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Usefulness of stereotactic biopsy and neuroimaging in management of HIV-1 Clade C associated focal brain lesions with special focus on cerebral toxoplasmosis.

Abstract

BACKGROUND

Focal brain lesions (FBL) in HIV/AIDS frequently pose a diagnostic dilemma as the etiology varies from infective (tuberculoma, toxoplasmosis and tuberculous abscesses) to neoplastic lesions like lymphoma. For determining etiology, advanced neuroimaging techniques, serological and molecular biological tests have been evolved with varying sensitivities/specificities. Stereotactic biopsy (STB) of the lesions is reserved for lesions unresponsive to appropriate therapy.

OBJECTIVE AND METHODS

In this study, the diagnostic yield of neuroimaging [cranial CT (n=25), MRI (n=24), and Th201/99Tc SPECT scan (n=18)] is compared with histopathological diagnosis obtained by STB (n=21) or autopsy (n=4) in 25 HIV-1 subtype C seropositive individuals with FBL identified by neuroimaging with special reference to cerebral toxoplasmosis in an eighteen month study period (2006-2007).

RESULTS AND CONCLUSION

Cerebral toxoplasmosis was the most frequent cause of FBL (21/25, 84%), followed by one case each of tuberculoma, progressive multifocal leukoencephalopathy (PML), primary central nervous system lymphoma (PCNSL) and measles inclusion body encephalitis (MIBE), the last two diagnosed at autopsy. Of the 21 cases of cerebral toxoplasmosis, definitive diagnosis with histopathological confirmation was available in 14/21 (66.6%), with indirect evidence suggesting probable toxoplasmosis in seven, all of whom responded to antitoxoplasma therapy. CT and MRI had comparable specificities (75%), while MRI had marginally higher sensitivity (85% versus 80.9%) in detecting multiple lesions. The positive predictive value of both CT and MRI was identical (94.4%), suggesting that CT maybe a cost effective screening tool in resource restricted settings, for evaluating FBL. Sensitivity of 99Tc SPECT scan for diagnosing inflammatory lesions was 75% but failed to differentiate PCNSL from toxoplasmosis. This study is the first of its kind from India analyzing FBL with specific focus on cerebral toxoplasmosis in the setting of HIV-1 subtype C.

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  • Authors+Show Affiliations

    ,

    Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.

    , , , , , , ,

    Source

    Clinical neurology and neurosurgery 115:7 2013 Jul pg 995-1002

    MeSH

    AIDS-Related Opportunistic Infections
    Adolescent
    Adult
    Autopsy
    Biopsy
    Brain
    CD4 Lymphocyte Count
    Encephalitis
    Female
    HIV Infections
    HIV-1
    Humans
    India
    Magnetic Resonance Imaging
    Male
    Middle Aged
    Neuroimaging
    Stereotaxic Techniques
    Tomography, Emission-Computed, Single-Photon
    Tomography, X-Ray Computed
    Toxoplasma
    Toxoplasmosis, Cerebral
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23153789

    Citation

    Shyam babu, C, et al. "Usefulness of Stereotactic Biopsy and Neuroimaging in Management of HIV-1 Clade C Associated Focal Brain Lesions With Special Focus On Cerebral Toxoplasmosis." Clinical Neurology and Neurosurgery, vol. 115, no. 7, 2013, pp. 995-1002.
    Shyam babu C, Satishchandra P, Mahadevan A, et al. Usefulness of stereotactic biopsy and neuroimaging in management of HIV-1 Clade C associated focal brain lesions with special focus on cerebral toxoplasmosis. Clin Neurol Neurosurg. 2013;115(7):995-1002.
    Shyam babu, C., Satishchandra, P., Mahadevan, A., Pillai Shibu, V., Ravishankar, S., Sidappa, N., ... Shankar, S. K. (2013). Usefulness of stereotactic biopsy and neuroimaging in management of HIV-1 Clade C associated focal brain lesions with special focus on cerebral toxoplasmosis. Clinical Neurology and Neurosurgery, 115(7), pp. 995-1002. doi:10.1016/j.clineuro.2012.10.012.
    Shyam babu C, et al. Usefulness of Stereotactic Biopsy and Neuroimaging in Management of HIV-1 Clade C Associated Focal Brain Lesions With Special Focus On Cerebral Toxoplasmosis. Clin Neurol Neurosurg. 2013;115(7):995-1002. PubMed PMID: 23153789.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Usefulness of stereotactic biopsy and neuroimaging in management of HIV-1 Clade C associated focal brain lesions with special focus on cerebral toxoplasmosis. AU - Shyam babu,C, AU - Satishchandra,P, AU - Mahadevan,A, AU - Pillai Shibu,V, AU - Ravishankar,S, AU - Sidappa,N, AU - Udaykumar,R, AU - Ravi,V, AU - Shankar,S K, Y1 - 2012/11/12/ PY - 2011/12/06/received PY - 2012/08/23/revised PY - 2012/10/16/accepted PY - 2012/11/17/entrez PY - 2012/11/17/pubmed PY - 2014/1/17/medline SP - 995 EP - 1002 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 115 IS - 7 N2 - BACKGROUND: Focal brain lesions (FBL) in HIV/AIDS frequently pose a diagnostic dilemma as the etiology varies from infective (tuberculoma, toxoplasmosis and tuberculous abscesses) to neoplastic lesions like lymphoma. For determining etiology, advanced neuroimaging techniques, serological and molecular biological tests have been evolved with varying sensitivities/specificities. Stereotactic biopsy (STB) of the lesions is reserved for lesions unresponsive to appropriate therapy. OBJECTIVE AND METHODS: In this study, the diagnostic yield of neuroimaging [cranial CT (n=25), MRI (n=24), and Th201/99Tc SPECT scan (n=18)] is compared with histopathological diagnosis obtained by STB (n=21) or autopsy (n=4) in 25 HIV-1 subtype C seropositive individuals with FBL identified by neuroimaging with special reference to cerebral toxoplasmosis in an eighteen month study period (2006-2007). RESULTS AND CONCLUSION: Cerebral toxoplasmosis was the most frequent cause of FBL (21/25, 84%), followed by one case each of tuberculoma, progressive multifocal leukoencephalopathy (PML), primary central nervous system lymphoma (PCNSL) and measles inclusion body encephalitis (MIBE), the last two diagnosed at autopsy. Of the 21 cases of cerebral toxoplasmosis, definitive diagnosis with histopathological confirmation was available in 14/21 (66.6%), with indirect evidence suggesting probable toxoplasmosis in seven, all of whom responded to antitoxoplasma therapy. CT and MRI had comparable specificities (75%), while MRI had marginally higher sensitivity (85% versus 80.9%) in detecting multiple lesions. The positive predictive value of both CT and MRI was identical (94.4%), suggesting that CT maybe a cost effective screening tool in resource restricted settings, for evaluating FBL. Sensitivity of 99Tc SPECT scan for diagnosing inflammatory lesions was 75% but failed to differentiate PCNSL from toxoplasmosis. This study is the first of its kind from India analyzing FBL with specific focus on cerebral toxoplasmosis in the setting of HIV-1 subtype C. SN - 1872-6968 UR - https://www.unboundmedicine.com/medline/citation/23153789/Usefulness_of_stereotactic_biopsy_and_neuroimaging_in_management_of_HIV_1_Clade_C_associated_focal_brain_lesions_with_special_focus_on_cerebral_toxoplasmosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0303-8467(12)00530-6 DB - PRIME DP - Unbound Medicine ER -