrome. In: Rosenblum ML, Levy RM, Bredesen DE. eds. AIDS and the nervous system. New York: Raven Press; 1988: 121-53.
4 Ell PJ, Costa CD, Harrison M. Imaging cerebral damage in HIV infections. Lancet 1987; i: 569-70.
5 Gardner MJ, Altman DG. Statistics with confidence: confidence intervals and statistical guidelines. London: British Medical Journal; 1989
6 Jack jr RR, Reese DF, Scheithauer BW. Radiographic findings in 32 cases of primary CNS lymphoma. Am J Roentgenol 1986; 146: 271-6.
7 LaFrance ND, Pearlson GD, Schaerf FW. et al. 1-123 IMP-SPECT in HIV-related dementia. Adv Funct Neuroim 1988; 01: 9-15.
8 Lee YY, Bruner JM, Van Tassel P, Libshitz HI. Primary central nervous lymphoma: CT and pathological correlation. Am J Roentgenol 1986; 147: 747-52.
9 Levy RM, Pons VG, Rosenblum ML. Central nervous system mass lesions in the acquired immunodeficiency syndrome (AIDS). J Neurosurg 1984; 61: 9-16.
10 Levy RM, Bredesen DE, Rosenblum ML. Neurologic manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg 1985; 62: 475-95.
11 Levy RM, Bredesen DE. Central nervous system dysfunction in acquired immunodeficiency syndrome. In: Rosenblum ML, Levy RM, Bredesen DE. eds. AIDS and the nervous system. New York: Raven Press; 1988: 29-63.
12 Luft BJ, Remington JS. AIDS commentary. Toxoplasmic encephalitis. J Infect Dis 1988; 157: 1-5.
13 Maini CL, Pigorini F, Pau FM. et al. Cortical cerebral blood flow in HIV-1 related dementia complex. Nucl Med Comm 1990; 11: 639-48.
14 Navia BA, Petito CK, Gold JWM. et al. Cerebral toxoplasmosis complicating the acquired immunodeficiency syndrome: clinical and neuropathological findings in 27 patients. Ann Neurol 1986; 19: 224-38.
15 Olesen WL, Cohen W. Neuroradiology of AIDS. In: Federle M, Megibow A, Naidich DP. eds. Radiology of acquired immunodeficiency syndrome. New York: Raven Press; 1988: 21-46.
16 Petito CK, Cho ES, Lemann W, Navia BA, Price RW. Neuropathology of acquired immunodeficiency syndrome (AIDS): an autopsy review. J Neuropathol Exp Neurol 1986; 45: 635-46.
17 Pitchenik AE, Fischl MA, Walls KW. Evaluation of cerebral mass lesions in acquired immunodeficiency syndrome. N Engl J Med 1985; 308: 1099.
18 Pohl P, Vogl G, Fill H. et al. Single photon emission computed tomography in AIDS dementia complex. J Nucl Med 1988; 29: 1382-6.
19 Pons VG, Jacobs RA, Hollander H. Nonviral infections of the central nervous system in patients with acquired immunodeficiency syndrome. In: Rosenblum ML, Levy RM, Bredesen DE. eds. AIDS and the nervous system. New York: Raven Press; 1988: 263-83.
20 Rottenberg DA, Moeller JR, Strother SC. et al. The metabolic pathology of the AIDS dementia complex. Ann Neurol 1987; 22: 700-6.
21 Shih WJ, Domstad PA, DeLand FH. Opportunistic intracranial infection in AIDS. Detection by technetium-99m DTPA brain scintigraphy. J Nucl Med 1986; 27: 498-501.
22 So YT, Beckstead JH, Davis RL. Primary central nervous system lymphoma in acquired immune deficiency syndrome: a clinical and pathological study. Ann Neurol 1986; 20: 566-72.