Thallium-201 brain SPECT of lymphoma in AIDS patients: Pitfalls and technique optimization

Larry S. Kessler, Armando Ruiz, M. Judith Donovan Post, William I. Ganz, Alfred H. Brandon, Joseph N. Foss

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

PURPOSE: Our aim was to examine the 201T1-SPECT scans in AIDS patients with focal CNS lesions to identify those studies with a false- positive or false-negative result to determine any potential pitfalls in interpretation as well as to suggest methods for technique optimization. METHODS: We retrospectively reviewed the charts of 162 AIDS patients with cerebral mass lesions on 201T1-SPECT studies. One hundred sixty-one patients had CT examinations, of which 50 also had MR studies. One patient had MR imaging without CT. Those patients in whom the diagnosis by 201T1- SPECT did not correspond with the known pathologic or clinically proved diagnosis were then singled out and their CT, MR, and 201T1-SPECT studies were reviewed, including blinded interpretation of the 201T1-SPECT scans alone and alongside the corresponding CT and MR examinations. Studies were examined for lesion morphology, size, location, enhancement pattern, and presence of necrosis. The review of the 201T1-SPECT studies included both a qualitative approach (subjective analysis of the scans for areas of abnormally increased uptake) and a quantitative approach (comparison of lesion activity versus activity within a reference standard, such as the scalp). RESULTS: Sensitivity and specificity of 201T1-SPECT in depicting lymphoma were 100% and 93%, respectively, based on the initial qualitative analysis. Fifty-one patients had positive 201T1-SPECT results, of whom 43 were determined to have lymphoma (four by biopsy/autopsy, 39 by clinical and radiologic findings). Upon reevaluation with both a quantitative and qualitative approach, those studies initially interpreted as positive in patients without lymphoma (false positives) were found to be negative. CONCLUSION: Brain 201T1-SPECT is an effective study in the diagnosis of CNS lymphoma in AIDS patients. Specificity can be increased by routinely performing a quantitative analysis of all lesions.

Original languageEnglish (US)
Pages (from-to)1105-1109
Number of pages5
JournalAmerican Journal of Neuroradiology
Volume19
Issue number6
StatePublished - Jun 1 1998

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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    Kessler, L. S., Ruiz, A., Post, M. J. D., Ganz, W. I., Brandon, A. H., & Foss, J. N. (1998). Thallium-201 brain SPECT of lymphoma in AIDS patients: Pitfalls and technique optimization. American Journal of Neuroradiology, 19(6), 1105-1109.