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Thallium-201 brain SPECT of lymphoma in AIDS patients: pitfalls and technique optimization Kessler LS; Ruiz A; Donovan Post MJ; Ganz WI; Brandon AH; Foss JNAJNR Am J Neuroradiol 1998[Jun]; 19 (6): 1105-9PURPOSE: Our aim was to examine the 201Tl-SPECT scans in AIDS patients with focal CNS lesions to identify those studies with a false-positive or false-negative result to determine any potential pitfalls in interpretation as well as to suggest methods for technique optimization. METHODS: We retrospectively reviewed the charts of 162 AIDS patients with cerebral mass lesions on 201Tl-SPECT studies. One hundred sixty-one patients had CT examinations, of which 50 also had MR studies. One patient had MR imaging without CT. Those patients in whom the diagnosis by 201Tl-SPECT did not correspond with the known pathologic or clinically proved diagnosis were then singled out and their CT, MR, and 201Tl-SPECT studies were reviewed, including blinded interpretation of the 201Tl-SPECT scans alone and alongside the corresponding CT and MR examinations. Studies were examined for lesion morphology, size, location, enhancement pattern, and presence of necrosis. The review of the 201Tl-SPECT studies included both a qualitative approach (subjective analysis of the scans for areas of abnormally increased uptake) and a quantitative approach (comparison of lesion activity versus activity within a reference standard, such as the scalp). RESULTS: Sensitivity and specificity of 201Tl-SPECT in depicting lymphoma were 100% and 93%, respectively, based on the initial qualitative analysis. Fifty-one patients had positive 201Tl-SPECT results, of whom 43 were determined to have lymphoma (four by biopsy/autopsy, 39 by clinical and radiologic findings). Upon reevaluation with both a quantitative and qualitative approach, those studies initially interpreted as positive in patients without lymphoma (false positives) were found to be negative. CONCLUSION: Brain 201Tl-SPECT is an effective study in the diagnosis of CNS lymphoma in AIDS patients. Specificity can be increased by routinely performing a quantitative analysis of all lesions.|*Thallium Radioisotopes[MESH]|*Tomography, Emission-Computed, Single-Photon[MESH]|Brain Neoplasms/*diagnostic imaging[MESH]|Brain/diagnostic imaging[MESH]|Humans[MESH]|Lymphoma, AIDS-Related/*diagnostic imaging[MESH]|Magnetic Resonance Imaging[MESH]|Retrospective Studies[MESH]|Sensitivity and Specificity[MESH]|Tomography, X-Ray Computed[MESH] |