A comparison of imaging, clinical, and pathologic aspects of space-occupying lesions within the brain in patients with acquired immune deficiency syndrome.

Important note: Information in this article was accurate in 1988. The state of the art may have changed since the publication date.

A comparison of imaging, clinical, and pathologic aspects of space-occupying lesions within the brain in patients with acquired immune deficiency syndrome.

Am J Physiol Imaging. 1986;1(3):134-41. Unique Identifier : AIDSLINE MED/88240741
Gill PS; Graham RA; Boswell W; Meyer P; Krailo M; Levine AM; Department of Medicine, University of Southern California School; of Medicine, Los Angeles 90033.

Abstract: Patients with acquired immune deficiency syndrome (AIDS) often have central nervous system mass lesions. Since clinical signs, symptoms, and results of imaging techniques are generally nonspecific, brain biopsy has been considered to be the optimal method for establishing a definitive diagnosis. In an effort to define better the imaging characteristics of such lesions, we retrospectively analyzed 24 patients with AIDS who had intracerebral space-occupying lesions, with subsequent definitive histologic diagnosis and/or a diagnostic response to empiric therapy for toxoplasmosis. We employed computerized tomography (CT), double-dose-delay CT (DDD-CT), and nuclear magnetic resonance imaging (NMRI) of the brain. Sixteen patients had toxoplasmosis, seven had high-grade non-Hodgkins lymphoma, and one had progressive multifocal leukoencephalopathy that was due to herpes simplex virus II (HPML). Toxoplasmosis generally occurred as multiple, small (2 cm or smaller), hypodense or isodense lesions with variable enhancement. Malignant lymphomas appeared as single lesions, always larger than 3 cm, which were isodense or hyperdense, with internal enhancement. The combined radiologic criteria of size, multiplicity, and pre- and postcontrast appearance were useful in differentiating these two pathologic processes. The best single discriminant of toxoplasmosis versus lymphoma was the average lesion size of less than 3 cm. In our experience, diagnostic brain biopsy may be averted when lesions typical of toxoplasmosis are seen. DDD-CT and NMRI may be useful in identifying lesions that are not seen optimally on routine CT.

Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS Adult Brain Diseases/*DIAGNOSIS/ETIOLOGY/RADIOGRAPHY Comparative Study Female Herpes Simplex/DIAGNOSIS/ETIOLOGY/RADIOGRAPHY Human Leukoencephalopathy, Progressive Multifocal/DIAGNOSIS/ETIOLOGY/ RADIOGRAPHY Lymphoma, Non-Hodgkin's/DIAGNOSIS/ETIOLOGY/RADIOGRAPHY Magnetic Resonance Imaging Male Middle Age Tomography, X-Ray Computed Toxoplasmosis/DIAGNOSIS/ETIOLOGY/RADIOGRAPHY JOURNAL ARTICLE

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