[The diagnosis of primary cerebral lymphoma in AIDS. The contribution of imaging].
Apart from the very frequent HIV encephalitis, which lays the foundation for opportunistic infections, the most common diseases encountered in HIV-infected patients are toxoplasmosis and lymphoma; the percentage of cases of other diseases is very small. It is capital to diagnose cerebral lymphoma at an early stage in these patients who already are in a precarious general and neurological state since this type of lesion usually occurs late in the natural course of AIDS. In the differential diagnosis between toxoplasmosis and lymphoma only stereotaxic biopsy enables a positive diagnosis to be made, but imaging methods, such as CT and MRI, provide data that help guide to a diagnosis which sometimes may be definitive. Suggestive of lymphoma is a single infiltrating lesion wider than 4 cm, which is paraventricular or located in the posterior fossa, has little perilesional alteration and a short tumoral doubling time during the imaging follow-up. Suggestive of toxoplasmosis are multiple, small, annular or nodular lesions with an important perilesional inflammation and usually located in basal ganglia. In addition, in MRI the kinetics of enhancement after contrast injection is intense and occurs early in lymphoma, in contrast with the toxoplasmic abscesses, and this should provide a more specific differential diagnosis. Scintigraphic studies with somatostatin or positron emission tomography, using fluorodeoxyglucose (FDG-PET scintigraphy), also seem to be an interesting mean of making a specific diagnosis of cerebral lesion, according to a principle that is close to dynamic MRI. In lymphoma, capturing of the tracer is about 3 times greater than in infective lesions, notably the toxoplasmic ones. Imaging, therefore, is provided with tools which permit an increasingly specific approach to the primary cerebral lymphoma of AIDS, the definitive diagnosis of which rests on stereotaxic biopsy. This high specificity facilitates a better selection of patients requiring this procedure and shortens the delay in its execution.
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis; D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D018792:Encephalitis, Viral / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D013238:Stereotaxic Techniques; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis
Diagnostic du lymphome cérébral primitif du SIDA. Apport de l'imagerie.