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Intracranial Mass Lesions: Sequential Thallium and Gallium Scintigraphy in Patients with AIDS¹

¹ From the Departments of Radiology (V.W.L., V.A., S.T.) and Medicine (J.D.F., T.P.C.), Boston University School of Medicine, Boston Medical Center, 818 Harrison Ave, Boston, MA 02118. Received January 30, 1998; revision requested April 7; final revision received August 19; accepted November 6. Address reprint requests to V.W.L.

PURPOSE: To determine the efficacy of sequential thallium and gallium scintigraphy to differentiate intracranial neoplasms (lymphoma and glioma) from other nonmalignant intracranial mass lesions among patients with acquired immunodeficiency syndrome (AIDS).

MATERIALS AND METHODS: The authors reviewed the cases of 40 patients with human immunodeficiency virus (HIV) who underwent thallium and gallium scanning to evaluate intracranial mass lesions from October l991 through November 1997. There was a definitive final diagnosis of the nature of the mass lesions in 21 of these cases. In these 21 cases, the scintigraphic patterns were reviewed and were compared with the final diagnosis.

RESULTS: On the basis of results at thallium and gallium scanning, the patients were divided into three groups. Group A included 13 patients (11 with brain tumors [lymphomas and gliomas] and two with progressive multifocal leukoencephalopathy [PML]) with thallium-positive, gallium-positive scans. Group B included five patients with intracranial infections (tuberculosis, Cryptococcus, bacteria) with thallium-negative, gallium-positive scans. Group C included three patients (one with PML and two with infarcts) with thallium-negative, gallium-negative scans. All patients with lymphomas were in group A. The sensitivity and specificity of the thallium-positive, gallium-positive pattern for intracranial malignancy were 100% and 80%, respectively.

CONCLUSION: Sequential thallium and gallium scanning helped differentiate tumors from nonmalignant intracranial mass lesions and may help differentiate infections from PML or infarcts.

Index terms: Acquired immunodeficiency syndrome (AIDS), 10.2068 • Brain, infarction, 10.4352 • Brain, infection, 10.2054, 10.23, 10.298 • Brain, radionuclide studies, 10.12163, 10.12178 • Brain neoplasms, radionuclide studies, 10.12163, 10.12178 • Fluorine, radioactive, 10.12163 • Gallium, radioactive • Lymphoma, AIDS-related, 10.34 • Thallium, radioactive • Progressive multifocal leukoencephalopathy, 10.8721

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