[Contribution of nuclear medicine to management of pulmonary complications in patients with acquired immune deficiency].
Opportunistic lung infections and malignancies are life-threatening complications in HIV-positive patients. In 72 HIV-positive patients the role of different non-invasive tests such as lung function tests, blood gas analysis, 67 gallium scanning and epithelial lung clearance with 99m Tc-DTPA for the management of these patients was prospectively studied. For all non-invasive tests the mean values of patients with pulmonary complications (n = 25) differed significantly from those of asymptomatic HIV-positive patients (n = 47) (p < 0.001). In 10 patients presenting with acute Pneumocystis carinii pneumonia, 99m Tc-DTPA clearance rates and 67 gallium uptake differed significantly before and after therapy (4.80 +/- 1.23%/min vs 2.47 +/- 0.72%/min and 2.15 +/- 0.42 vs 1.39 +/- 0.18, respectively). Follow-up after therapy revealed different time courses of these tests for normalization. A significant inverse correlation was found between DLCO and 99m Tc-DTPA lung clearance (r = -0.90, p < 0.001, n = 35). A diffuse homogeneous 67 gallium uptake is not diagnostic for PCP, the same pattern was found in a patient with lymphoid interstitial pneumonitis and in patients with CMV pneumonitis; these patients also had accelerated epithelial lung clearance rates. 67 gallium (6/6) was superior to 99m Tc-labelled immunoglobulin G (3/6) for detection of PCP. The 3 patients with Kaposi sarcoma of the lung had negative 67 gallium scans, but positive 201 thallium scans and increased 99m Tc-DTPA clearance rates.(ABSTRACT TRUNCATED AT 250 WORDS)
Institut für Nuklearmedizin, Wilhelminenspital, Wien.
H
H
Köhn
C
C
Armbruster
B
B
König
N
N
Vetter
A
A
Mostbeck
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000328:Adult; D003586:Cytomegalovirus Infections / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011020:Pneumonia, Pneumocystis / Q000000981:diagnostic imaging / Q000503:physiopathology; D011024:Pneumonia, Viral / Q000000981:diagnostic imaging / Q000503:physiopathology; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D011877:Radionuclide Imaging; D012514:Sarcoma, Kaposi / Q000000981:diagnostic imaging / Q000503:physiopathology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000503:physiopathology; D014692:Ventilation-Perfusion Ratio / Q000502:physiology
D010100:Oxygen