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Thirty-one patients were included, 13 with PCNSL and 18 with nontumor disorders. In 11 PCNSL patients, EBV-DNA was positive. Thallium-201 uptake ranged from 1.90 to 4.07 in PCNSL cases (mean, 1.77; 95% confidence interval [C], 2.35 to 3.19) and from 0.91 to 3.38 in nontumor patients (mean 1.62;95% CI, 1.30 to 1.94). Using a lesion/background ratio of 1.95 as cutoff, a negative SPECT was found in one PCNSL case and 16 nonneoplastic cases. A cryptococcoma and a tuberculoma showed highly increased 201 Tl uptake. Epstein-Barr virus DNA was never detected in nonneoplastic cases. For PCNSL diagnosis, hyperactive lesions showed 92% sensitivity and 94% negative predictive value (NPV) whereas positive EBV-DNA had 100% specificity and 100% positive predictive value. The presence of increased uptake and/or positive EBV-DNA had 100% sensitivity and 100% NPV. Combined SPECT and EBV- DNA showed a very high diagnostic accuracy for AIDS-related PCNSL. Because PCNSL likelihood is extremely high in patients with hyperactive lesions and positive EBV-DNA, brain biopsy could be avoided and patients could promptly undergo radiotherapy or multimodal therapy. On the contrary, in patients showing hypoactive lesions with negative EBV-DNA, empiric anti-toxoplasma therapy is indicated. In patients with discordant SPECT/PCR results, brain biopsy seems to be advisable. |
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acquired immunodeficiency syndrome
brain biopsy
cerebrospinal fluid
cerebrospinal fluid,abnormal
Epstein-Barr virus
human immunodeficiency virus type 1
lymphoma
lymphoma involving CNS
lymphoma,primary of CNS
neurologic disease,diagnoses of
polymerase chain reaction
polymerase chain reaction,false negative
single photon emission computed tomography
single photon emission computed tomography,false negative
single photon emission computed tomography,false positive
single photon emission computed tomography,thallium
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