Cryptococcal neuroradiological lesions correlate with severity during cryptococcal meningoencephalitis in HIV-positive patients in the HAART era.
Cryptococcal neuroradiological lesions correlate with severity during cryptococcal meningoencephalitis in HIV-positive patients in the HAART era.
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DOI：
10.1371/journal.pone.0001950
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发表时间：
2008-04-16
期刊：
影响因子：
3.7
通讯作者：
French Cryptococcosis Study Group
中科院分区：
文献类型：
--
作者：
Charlier C;Dromer F;Lévêque C;Chartier L;Cordoliani YS;Fontanet A;Launay O;Lortholary O;French Cryptococcosis Study Group
隐球菌脑膜脑炎在艾滋病患者中的总体全球死亡率为20%，尽管使用了抗真菌药物。需要有更多的手段来精确评估疾病的严重程度。因此，我们研究了62例HIV阳性的隐球菌性脑膜脑炎患者的放射学脑影像，分析与隐球菌病相关的脑病变与疾病严重程度的关系，以及磁共振（MR）与计算机断层扫描（CT）各自的诊断贡献。在这项回顾性多中心分析中，两名神经放射科医生对脑成像进行了盲态审查。在基线和随访期间，可获得Proximal获得的临床和真菌学数据。92%的MR扫描基线图像异常，而53%的CT扫描基线图像异常。隐球菌病的MR/CT表现为肿块（21%/9%）、血管周围间隙（46%/5%）和假性囊肿（8%/4%）。与不存在隐球菌病相关病变相比，隐球菌病相关病变的存在与高血清（78% vs. 42%，p = 0.008）和CSF（81% vs. 50%，p = 0.024）抗原滴度显著相关，与神经系统异常无关。 对于17名接受过两种检查的患者，MR检测到的隐球菌相关病变明显多于CT（76%比24%，p = 0.005）。 总之，MR比CT更有效地评价艾滋病相关的脑隐球菌病。此外，脑部成像是评估这种情况下初始疾病严重程度的有效工具。鉴于此，我们建议，调查隐球菌病相关的病变是值得的，即使在没有神经系统异常，如果一个高的真菌负荷的基础上怀疑高血清和/或CSF抗原滴度。
Cryptococcal meningoencephalitis has an overall global mortality rate of 20% in AIDS patients despite antifungals. There is a need for additional means of precise assessment of disease severity. We thus studied the radiological brain images available from 62 HIV-positive patients with cryptococcocal meningoencephalitis to analyse the brain lesions associated with cryptococcosis in relationship with disease severity, and the respective diagnostic contribution of magnetic resonance (MR) versus computed tomography (CT). In this retrospective multicenter analysis, two neuroradiologists blindly reviewed the brain imaging. Prospectively acquired clinical and mycological data were available at baseline and during follow-up. Baseline images were abnormal on 92% of the MR scans contrasting with 53% of the CT scans. MR/CT cryptococcosis-related lesions included mass(es) (21%/9%), dilated perivascular spaces (46%/5%) and pseudocysts (8%/4%). The presence compared to absence of cryptococcosis-related lesions was significantly associated with high serum (78% vs. 42%, p = 0.008) and CSF (81% vs. 50%, p = 0.024) antigen titers, independently of neurological abnormalities. MR detected significantly more cryptococcosis-related lesions than CT for 17 patients who had had both investigations (76% vs. 24%, p = 0.005). In conclusion, MR appears more effective than CT for the evaluation of AIDS-associated cerebral cryptococcosis. Furthermore, brain imaging is an effective tool to assess the initial disease severity in this setting. Given this, we suggest that investigation for cryptococcosis-related lesions is merited, even in the absence of neurological abnormality, if a high fungal burden is suspected on the basis of high serum and/or CSF antigen titers.
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