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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.

View larger version (183K): [in a new window]   Figure 1a. Group A (thallium-positive, gallium-positive scans). Brain images obtained in a 33-year-old man with known history of AIDS who was admitted because of grand mal seizures after a recent history of sinusitis. (a) Initial coronal gadolinium-enhanced, T1-weighted (repetition time msec/echo time msec = 655/16) MR image demonstrates a 4-cm-diameter mass (arrow) in the left occipital pole with a ringlike contrast enhancing pattern and extensive surrounding edema. (b) Thallium scans obtained at 3 hours (left column) and gallium scans obtained at 48 hours (right column) (top row, transaxial; middle row, sagittal; bottom row, coronal). Lesion (arrows) was both thallium and gallium avid. Findings at biopsy confirmed the diagnosis of B cell non-Hodgkin lymphoma.

View larger version (98K): [in a new window]   Figure 1b. Group A (thallium-positive, gallium-positive scans). Brain images obtained in a 33-year-old man with known history of AIDS who was admitted because of grand mal seizures after a recent history of sinusitis. (a) Initial coronal gadolinium-enhanced, T1-weighted (repetition time msec/echo time msec = 655/16) MR image demonstrates a 4-cm-diameter mass (arrow) in the left occipital pole with a ringlike contrast enhancing pattern and extensive surrounding edema. (b) Thallium scans obtained at 3 hours (left column) and gallium scans obtained at 48 hours (right column) (top row, transaxial; middle row, sagittal; bottom row, coronal). Lesion (arrows) was both thallium and gallium avid. Findings at biopsy confirmed the diagnosis of B cell non-Hodgkin lymphoma.

View larger version (146K): [in a new window]   Figure 2a. Group B (thallium-negative, gallium-positive scans). Brain images obtained in a 40-year-old man with known history of AIDS for 3 years. He was admitted because of three episodes of grand mal seizures and 3 days of fever. Meningism was present at admission. (a) Initial coronal T2-weighted (908/90) MR images reveal a mass lesion (arrows) in the medial portion of the right temporal lobe, extending into the temporal horn of the ventricle. (b) Top row: Early thallium scans demonstrate high uptake in the parenchymal lesion (arrowheads) and diffuse increased uptake in the subarachnoid space (arrows), especially in the interhemispheric cistern. Middle row: Thallium scans obtained at 4 hours show only background activity, and the areas of increased uptake are cleared almost completely. Bottom row: Gallium scans show high uptake in the parenchymal lesion (arrowheads), ventricle, and subarachnoid space (arrows). The final diagnosis of Cryptococcus neoformans meningitis, ventriculitis, and encephalitis was established when cerebrospinal fluid showed numerous Cryptococcus organisms. These scans demonstrate the importance of delayed versus early thallium scanning to differentiate tumors from infections. All thallium and gallium scans were obtained in the transaxial plane.

View larger version (92K): [in a new window]   Figure 2b. Group B (thallium-negative, gallium-positive scans). Brain images obtained in a 40-year-old man with known history of AIDS for 3 years. He was admitted because of three episodes of grand mal seizures and 3 days of fever. Meningism was present at admission. (a) Initial coronal T2-weighted (908/90) MR images reveal a mass lesion (arrows) in the medial portion of the right temporal lobe, extending into the temporal horn of the ventricle. (b) Top row: Early thallium scans demonstrate high uptake in the parenchymal lesion (arrowheads) and diffuse increased uptake in the subarachnoid space (arrows), especially in the interhemispheric cistern. Middle row: Thallium scans obtained at 4 hours show only background activity, and the areas of increased uptake are cleared almost completely. Bottom row: Gallium scans show high uptake in the parenchymal lesion (arrowheads), ventricle, and subarachnoid space (arrows). The final diagnosis of Cryptococcus neoformans meningitis, ventriculitis, and encephalitis was established when cerebrospinal fluid showed numerous Cryptococcus organisms. These scans demonstrate the importance of delayed versus early thallium scanning to differentiate tumors from infections. All thallium and gallium scans were obtained in the transaxial plane.

View larger version (147K): [in a new window]   Figure 3a. Group C (thallium-negative, gallium-negative scans). Brain images obtained in a 30-year-old woman with a 2-year history of AIDS. She had lower extremity weakness for 6 months and was admitted because of depression and suicide attempts. (a) Axial T2-weighted (3,000/120) MR images demonstrate multiple mass lesions (arrows) of various sizes. (b) Transaxial thallium scans obtained at 4 hours (left two scans) and gallium scans obtained at 48 hours (right two scans). In each scan, lesion uptake was negative. The diagnosis of PML was made at brain biopsy.

View larger version (50K): [in a new window]   Figure 3b. Group C (thallium-negative, gallium-negative scans). Brain images obtained in a 30-year-old woman with a 2-year history of AIDS. She had lower extremity weakness for 6 months and was admitted because of depression and suicide attempts. (a) Axial T2-weighted (3,000/120) MR images demonstrate multiple mass lesions (arrows) of various sizes. (b) Transaxial thallium scans obtained at 4 hours (left two scans) and gallium scans obtained at 48 hours (right two scans). In each scan, lesion uptake was negative. The diagnosis of PML was made at brain biopsy.