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[Use of 99mTc-HMPAO SPECT in the study of AIDS-correlated dementia]
P L Garavelli1, R Zoccola, G Villa
1Divisione di Malattie infettive, Ospedale civile, Alessandria.
Insights
Technetium Tc 99m HMPAO SPECT scans show cerebral blood flow changes in patients with Human Immunodeficiency Virus (HIV) infection, even in early stages. These findings may indicate future neurological damage and disease progression.
Area of Science:
- Neurology
- Nuclear Medicine
- Infectious Diseases
Background:
- AIDS dementia complex is a neurological complication of HIV infection.
- It involves cerebral atrophy, grey/white matter abnormalities, and progressive dementia.
- SPECT imaging with Tc 99m HMPAO is a tool for studying dementia.
Purpose of the Study:
- To evaluate the utility of Tc 99m HMPAO SPECT in assessing cerebral blood flow (CBF) changes in different stages of HIV infection.
- To determine if SPECT findings can serve as early markers for neurological damage in AIDS dementia complex.
Main Methods:
- A study involving 57 patients (11 HIV+, 26 ARC, 17 AIDS) and 7 HIV-negative drug-addicted controls.
- Cerebral blood flow was assessed using SPECT with Tc 99m HMPAO.
- Results were compared with CT scans and neurological dementia tests.
Main Results:
- SPECT showed positive results in 45% of HIV+, 52% of ARC, and 94% of AIDS patients.
- CT and neurological tests showed lower positive rates, increasing with disease stage.
- All control patients had negative results, though the group was small.
Conclusions:
- Tc 99m HMPAO SPECT is valuable for detecting CBF changes in early HIV stages.
- These changes may precede definitive cerebral damage and indicate disease progression.
- SPECT imaging can be an important marker for monitoring AIDS dementia complex advancement.
Abstract:
AIDS dementia complex is a well-defined neurological manifestation of the HIV infection. Its anatomo-pathological pattern is cerebral atrophy, grey and white matter abnormalities and vascular changes, and the main symptom is progressive dementia. SPECT with Tc 99m HMPAO has proved to be an useful tool in studying Alzheimer and multi-infarct dementia, and its use has been recently proposed in AIDS-dementia. We studied with Tc 99m HMPAO 57 Pts (11 HIV+, 26 ARC, 17 AIDS) and control group of 7 drug-addicted seronegative Pts. We found positive results in 45% SPECT, 18% CT, 0% neurological tests of dementia in HIV+ phase, versus 52%, 41, 20% in ARC phase and 94%, 88% and 76% in AIDS phase, while all control Pts were negative. Control group is too small to exclude with all possibility of doubt cerebral blood flow impairment caused by drug damage but nevertheless we think that SPECT examination with 99 mTc HMPAO has an important role in assessing CBF changes in earlier stages of AIDS disease. These changes are probably forerunners of definitive cerebral damage and may be important markers of the advancement of disease.