Stellenwert der ⁶⁷Ga-Szintigraphie in der Primärdiagnostik und Verlaufsbeurteilung opportunistischer Pneumonien bei Patienten mit AIDS^[**]

Opportunistic pneumonias are a life-threatening complication in patients with AIDS. Early diagnosis and therapy is necessary to improve prognosis. This study was designed to assess the value of ⁶⁷Ga scintigraphy in the primary detection and follow-up of these special pneumonias. ⁶⁷Ga scintigraphy was performed in 40 patients: 10 normal controls and 30 HIV-positive patients with AIDS or AIDS-related complex (ARC). ⁶⁷Ga scan results were compared with current chest radiographs and the results of pathogen detection. The evaluation of positive scans was based on a quantification of the pulmonary uptake, expressed as a pulmonary/soft-tissue uptake ratio. Only 8/30 patients had a normal scan, 22/30 showed diffuse (13/22) or focal (9/22) increases of pulmonary uptake. In 7/8 patients with normal scans the chest radiograph was negative as well. The one patient with negative scan but positive chest radiograph had pulmonary Kaposi’s sarcoma. In 11/22 patients the ⁶⁷Ga scan and chest radiograph were positive simultaneously. In the other 11/22 patients with positive scans chest radiographs were initially negative but showed pathology in 5 cases within 1-2 weeks. The reason for positive scans in most cases was an opportunistic lung infection; other forms of pneumonia were only observed in two cases. The defined uptake ratio demonstrated to be a highly sensitive parameter for monitoring pneumonia and the effects of therapy in follow-up studies. In conclusion, quantitative ⁶⁷Ga scintigraphy proved to be a reliable and highly sensitive method for primary detection and follow-up of opportunistic pneumonias in patients with AIDS.

Zusammenfassung

Opportunistische Pneumonien bedeuten für AIDS-Patienten eine lebensbedrohliche Komplikation. Zur Verbesserung der Prognose sind frühzeitige Diagnosestellung und Therapieeinleitung unerläßlich. Ziel der vorliegenden Studie war es, den Stellenwert der ⁶⁷Ga-Szintigraphie für Primärdiagnostik und Verlaufsbeurteilung dieser spezifischen Pneumonieformen zu untersuchen. Die Studie umfaßte 40 Patienten: 10 Lungengesunde und 30 HIV-positive Patienten mit AIDS oder AIDS-related complex (ARC). Die Befunde von Szintigraphie und konventionellem Thorax- Röntgen wurden verglichen und dem Erregerspektrum zugeordnet. Kriterium für ein pathologisches Szintigramm war ein am lungengesunden Normalkollektiv ermittelter Lunge/ Weichteilquotient (LWQ). Nur 8/30 Patienten hatten ein normales Szintigramm. 22/30 wiesen diffuse (13/22) oder fokale (9/22) Mehranreicherungen in der Lunge auf. 7/8 Patienten mit normalem Szintigramm waren gleichzeitig Röntgen-negativ. In dem Einzelfall mit positivem Röntgenbefund und negativem Szintigramm lag ein pulmonales Kaposi-Sarkom vor. Bei 11/22 Patienten mit positivem Szintigramm war gleichzeitig der Röntgenbefund pathologisch. Die anderen 11 Patienten mit pathologischem Szintigramm hatten einen negativen Röntgenausgangsbefund, der aber in 5 Fällen noch innerhalb 1-2 Wochen positiv wurde. Pathologische Szintigramme waren meist Folge einer opportunistischen Pneumonie; gewöhnliche Pneumonien kamen selten vor. Zur Therapiekontrolle und Verlaufsbeurteilung opportunistischer Pneumonien sind als hochsensitiver und objektivierbarer Parameter ⁶⁷Ga- Verlaufsuntersuchungen mit Quantifizierung der Lungenanreicherung zu empfehlen.

^** Herrn Prof. Dr. Dr. h.c. J. Lissner zum 65. Geburstag gewidmet.

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