Differentiation of Toxoplasmosis and Lymphoma in AIDS Patients by Using Apparent Diffusion Coefficients

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2003 Apr 16

PMID 12695194

Citations 23

Authors

Daniel L A Camacho

J Keith Smith

Mauricio Castillo

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Distinguishing between toxoplasmosis and lymphoma brain lesions in AIDS patients is difficult but clinically relevant. This study was performed to test the hypothesis that diffusion-weighted (DW) imaging with apparent diffusion coefficient (ADC) maps can be used to distinguish these two lesions.

Methods: The ADC values were calculated in regions of interest placed in 13 brain toxoplasmosis lesions and eight brain lymphoma lesions in patients with AIDS. These values were compared with those of normal white matter. ADC ratios in lymphoma lesions then were compared with those in toxoplasmosis lesions by using a two-sample two-tailed t test.

Results: Toxoplasmosis lesions demonstrated significantly greater diffusion than that of lymphoma lesions (P =.004). ADC ratios were 1.63 +/- 0.41 (mean +/- standard deviation) in the 13 toxoplasmosis lesions and 1.14 +/- 0.25 in the eight lymphoma lesions. While considerable overlap was present for ADC ratios between 1.0 and 1.6, ADC ratios greater than 1.6 were associated solely with toxoplasmosis, accounting for seven of 13 toxoplasmosis lesions.

Conclusion: ADC values are helpful in differentiating toxoplasmosis from lymphoma in patients with AIDS.

Citing Articles

Imaging of Central Nervous System Involvement in Pediatric Hematologic Disorders.

Kalin S, Koral K Turk Arch Pediatr. 2022; 57(3):267-281.

PMID: 35781229 PMC: 9131816. DOI: 10.5152/TurkArchPediatr.2022.22085.

Advanced Magnetic Resonance Imaging in Pediatric Glioblastomas.

Goncalves F, Viaene A, Vossough A Front Neurol. 2021; 12:733323.

PMID: 34858308 PMC: 8631300. DOI: 10.3389/fneur.2021.733323.

MRI imaging features of HIV-related central nervous system diseases: diagnosis by pattern recognition in daily practice.

Sakai M, Higashi M, Fujiwara T, Uehira T, Shirasaka T, Nakanishi K Jpn J Radiol. 2021; 39(11):1023-1038.

PMID: 34125369 PMC: 8202053. DOI: 10.1007/s11604-021-01150-4.

A comparative study of multimodal magnetic resonance in the differential diagnosis of acquired immune deficiency syndrome related primary central nervous system lymphoma and infection.

Li J, Xue M, Yan S, Guan C, Xie R, Chen B BMC Infect Dis. 2021; 21(1):165.

PMID: 33568094 PMC: 7874668. DOI: 10.1186/s12879-021-05779-4.

Primary central nervous system lymphoma presenting as multiple space-occupying lesions in advanced human immunodeficiency virus infection.

Zafar S, Javed M, Rockwood N, Kazmi F SA J Radiol. 2019; 21(2):1234.

PMID: 31754481 PMC: 6837767. DOI: 10.4102/sajr.v21i2.1234.

References

Okamoto K, Ito J, Ishikawa K, Sakai K, Tokiguchi S . Diffusion-weighted echo-planar MR imaging in differential diagnosis of brain tumors and tumor-like conditions. Eur Radiol. 2000; 10(8):1342-50. DOI: 10.1007/s003309900310. View

Heald A, Hoffman J, Bartlett J, Waskin H . Differentiation of central nervous system lesions in AIDS patients using positron emission tomography (PET). Int J STD AIDS. 1996; 7(5):337-46. DOI: 10.1258/0956462961918239. View

Krabbe K, Gideon P, Wagn P, Hansen U, Thomsen C, Madsen F . MR diffusion imaging of human intracranial tumours. Neuroradiology. 1997; 39(7):483-9. DOI: 10.1007/s002340050450. View

Noguchi K, Watanabe N, Nagayoshi T, Kanazawa T, Toyoshima S, Shimizu M . Role of diffusion-weighted echo-planar MRI in distinguishing between brain brain abscess and tumour: a preliminary report. Neuroradiology. 1999; 41(3):171-4. DOI: 10.1007/s002340050726. View

Mamidi A, DeSimone J, Pomerantz R . Central nervous system infections in individuals with HIV-1 infection. J Neurovirol. 2002; 8(3):158-67. DOI: 10.1080/13550280290049723. View

Ruiz A, Ganz W, Post M, Camp A, Landy H, Mallin W . Use of thallium-201 brain SPECT to differentiate cerebral lymphoma from toxoplasma encephalitis in AIDS patients. AJNR Am J Neuroradiol. 1994; 15(10):1885-94. PMC: 8334279. View

Hollinger P, Zurcher R, Schroth G, Mattle H . Diffusion magnetic resonance imaging findings in cerebritis and brain abscesses in a patient with septic encephalopathy. J Neurol. 2000; 247(3):232-4. DOI: 10.1007/s004150050573. View

Sinha S, Bastin M, Whittle I, Wardlaw J . Diffusion tensor MR imaging of high-grade cerebral gliomas. AJNR Am J Neuroradiol. 2002; 23(4):520-7. PMC: 7975109. View

Tung G, Evangelista P, Rogg J, Duncan 3rd J . Diffusion-weighted MR imaging of rim-enhancing brain masses: is markedly decreased water diffusion specific for brain abscess?. AJR Am J Roentgenol. 2001; 177(3):709-12. DOI: 10.2214/ajr.177.3.1770709. View

10.

Chinn R, Wilkinson I, Hall-Craggs M, Paley M, Miller R, Kendall B . Toxoplasmosis and primary central nervous system lymphoma in HIV infection: diagnosis with MR spectroscopy. Radiology. 1995; 197(3):649-54. DOI: 10.1148/radiology.197.3.7480733. View

11.

Skiest D, Erdman W, Chang W, Oz O, Ware A, Fleckenstein J . SPECT thallium-201 combined with Toxoplasma serology for the presumptive diagnosis of focal central nervous system mass lesions in patients with AIDS. J Infect. 2000; 40(3):274-81. DOI: 10.1053/jinf.2000.0664. View

12.

Dina T . Primary central nervous system lymphoma versus toxoplasmosis in AIDS. Radiology. 1991; 179(3):823-8. DOI: 10.1148/radiology.179.3.2027999. View

13.

Chang L, Ernst T . MR spectroscopy and diffusion-weighted MR imaging in focal brain lesions in AIDS. Neuroimaging Clin N Am. 1997; 7(3):409-26. View

14.

Chang L, Miller B, McBride D, Cornford M, Oropilla G, Buchthal S . Brain lesions in patients with AIDS: H-1 MR spectroscopy. Radiology. 1995; 197(2):525-31. DOI: 10.1148/radiology.197.2.7480706. View

15.

Ramsey R, Gean A . Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin N Am. 1997; 7(2):171-86. View

16.

Guo A, Provenzale J, Cruz Jr L, Petrella J . Cerebral abscesses: investigation using apparent diffusion coefficient maps. Neuroradiology. 2001; 43(5):370-4. DOI: 10.1007/s002340000519. View

17.

Ernst T, Chang L, Witt M, Aronow H, Cornford M, Walot I . Cerebral toxoplasmosis and lymphoma in AIDS: perfusion MR imaging experience in 13 patients. Radiology. 1998; 208(3):663-9. DOI: 10.1148/radiology.208.3.9722843. View

18.

Burdette J, Elster A, Ricci P . Calculation of apparent diffusion coefficients (ADCs) in brain using two-point and six-point methods. J Comput Assist Tomogr. 1998; 22(5):792-4. DOI: 10.1097/00004728-199809000-00023. View

19.

de la Pena R, Ketonen L, Villanueva-Meyer J . Imaging of brain tumors in AIDS patients by means of dual-isotope thallium-201 and technetium-99m sestamibi single-photon emission tomography. Eur J Nucl Med. 1998; 25(10):1404-11. DOI: 10.1007/s002590050315. View

20.

PIERCE M, Johnson M, Maciunas R, Murray M, Allen G, Harbison M . Evaluating contrast-enhancing brain lesions in patients with AIDS by using positron emission tomography. Ann Intern Med. 1995; 123(8):594-8. DOI: 10.7326/0003-4819-123-8-199510150-00005. View