Usefulness of stereotactic biopsy and neuroimaging in management of HIV-1 Clade C associated focal brain lesions with special focus on cerebral toxoplasmosis.
Usefulness of stereotactic biopsy and neuroimaging in management of HIV-1 Clade C associated focal brain lesions with special focus on cerebral toxoplasmosis.
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DOI：
10.1016/j.clineuro.2012.10.012
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发表时间：
2013-07
影响因子：
1.9
通讯作者：
Shankar SK
中科院分区：
文献类型：
--
作者：
Shyam babu C;Satishchandra P;Mahadevan A;Pillai Shibu V;Ravishankar S;Sidappa N;Udaykumar R;Ravi V;Shankar SK
HIV/AIDS的局灶性脑部病变(FBL)经常造成诊断难题，因为其病因从感染性(结核球、弓形虫病和结核脓肿)到淋巴瘤等肿瘤性病变。为了确定病原学，先进的神经成像技术、血清学和分子生物学测试已经演变为具有不同的敏感性/特异性。病变的立体定向活检(STB)是为对适当治疗无反应的病变保留的。在这项研究中，神经影像[头颅CT(n=25)，MRI(n=24)，Th 201/99TcSPECT(n=18)]的诊断效率与STB(n=21)或尸检(n=4)获得的组织病理诊断结果进行了比较，在18个月的研究期间(2006-2007年)，特别参考脑弓形虫病，神经影像证实了HIV-1 C亚型血清阳性个体。脑弓形虫病是FBL最常见的病因(21/25，84%)，其次是结核球、进行性多灶性白质脑病(PML)、原发性中枢神经系统淋巴瘤(PCNSL)和麻疹包涵体脑炎(MIBE)，最后两例均经尸检确诊。在21例脑弓形体病患者中，14/21(66.6%)获得了明确的诊断并经组织病理学证实，间接证据提示7例可能患有弓形虫病，所有患者均对抗弓形虫治疗有反应。CT和MRI具有类似的特异性(75%)，而MRI在发现多个病变方面的敏感性略高(85%对80.9%)。CT和MRI的阳性预测值相同(94.4%)，提示在资源有限的情况下，CT可能是一种评估FBL的经济有效的筛查工具。99TcSPECT诊断炎性病变的敏感性为75%，但不能鉴别PCNSL和弓形虫病。这项来自印度的研究是第一次分析FBL，特别关注HIV-1 C亚型背景下的脑弓形体病。
Focal brain lesions (FBL) in HIV/AIDS frequently pose a diagnostic dilemma as the etiology varies from infective (tuberculoma, toxoplasmosis and tuberculous abscesses) to neoplastic lesions like lymphoma. For determining etiology, advanced neuroimaging techniques, serological and molecular biological tests have been evolved with varying sensitivities/specificities. Stereotactic biopsy (STB) of the lesions is reserved for lesions unresponsive to appropriate therapy. In this study, the diagnostic yield of neuroimaging [Cranial CT (n=25), MRI (n=24), and Th 201/99 Tc SPECT scan (n=18)] is compared with histopathological diagnosis obtained by STB (n=21) or autopsy (n=4) in 25 HIV-1 subtype C seropositive individuals with FBL identified by neuroimaging with special reference to cerebral toxoplasmosis in an eighteen month study period (2006–2007). Cerebral toxoplasmosis was the most frequent cause of FBL (21/25, 84%), followed by one case each of tuberculoma, progressive multifocal leukoencephalopathy (PML), primary central nervous system lymphoma (PCNSL) and measles inclusion body encephalitis (MIBE), the last two diagnosed at autopsy. Of the 21 cases of cerebral toxoplasmosis, definitive diagnosis with histopathological confirmation was available in 14/21 (66.6%), with indirect evidence suggesting probable toxoplasmosis in seven, all of whom responded to antitoxoplasma therapy. CT and MRI had comparable specificities (75%), while MRI had marginally higher sensitivity (85% versus 80.9%) in detecting multiple lesions. The positive predictive value of both CT and MRI were identical (94.4%), suggesting that CT maybe a cost effective screening tool in resource restricted settings, for evaluating FBL. Sensitivity of 99Tc SPECT scan for diagnosing inflammatory lesions was 75% but failed to differentiate PCNSL from toxoplasmosis. This study is the first of its kind from India analysing FBL with specific focus on cerebral toxoplasmosis in the setting of HIV-1 subtype C.
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影响因子：
4.8
作者：
CHAPPELL, ET;GUTHRIE, BL;ORENSTEIN, J
通讯作者：
ORENSTEIN, J
影响因子：
1.7
作者：
Katrak, S. M.;Mahadevan, A.;Shankar, S. K.
通讯作者：
Shankar, S. K.
影响因子：
4.4
作者：
Kumar, G. G. Sharath;Mahadevan, A.;Guruprasad, A. S.;Kovoor, Jerry M. E.;Satishchandra, P.;Nath, Avindra;Ranga, Udaykumar;Shankar, S. K.
通讯作者：
Shankar, S. K.
影响因子：
39.2
作者：
BERGER, JR;KASZOVITZ, B;DICKINSON, G
通讯作者：
DICKINSON, G
影响因子：
9.4
作者：
Siddappa, NB;Dash, PK;Ranga, U
通讯作者：
Ranga, U