INTESTINAL DISEASE IN ACQUIRED IMMUNODEFICIENCY - EVALUATION BY CT

Intestinal symptoms affect most AIDS patients at some point in their d isease. The purpose of this study was to evaluate the use of CT in thi s setting. A total of 339 abdominal CT exams were reviewed for signs o f intestinal disease. Abdominal CT scans of 45 patients with intestina l symptoms were compared with colonoscopy and histologic data. The CT results were correlated with CD4(+) T-lymphocyte counts and patient su rvival. More than 14 % of all abdominal CT exams displayed signs of en teric disease. Of the 45 patients studied with both CT and colonoscopy , 35 (78 %) had signs of intestinal disease by CT. Of these 35 patient s, colonoscopic signs of an intestinal lesion were found in 29 and his tologic proof of disease was established in 30 cases, Colonoscopy and histology detected 8 lesions missed by CT. There were 14 cases of unsp ecific colitis, 15 cases of cytomegalovirus (CMV) colitis, and 4 cases of enteric tuberculosis as per biopsy. Five patients presented with K aposi's sarcoma and 1 with a non-Hodgkin's lymphoma. Neither colonosco pic nor CT signs of intestinal disease did reliably distinguish betwee n histologic subgroups. Specifically, CMV colitis could not be disting uished from unspecific colitis. CD4(+) T-lymphocyte counts for histolo gic subgroups were not significantly different, either. No colonoscopi c or histologic feature predicted survival, whereas low CD4 counts and ascites on CT indicated a poor prognosis. Whereas CT detects signs of intestinal disease in most AIDS patients, these signs remain largely unspecific. Colonoscopy and biopsies provide no consistently valid sta ndard with which to compare CT because of controversial sensitivity an d specificity of these methods. The CT technique detects small bowel a s well as extraintestinal disease. Therefore, CT is an important diagn ostic modality in abdominal disease of immunocompromised patients.