A comparison of cerebral SPECT abnormalities in HIV-positive homosexual men with and without cognitive impairment
N. Sacktor, R. L. Van Heertum, G. Dooneief, J. Gorman, A. Khandji, K. Marder, R. Nour, G. Todak, Y. Stern and R. Mayeux
Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
OBJECTIVE: To determine whether technetium Tc 99m exametazime (HMPAO)
single-photon emission computed tomography (SPECT) can distinguish between
human immunodeficiency virus (HIV)-positive homosexual men with normal
neuropsychologic test results and HIV-positive homosexual men with abnormal
neuropsychologic test results. DESIGN: Neurologic, neuropsychologic,
magnetic resonance imaging, and Tc 99m HMPAO SPECT examinations were
performed on 10 HIV-positive homosexual men without cognitive impairment
and five HIV-positive homosexual men with cognitive impairment. PATIENTS:
Human immunodeficiency virus-positive homosexual men from New York City
were recruited for the study. MAIN OUTCOME MEASURES: Findings on SPECT
scans were evaluated qualitatively for focal defects, heterogeneity of the
cortical margin, white matter hypoperfusion, and decreased global cortical
uptake. All SPECT focal defects were coregistered with magnetic resonance
images; SPECT heterogeneity and global cortical uptake were also measured
quantitatively. RESULTS: Coregistration with magnetic resonance imaging
revealed that 63% of the focal SPECT defects corresponded to brain gyri and
37% corresponded to sulci. There was no significant difference in the
frequency of qualitative or quantitative SPECT abnormalities between
HIV-positive homosexual men ith and without cognitive impairment. However,
after examining individual neuropsychologic test factors, impaired motor
speed performance was associated with decreased quantitative global
cerebral uptake. CONCLUSIONS: Qualitative SPECT abnormalities are not
increased in frequency in HIV-positive homosexual men with global cognitive
impairment compared with those in HIV-positive homosexual men without
cognitive impairment. Impaired motor speed performance may be associated
with decreased quantitative global cerebral uptake.