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DOI: 10.1055/s-0038-1629548
Cerebral Blood Flow in AIDS- Related Neurotoxoplasmosis: A Preliminary 99mTc-HMPAO SPECT Study
Zerebraler Blutfluss bei AIDSRelated Neurotoxoplasmose: Ein vorläufiges 99mTc-HMPAO SPECT-StudiePublication History
Received:
11 June 1990
in revised form:
12 October 1990
Publication Date:
04 February 2018 (online)
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.
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