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Sample records for 99mtc-ecd brain spect

  1. Brain SPECT

    Brain SPECT investigations have gained broad acceptance since the introduction of the lipophilic tracer Tc-99m-HMPAO. Depending on equipment and objectives in different departments, the examinations can be divided into three groups: 1. Under normal conditions and standardised patient preparation the 'rest' SPECT can be performed in every department with a tomographic camera. In cerebrovascular disease there is a demand for determination of either the perfusion reserve in reversible ischemia or prognostic values in completed stroke. In cases of dementia, SPECT may yield useful results according to differential diagnosis. Central cerebral system involvement in immunologic disease may be estimated with higher sensitivity than in conventional brain imaging procedures. In psychiatric diseases there is only a relative indication for brain SPECT, since results during recent years have been contradictory and may be derived only in interventional manner. In brain tumor diagnostics SPECT with Tl-201 possibly permits grading. In inflammatory disease, especially in viral encephalitis, SPECT may be used to obtain early diagnosis. Normal pressure hydrocephalus can be distinguished from other forms of dementia and, consequently, the necessity for shunting surgery can be recognised. 2. In departments equipped for emergency cases an 'acute' SPECT can be performed in illnesses with rapid changing symptoms such as different forms of migraine, transient global amnesia, epileptic seizures (so-called 'ictal SPECT') or urgent forms like trauma. 3. In cooperation with several departments brain SPECT can be practised as an interventional procedure in clinical and in scientific studies. (orig./MG)

  2. Brain Single Photon Emission Computed Tomography in Anosmic Subjects Ater Closed Head Trauma

    Roozbeh Banan

    2011-01-01

    Full Text Available Anosmia following head trauma is relatively common and in many cases is persistent and irreversible. The ability to objectively measure such a decline in smelling, for both clinical and medicolegal goals, is very important. The aim of this study was to find results of brain Single Photon Emission Computed Tomography (SPECT in anosmic subjects after closed head trauma. This case-control cross sectional study was conducted in a tertiary referral University Hospital. The brain perfusion state of nineteen anosmic patients and thirteen normal controls was evaluated by means of the SPECT with 99mtc- ECD infusion- before and after olfactory stimulation. The orbitofrontal lobe of the brain was assumed as the region of interest and changes in perfusion of this area before and after the stimulations were compared in two groups. The mean of brain perfusion in controls before and after the stimulation was 8.26% ± 0.19% and 9.89% ± 0.54%, respectively (P < 0.0001. Among patients group, these quantities were 7.97% ± 1.05% and 8.49% ± 1.5%, respectively (P < 0.004. The difference between all the measures in cases and controls were statistically significant (P < 0.0001. There were no differences in age and sex between two groups. The brain SPECT is an objective technique suitable for evaluating anosmia following the head trauma and it may be used with other diagnostic modalities

  3. Usefulness of brain SPECT

    Brain SPECT was not effectively exploited until I-123 isopropyl amphetamine (IAMP), indicator able to penetrate the blood brain barrier, became available. Although the experience of research teams working with IAMP is quite restricted due to the high cost of the indicator, some applications now appear to be worth the cost and in some cases provide data which cannot be obtained with routine techniques, especially in cerebrovascular patients, in epilepsy and some cases of tumor. Brain SPECT appears as an atraumatic test which is useful to establish a functional evaluation of the cerebral parenchyma, and which is a complement to arteriography, X-ray scan and regional cerebral blood flow measurement

  4. Brain SPECT in childhood

    The modalities and the indications of perfusion and neurotransmission SPECT in childhood are presented. The perfusion as well as neurotransmission tracers have not yet authorization for use in children; they have to be used by prescription of magistral preparation or in research protocols. The radioprotection rules have to be strictly respected. The most frequent indication of perfusion SPECT is pharmacologically resistant epilepsy; the ictal SPECT before surgery allows the localization of the epileptogenic focus. Other indications are relevant in the prognosis of neonatal anoxia and encephalitis. In psychiatric disorders, especially in autism, the interest is the physiopathological approach of the brain dysfunctions. The neurotransmission SPECT is emerging as a consequence of the development of new radiotracer, as the dopaminergic system ligands. The decrease of the dopamine D2 receptors in the striatum can be imaged and quantified in the neonate. The lesions of dopamine system seem to be a consequence of the neonatal hypoxia-ischemia and it is predictive of motor sequelae. Brain SPECT should become a routine examination in child neurologic and psychiatric disorders. (authors)

  5. Brain SPECT. SPECT in der Gehirndiagnostik

    Feistel, H. (Erlangen-Nuernberg Univ., Erlangen (Germany). Nuklearmedizinische Klinik mit Poliklinik)

    1991-12-01

    Brain SPECT investigations have gained broad acceptance since the introduction of the lipophilic tracer Tc-99m-HMPAO. Depending on equipment and objectives in different departments, the examinations can be divided into three groups: 1. Under normal conditions and standardised patient preparation the 'rest' SPECT can be performed in every department with a tomographic camera. In cerebrovascular disease there is a demand for determination of either the perfusion reserve in reversible ischemia or prognostic values in completed stroke. In cases of dementia, SPECT may yield useful results according to differential diagnosis. Central cerebral system involvement in immunologic disease may be estimated with higher sensitivity than in conventional brain imaging procedures. In psychiatric diseases there is only a relative indication for brain SPECT, since results during recent years have been contradictory and may be derived only in interventional manner. In brain tumor diagnostics SPECT with Tl-201 possibly permits grading. In inflammatory disease, especially in viral encephalitis, SPECT may be used to obtain early diagnosis. Normal pressure hydrocephalus can be distinguished from other forms of dementia and, consequently, the necessity for shunting surgery can be recognised. 2. In departments equipped for emergency cases an 'acute' SPECT can be performed in illnesses with rapid changing symptoms such as different forms of migraine, transient global amnesia, epileptic seizures (so-called 'ictal SPECT') or urgent forms like trauma. 3. In cooperation with several departments brain SPECT can be practised as an interventional procedure in clinical and in scientific studies. (orig./MG).

  6. SPECT of brain blood flow

    Morphological observation of the brain became possible by CT and various informations on vascularity and damages in brain blood barrier (BBB) became obtainable by the combined use of contrast medium. Then the appearance of MRI had enabled to discriminate the cortex and the medula of the brain and to perform MR angiography. However, it was still difficult to observe the cerebral tissue in detail. Recently, nuclear medical procedures have been developed and applied to diagnosis. SPECT images attributable to the distribution of γ-ray from a tracer, which monitors the blood flow and various metabolisms. Thus, investigations of cerebral functions including blood flow metabolism and neural transmission etc. became possible by the technique. Here, SPECT by Xe-133 clearance and 99mTc HMPAO methods were reviewed. For Xe-133 method, subjects positioned in SPECT instrument underwent bolus inhalation of Xe-133, 1850 Mbq followed by washout respiration of room air. During these treatment, cerebral projection and determination of the concentration of Xe-133 CO2 in the expired air were continuously carried out. And the blood flow level per pixel was estimated from SPECT images and the end-tidal Xe-133 concentration curve. This method was thought to be the most excellent method for the determination of local blood flow in respect of accuracy and reproducibility. The tracer distribution expressed the functional level of the stagnant state of blood flow. SPECT provides useful informations to investigate the physiological functions and pathology in the brain. (M.N.)

  7. Evaluating brain tumors with SPECT

    The evaluation of cerebral blood flow and metabolism using functional imaging in combination with morphological imaging by CT and MRI has recently been attracting attention in neuroradiological diagnosis of brain tumor. This report assesses the clinical usefulness of SPECT for brain tumor. Because 201TlCl SPECT is useful in determining the degree of brain tumor malignancy and clearly reflects tumor metabolism after radiochemotherapy, it is capable of determining therapeutic outcomes earlier than MRI. To increase the diagnostic performance of 201TlCl SPECT, time-course accumulation dynamics were investigated using early and delayed imaging. Three-dimensional SPECT imaging using N-isopropyl-p[123I]-iodoamphetamine (123I-IMP) is a new diagnostic method that not only visually evaluates the lesion but also quantifies the expansion volume of the hypoperfusion area associated with the lesion. Development of functional imaging may lead to a new therapeutic method by providing clinical images that more faithfully reproduce the pathological state. (author)

  8. Contralateral thalamic hypoperfusion on brain perfusion SPECT

    Brain perfusion single photon emission computed tomography (SPECT) is useful for the localization of cerebrovascular lesion and sometimes reveals more definite lesion than radiologic imaging modality such as CT or MRI does. The purpose of this study was to evaluate the diagnostic usefulness of brain perfusion SPECT in patients with hemisensory impairment. Thirteen consecutive patients (M:F= 8:5, mean age = 48) who has hemisensory impairment were included. Brain perfusion SPECT was performed after intravenous injection of 1110 MBq of Tc-99m ECD. The images were obtained using a dual-head gamma camera with ultra-high resolution collimator. Semiquantitative analysis was performed after placing multiple ROIs on cerebral cortex, basal ganglia, thalamus and cerebellum. There were 10 patients with left hemisensory impairment and 3 patients with right-sided symptom. Only 2 patients revealed abnormal signal change in the thalamus on MRI. But brain perfusion SPECT showed decreased perfusion in the thalamus in 9 patients. Six patients among 10 patients with left hemisensory impairment revealed decreased perfusion in the contralateral thalamus on brain SPECT. The other 4 patients revealed no abnormality. Two patients among 3 patients with right hemisensory impairment also showed decreased perfusion in the contralateral thalamus on brain SPECT. One patients with right hemisensory impairment showed ipsilateral perfusion decrease. Two patients who had follow-up brain perfusion SEPCT after treatment revealed normalization of perfusion in the thalamus. Brain perfusion SPECT might be a useful tool in diagnosing patients with hemisensory impairment

  9. Brain SPECT imaging in temporal lobe epilepsy

    Temporal lobe epilepsy is diagnosed by clinical symptoms and signs and by localization of an epileptogenic focus. A brain SPECT study of two patients with temporal lobe epilepsy, using 99mTc-HMPAO, was used to demonstrate a perfusion abnormality in the temporal lobe, while brain CT and MRI were non-contributory. The electroencephalogram, though abnormal, did not localize the diseased area. The potential role of the SPECT study in diagnosis and localization of temporal lobe epilepsy is discussed. (orig.)

  10. Crossed cerebellar hyperperfusion in brain perfusion SPECT

    Jinnouchi, Seishi; Nagamachi, Shigeki; Nishii, Ryuuichi; Futami, Shigemi; Tamura, Shozo [Miyazaki Medical Coll., Kiyotake (Japan); Kawai, Keiichi

    2000-10-01

    Crossed cerebellar diaschisis is a well-known brain SPECT finding in stroke patients. Few reports, however, have described supratentorial and contralateral cerebellar hyperperfusion (crossed cerebellar hyperperfusion, CCH). We assessed the incidence of CCH in 33 patients with cerebral hyperperfusion. Brain SPECT showed CCH in five patients out of 20 epilepsy and three of 13 patients with acute encephalitis. These eight patients with CCH had recent epileptic attack. CCH was found in ECD SPECT as well as HM-PAO. The contralateral cerebellar activity correlated with the cerebral activity in patients with CCH. CCH would have a relation with supratentrial hyperfunction in epilepsy and acute encephalitis. (author)

  11. Brain SPECT in psychiatry: Delusion or reality?

    Aim: The need for functional information is becoming increasingly evident for proper therapeutic approaches to the treatment and follow up of psychiatric diseases. While data on this subject already exists, there is a general lack of consensus about the use of brain SPECT in this domain and also a considerable negative prejudice due to a number of factors including poor quality imaging and unrealistic expectations. Based on a large group of brain SPECT-s performed over the past 3 years we attempted to sort and refine the indications for SPECT in psychiatry. Materials and Methods: High resolution brain SPECT was performed with triple head gamma camera, super-high resolution fan beam collimator and Tc-HMPAO. A comprehensive semiquantitative color, 3D surface as well as multi-thresholded volume display was routinely used and supplemented by automatic realignment in case of longitudinal follow-up. Results: 470 brain SPECT-s done on 432 patients were all referred by psychiatrists or neuro-psychiatrists for a wide spectrum of psychiatric diseases and ranged in age from 7 to 88 years. The most common primary reasons for referral were : attention deficit hyperactive disorder (ADHD); anxiety; obsessive-compulsive disease, depression (refractory, chronic, bipolar ), impulse control problems; oppositional defiance, post traumatic brain injury; seizures, learning difficulties, pervasive development disorders, memory loss and differential of dementia. Among common denominators were long duration of the disease, unresponsiveness to treatment, worsening of clinical status, and presence of multiple conditions at the same time. The multiparametric display used enabled a comprehensive evaluation of the brain volume which included the hemispheric surfaces; the basal ganglia (striatum) and the thalamus, several components of the limbic and paralimbic systems: anterior and posterior cingulate and their respective subdivisions, insula-s and their subdivisions, apical and mesial

  12. Brain SPECT in severs traumatic head injury

    The aim of this work was to compare the results of the early brain scintigraphy in traumatic brain injury to the long term neuropsychological behavior. Twenty four patients had an ECD-Tc99m SPECT, within one month after the trauma; scintigraphic abnormalities were evaluated according to a semi-quantitative analysis. The neuropsychological clinical investigation was interpreted by a synthetic approach to evaluate abnormalities related to residual motor deficit, frontal behavior, memory and language disorders. Fourteen patients (58%) had sequela symptoms. SPECT revealed 80 abnormalities and CT scan only 31. Statistical analysis of uptake values showed significantly lower uptake in left basal ganglia and brain stem in patients with sequela memory disorders. We conclude that the brain perfusion scintigraphy is able to detect more lesions than CT and that it could really help to predict the neuropsychological behavior after severe head injury. Traumatology could become in the future a widely accepted indication of perfusion SPECT. (authors)

  13. Brain SPECT with Tl-201 DDC

    The development, animal and human experiments and the first clinical results of a new blood flow tracer thallium-201 diethyldithiocarbamate (Tl-201 DDC) are discussed for functional brain imaging with single-photon emission computed tomography (SPECT). 325 refs.; 43 figs.; 22 tabs

  14. Anything wrong with brain SPECT? Not really

    Aim: Despite increased evidence about the usefulness of Brain SPECT in Neuro-Psychiatry, it continues to represent only a low percentage of Nuclear Medicine procedures. The prevalent perception is that it is an inadequate diagnostic tool, and/or is not changing patient management. There are objective reasons for this, as the lack of awareness by Psychiatrists about the value of SPECT, but most important is the frequently poor quality of images provided. This can be due to inadequate gamma cameras but is mostly due to poor quality software. Materials and Methods: High resolution brain SPECT via triple head gamma camera, super-high resolution fan beam collimator and Tc-HMPAO. A combination of commercial software and local optimization was used for the final displays as well as for realignment of sequential brain SPECT studies. Results: We found out that 6 basic software improvements are needed to generate a final display where features can be clearly distinguished and which can be also easily assimilated by the referring physician. 1) Color scales: simple and efficient tools needed to generate user friendly and semiquantitative color shades as needed. Unfortunately various color scales may be needed depending on printer and paper used. 2): 3 D displays allowing, multiple standardized thresholdings, any number of groupings, differential coloring (with functional meaning) and adequate labeling. Should be completely or at least mostly automatic. 3) Automatic realignment of sequential studies: such programs exist in various forms (free WWW versions, proprietary Beta versions, etc.) but are still not supplied by the gamma camera vendors for general use. Should provide SPECT -SPECT and SPECT MRI options. 4) Localization of structures and slices a) Triangulation of structures and b) Identification of section location. 5) Graphics improvement for generating any number of optimized summary displays to accompany reports. 6) Availability of voxel based quantification software

  15. Brain perfusion SPECT in dementia syndromes

    Aim: Brain perfusion SPECT is used in differential diagnostics of dementia syndromes. First of all the aim is to distinguish vascular dementia from degenerative dementia and to differentiate dementia from delirium, psychiatric syndromes, depression and secondary dementia, which is important in relation to therapy. The purpose of our study was to detect significance of BP SPECT and include it into the diagnostic process in dementia syndromes. Materials and methods: 51 women and 63 men aged 55 - 88 were evaluated in the study. The patients correspond to the general criteria of dementia diagnosis. They were sent to the examination by neurological, internal and psychiatric departments and out-patient departments. All patients were examined by 99mTc ECD SPECT using a double head camera PRISM 200 VP with LEHR collimator. The scintigraphic data were evaluated by the visual and semiquantitative analysis. Results: It was established that most patients in our group had vascular dementia, while Alzheimer's disease was second. In other groups we found out dementia at strategic infarct location, e.g. in gyrus angularis in the dominant hemisphere, frontal temporal lobe dementia and alcoholic dementia. Twenty-four patients had a normal diagnosis. Fifteen of them had a somatic reason of the delirious state and were re-classified into pseudodementia. Nine patients were not diagnostically included and the examination will repeated in four months time. Conclusion: We have found out a good applicability of brain perfusion SPECT in dementia syndromes diagnosis in our work. The best diagnosticable and most specific were the findings in multi-infarct dementia, Alzheimer's disease and frontal temporal lobe dementia. When vascular dementia is concerned we can even distinguish dementia at strategic infarction location, e.g. in thalamus, basal frontal telencefalon, in gyrus angularis of the dominant hemisphere, etc

  16. The clinical use of brain SPECT imaging in neuropsychiatry

    This article reviews the literature on brain SPECT imaging in brain trauma, dementia, and temporal lobe epilepsy. Brain SPECT allows clinicians the ability to view cerebral areas of healthy, low, and excessive perfusion. This information can be correlated with what is known about the function or dysfunction of each area. SPECT has a number of advantages over other imaging techniques, including wider availability, lower cost, and high quality resolution with multi-headed cameras. There are a number of issues that compromise the effective use of SPECT, including low quality of some imaging cameras, and variability of image rendering and readings (Au)

  17. 99mTc-HMPAO Brain SPECT in Seizure Disorder: Comparison Brain SPECT, MRI / CT and EEG

    We studied 115 patients with seizure who had been performed brain SPECT brain MRI of CT and EEG. To evaluate the pattern of brain SPECT in seizure patients 28 of them had secondary epilepsies, 87 had primary epilepsies. In primary epilepsies, 42 were generalized seizure and 45 were partial seizure. The causes of secondary epilepsies were congenital malformation, cerebromalacia, cerebral infarction ultiple sclerosis, AV-malformation. granuloma and etc, in order. In 28 secondary epilepsies, 25 of them, brain SPECT lesions was concordant with MRI or CT lesions. 3 were disconcordant. The brain SPECT findings of generalized seizure were normal in 22 patients, diffuse irregular decreased perfusion in 8, decreased in frontal cortex in 4. temporal in 5 and frontotemporal in 3. In 45 partial seizure, 19 brain SPECT were concordant with EEG (42.4%).

  18. Four-view spect brain imaging detector

    This paper reports that with increasing use of single photon radiopharmaceuticals for brain imaging, there is a growing demand for efficient, economical SPECT brain imaging instrumentation. This new multiple view imaging detector design has the sensitivity advantages of an array of four discrete cameras, but functions essentially like a single camera head. Four separate flat crystals are surrounded with PMT's which perform as a single array for photon event detection. Unique windows on adjoining crystal edges are coupled to corner light pipe/PMT assemblies. Reduced edge packing range, and sharing of corner PMT's allows a compact assembly volume, even with 3 inch PMT's. The imaging volume is approximately a 23 centimeter cube, and the imaging electronics are nearly the same as used in a single 64 PMT gamma camera

  19. Significance and evaluation of SPECT in brain disorders

    SPECT images and CT scan were reported in 158 cerebral diseases, including 84 acute cerebral diseases, 50 epilepsy, 12 brain tumor, 7 migraine, and 5 Parkinson's diseases. The results revealed that SPECT was better than CT for the early diagnosis of ischemic stroke and transient ischemic attacks, although the CT had more advantages for the location and qualitative diagnosis of acute cerebral diseases. It was also showed that SPECT had its unique value in the diagnosis of epilepsy, but its value in the diagnosis of brain tumor and Parkinson's disease was uncertain

  20. Interobserver variation in diagnosis of dementia by brain perfusion SPECT

    Brain perfusion SPECT (BP-SPECT) has characteristic patterns of abnormality, enabling the differential diagnosis of dementia. The purpose of this study was to measure interobserver variations in the diagnosis of dementia using BP-SPECT. BP-SPECT images of 57 cases, 19 of Alzheimer's disease (AD), eight of multi-infarct dementia (MID), three of Pick's disease, five of other dementias, and 22 normal controls, were interpreted by ten nuclear medicine physicians with varying levels of experience. Brain MR images of the cases were then interpreted apart from SPECT. The physicians independently rated all of the diagnoses listed beforehand according to a five-point scale, with clinical information provided. Receiver-operating characteristic (ROC) curves and the area under the ROC curve (Az) were calculated. Az varied from 0.48 to 0.87. Mean Az's were significantly larger (p<0.05) in the diagnosis by SPECT than in that by MRI (0.715 and 0.629 for dementia vs. normal, 0.670 and 0.560 for AD or MID vs. normal, 0.610 and 0.416 for AD vs. normal, and 0.672 and 0.412 for AD vs. MID, respectively). Considerable interobserver variation was present in BP-SPECT interpretation, BP-SPECT may be more effective for the evaluation of dementia than MRI when the same nuclear medicine physicians interpret both images. (author)

  1. Brain SPECT using dipyridamole for evaluation of vascular reserve

    Baseline and stress brain SPECT studies using CO2 inhalation, acetazolamide (DiamoxR) and adenosine administrations have been used in the evaluation of cerebral vascular reserve. Recently dipyridamole (PersantineR) which is one of the pharmacologic myocardial perfusion SPECT agents as a potent vasodilator is suggested as another cerebral vasodilator. IV DiamoxR is not available in Korea. Therefore, the purpose of our study was to evaluate dipyridamole in stress brain SPECT in patients with Moya Moya disease. Eight patients with angiographically proven Moya Moya disease were studied. Their ages ranged from 7 to 62 year old. There were 4 males and 4 females. Each patient had a baseline and persantine brain SPECT studies with 1 to 3 days' interval. Dipyridamole was given intravenously at a dose of 0.56 mg/kg over 4 minutes while watching vital signs such as blood pressure, heart rate, and electrocardiogram. Three minutes after the completion of the infusion, 99mTc-ECD (0.2 mCi/Ib body weight) was injected. Brain SPECT was performed 30 minutes later using a tripple head gamma camera equipped with LEHR collimators. A total of 128 projections with an acquisition time of 30 second per projection was obtained and reconstructed by filtered back projections without attenuation correction. The difference between the baseline and persantine studies was analysed by visual and semiquantitavely. During the infusion of persantine, heart rate, blood pressure and side effects such as headache, chest discomfort were similar to the persantine myocardial SPECT studies. Five of eight patients showed a significant decrease in rCBF on persantine brain SPECT in comparison to the baseline study. The remaining three revealed no significant change in rCBF. Our study suggests that the dipyridamole stress brain SPECT is feasible and useful in assessing cerebral blood flow reserve. However we need to evaluate more number of patients in the future

  2. 123I-iomazenil brain receptor SPECT in focal epilepsy. In comparison with 99mTc-HMPAO brain SPECT, MRI and Video/EEG monitoring

    Purpose: To evaluate the clinical value of 123I-Iomazenil brain receptor SPECT in diagnosis of focal epilepsy in comparison with 99mTc-HMPAO brain SPECT, MRI and Video/EEG monitoring. Methods 123I-Iomazenil brain receptor SPECT was performed on 40 patients with focal epilepsy. The results were compared with those obtained by 99mTc-HMPAO brain SPECT, MRI and Video/EEG monitoring. Results: In 40 patients, the sensitivity of Video/EEG monitoring for localization of epileptogenic area was 95% (38/40). The sensitivity of 123I-iomazenil brain receptor SPECT, 99mTc-HMPAO brain SPECT and MRI for localization of epileptogenic area compared with Video/EEG monitoring ('gold standard') was 65.8%(25/38), 55.3%(21/38) and 47.4%(18/38), respectively. The localization of epileptogenic area with 123I-Iomazenil brain receptor SPECT was in concordance with Video/EEG monitoring in 20 patients, 99mTc-HMPAO brain SPECT in 15 patients and MRI in 16 patients, respectively. The sensitivity of 123I-Iomazenil brain receptor SPECT combined with MRI for localization of epileptogenic area was 84.2%(32/38). Conclusions: 123I-Iomazenil brain receptor SPECT is a useful method in detecting and localizing epileptogenic area. The combination of 123I-Iomazenil brain receptor SPECT and MRI has a high sensitivity for detecting epileptogenic area

  3. PET/SPECT imaging: From carotid vulnerability to brain viability

    Meerwaldt, Robbert [Department of Surgery, Isala Clinics, Zwolle (Netherlands); Slart, Riemer H.J.A. [Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen (Netherlands); Dam, Gooitzen M. van [Department of Surgery, University Medical Center Groningen, Groningen (Netherlands); Luijckx, Gert-Jan [Department of Neurology, University Medical Center Groningen, Groningen (Netherlands); Tio, Rene A. [Department of Cardiology, University Medical Center Groningen, Groningen (Netherlands); Zeebregts, Clark J. [Department of Surgery, University Medical Center Groningen, Groningen (Netherlands)], E-mail: czeebregts@hotmail.com

    2010-04-15

    Background: Current key issues in ischemic stroke are related to carotid plaque vulnerability, brain viability, and timing of intervention. The treatment of ischemic stroke has evolved into urgent active interventions, as 'time is brain'. Functional imaging such as positron emission tomography (PET)/single photon emission computed tomography (SPECT) could improve selection of patients with a vulnerable plaque and evaluation of brain viability in ischemic stroke. Objective: To describe the current applications of PET and SPECT as a diagnostic tool in relation to ischemic stroke. Methods: A literature search using PubMed identified articles. Manual cross-referencing was also performed. Results: Several papers, all observational studies, identified PET/SPECT to be used as a tool to monitor systemic atheroma modifying treatment and to select high-risk patients for surgery regardless of the degree of luminal stenosis in carotid lesions. Furthermore, PET/SPECT is able to quantify the penumbra region during ischemic stroke and in this way may identify those patients who may benefit from timely intervention. Discussion: Functional imaging modalities such as PET/SPECT may become important tools for risk-assessment and evaluation of treatment strategies in carotid plaque vulnerability and brain viability. Prospective clinical studies are needed to evaluate the diagnostic accuracy of PET/SPECT.

  4. PET/SPECT imaging: From carotid vulnerability to brain viability

    Background: Current key issues in ischemic stroke are related to carotid plaque vulnerability, brain viability, and timing of intervention. The treatment of ischemic stroke has evolved into urgent active interventions, as 'time is brain'. Functional imaging such as positron emission tomography (PET)/single photon emission computed tomography (SPECT) could improve selection of patients with a vulnerable plaque and evaluation of brain viability in ischemic stroke. Objective: To describe the current applications of PET and SPECT as a diagnostic tool in relation to ischemic stroke. Methods: A literature search using PubMed identified articles. Manual cross-referencing was also performed. Results: Several papers, all observational studies, identified PET/SPECT to be used as a tool to monitor systemic atheroma modifying treatment and to select high-risk patients for surgery regardless of the degree of luminal stenosis in carotid lesions. Furthermore, PET/SPECT is able to quantify the penumbra region during ischemic stroke and in this way may identify those patients who may benefit from timely intervention. Discussion: Functional imaging modalities such as PET/SPECT may become important tools for risk-assessment and evaluation of treatment strategies in carotid plaque vulnerability and brain viability. Prospective clinical studies are needed to evaluate the diagnostic accuracy of PET/SPECT.

  5. 99mTc HM-PAO brain perfusion SPECT in brain death

    We have easily carried out and interpreted 99mTc HM-PAO SPECT in a consecutive series of 40 comatose patients with brain damage, without discontinuing therapy. Brain death was diagnosed in 7 patients, by recognising absence of brain perfusion, as shown by no intracranial radionuclide uptake. In patients in whom perfusion was seen on brain scans, HM-PAO SPECT improved assessment of the extent of injury, which in general was larger than suggested by CT. (orig.)

  6. Brain SPECT imaging of Alzheimer's disease and mild cognitive impairment

    Objective: To assess the early diagnostic and prognostic value of brain SPECT imaging in Alzheimer's disease (AD) and mild cognitive impairment (MCI). Methods: Brain SPECT imaging and follow-up study were performed in 33 AD patients, 17 MCI patients and 12 cognitive normal subjects. Results: The typical feature of AD was bilateral temporoparietal hypoperfusion. Compared with MCI and normal group, the regional cerebral blood flow (rCBF) of temporal lobe, parietal lobe, frontal lobe, thalamus and cingulum decreased significantly (P< 0.05). MCI had a significant lower rCBF in temporal lobe only than that in normal group (P<0.05). Besides, the rCBF in cingulum of instable MCI was much lower than that in cingulum of stable MCI (P<0.05). Conclusion: Brain SPECT imaging can provide useful information for the early diagnosis of AD and MCI, and also for the prognosis of MCI. (authors)

  7. [123I] HIPDM as a brain perfusion indicator for SPECT

    The metabolism and kinetics of cerebral uptake of radioactive iodine labelled HIPDM were studied in vivo in rats to evaluate its potential usefulness for quantitative measurement of regional cerebral blood flow (rCBF). The results demonstrate that a method for quantitative measurement of rCBF with iodine labelled HIPDM must take into account its metabolic degradation, diffusion limitations, and bidirectional flux across the blood-brain barrier. Clinical studies have demonstrated that its intracerebral distribution, as assessed by single photon emission tomography (SPECT), reflects the distribution of rCBF. These observations suggest that this molecule might be of potential usefulness for quantitative rCBF measurement with SPECT. (author)

  8. Preliminary application of brain perfusion SPECT imaging in schizophrenia

    The clinical value of 99mTc-ECD brain perfusion SPECT imaging was evaluated in patients with schizophrenia. 32 patients with schizophrenia and 21 normal controls were analyzed with 99mTc-ECD SPECT. 93.8% (30/32) of the patients showed decreased regional cerebral blood flow (rCBF). There was normal rCBF in controls. In the patient group rCBF decreased significantly in bilateral frontal lobes, left temporal lobe and right basal ganglion. The rCBF of left temporal lobe was significantly lower than that of right temporal lobe. The decreasing rCBF was not significantly related to previous treatment and duration of illness. 99mTc-ECD SPECT is useful for the study and diagnosis of patients with schizophrenia

  9. A correlation of clinical, MRI and brain SPECT in dementia

    Background: Dementia is a clinical syndrome characterised by acquired impairment in multiple neuropsycologic and behavior domains including memory, language, speech, visuospatial ability, cognition and mood/personality. Dementia produces deficits in perfusion reflecting decreased metabolic needs. Neuroimaging techniques help in determining whether the cognitive symptoms are organic and in which pattern of cognitive loss the patient may evolve. AIM: To differentiate various types of Dementia, based on the regional perfusion abnormalities seen in Brain SPECT and correlate this with Clinical and MRI findings. Material and methods: Patients suffering from memory impairment and memory loss were referred to our department for Brain SPECT as a part of work up for Dementia. They had undergone a detailed clinical examination, psychometry, mini mental status examination (MMSE), memory/cognitive testing and an MRI. Brain SPECT was done after injecting Tc 99m ECD (Ethylene Cysteinate Dimer ) and imaging after 45 minutes. The images obtained were reconstructed in a conventional way. The various patterns of perfusion abnormalities seen in the SPECT images was studied and correlated with MRI and clinical findings. The patients were thus classified as having Multi Infarct Dementia, Alzheimer's disease, Fronto-Temporal Dementia and Mixed variety. Results: Twenty One Patients were included in our study from February 2003 to February 2004. The mean age of the patients was 73 years ( 37 to 81). 15 were males and 6 were females. Out of 21 patients, 12 had Multi Infarct Dementia, 4 had Alzheimer's disease, 1 had Fronto- Temporal Dementia and 4 had Mixed variety. Conclusion: Brain SPECT aids in substantiating the clinical findings and in correlation with MRI helps in distinguishing various types of Dementia and thus has prognostic implications and helps in instituting early appropriate treatment to the patient. In our study, the majority of the patients have Multi Infarct Dementia

  10. Clinical significance of I-123 IMP brain SPECT in children with brain diseases

    Single photon emission computed tomography (SPECT) of the brain using N-isopropyl p-I-123-iodoamphetamine (I-123 IMP) was performed in 43 children with suspected brain diseases. Forty-three children (25 males and 18 females), with an age range of 24 days-15 years (mean: 6.6 years), were included in the study. Six patients were subsequently diagnosed as normal. Early SPECT of the brain was performed 30 minutes after intravenous administration of 74-111 MBq (2-3 mCi) I-123 IMP using a rotating gamma camera equipped with a 30-degree slant hole and medium energy collimator. Transverse images were reconstructed by Shepp-Logan filtered back projection method with attenuation correction after spatial filtering using an 8th order Butterworth-Wiener filter. Findings of I-123 IMP SPECT were compared with those of X-ray computed tomography (CT) and electroencephalography (EEG). The results showed that in I-123 IMP SPECT, abnormality was found in 30 out of 37 children with brain diseases. The incidence of abnormal findings in the 37 patients was 81% in I-123 IMP SPECT, 61% in X-ray CT, and 78% in EEG; in both cryptogenic and secondary epilepsy, the incidence of abnormality was higher in I-123 IMP SPECT than in X-ray CT. (70% and 94% vs 50% and 81% respectively), and epileptic foci detected by EEG did not correspond with defects found using I-123 IMP SPECT in 27% of the patients; and in asphyxiated infants, a high incidence of abnormality was observed on both I-123 IMP SPECT (86%) and X-ray CT (86%). In conclusion, I-123 IMP SPECT is a clinically useful examination in children with brain disease. (author)

  11. Assessment of brain retraction injury from tumor operation with 99Tcm-ECD brain SPECT imaging

    Objective: To evaluate the rCBF of brain retraction injury by 99Tcm-ECD SPECT imaging. Methods: The 99Tcm-ECD SPECT brain imaging was performed in 21 patients with brain tumor before and after operation. To compare the rCBF of peripheral tumor region with that of retraction injury region by semi-quantitative analysis. The rCBF levels of the central and peripheral areas of brain retraction injury were also studied. Results: Both the peripheral tumor region before operation and retraction region after operation were ischemic, but the difference between them was significant (P99Tcm-ECD SPECT brain imaging is a useful technique in detecting retraction injury come from brain tumor operation

  12. Absolute quantification in brain SPECT imaging

    Cot Sanz, Albert

    2003-01-01

    Certes malalties neurològiques estan associades amb problemes en els sistemes de neurotransmissió. Una aproximació a l'estudi d'aquests sistemes és la tomografia d'emissió SPECT (Single Photon Emission Computed Tomography) com a tècnicano-invasiva que proporciona imatges funcionals representatives de l'activitat neuronal. Aquesta tècnica permet la visualització i l'anàlisi de diferents òrgans i teixits dins l'àmbit de la Medicina Nuclear.Malgrat que la inspecció visual de la imatge a vegades ...

  13. The need of appropriate brain SPECT templates for SPM comparisons

    Statistical parametric mapping (SPM) is used worldwide to compare brain perfusion single photon emission computed tomography (SPECT) data. The default template within the SPM package used for SPECT image normalization includes images of a group of healthy subjects studied with 99mTcHMPAO. Since [99mTc] HMPAO and [99mTc] ECD have shown to distribute differently in SPECT studies, we formulated the hypothesis that comparing set of [99mTc]ECD data normalized by means of a [99mTc]HMPAO template may lead to incorrect results. A customized [99mTc]ECD template was built with SPECT and magnetic resonance imaging (MRI) images of 22 neurologically healthy women. Then, two sets of subjects, i.e. a group of patients with very early Alzheimer's disease (eAD) and a matched control group, studied by means of [99mTc]ECD SPECT, were chosen for comparisons. The same statistical approach (t-test between eAD patients and controls and correlation analysis between brain SPECT and a cognitive score) was applied twice, i.e. after normalization with either the default [99mTc]HMPAO template or the customized [99mTc]ECD template. In the comparison between eAD and controls, a cluster of difference in the posterior-cingulate gyrus of both hemispheres was only highlighted when using the customized [99mTc]ECD template, but was missed when using the default [99mTc]HMPAO template. In the correlation between brain perfusion and a cognitive score, the significant cluster was more significant and far more extended, also including the right superior temporal gyrus, using the customized [99mTc]ECD template than using the default [99mTc]HMPAO template. These data suggest the need of customized, radiopharmaceutical-matched SPECT templates to be used within the SPM package. The present customized [99mTc]ECD template is now freely available on the web. (authors)

  14. Collimator design for a multipinhole brain SPECT insert for MRI

    Purpose: Brain single photon emission computed tomography (SPECT) imaging is an important clinical tool, with unique tracers for studying neurological diseases. Nowadays, most commercial SPECT systems are combined with x-ray computed tomography (CT) in so-called SPECT/CT systems to obtain an anatomical background for the functional information. However, while CT images have a high spatial resolution, they have a low soft-tissue contrast, which is an important disadvantage for brain imaging. Magnetic resonance imaging (MRI), on the other hand, has a very high soft-tissue contrast and does not involve extra ionizing radiation. Therefore, the authors designed a brain SPECT insert that can operate inside a clinical MRI. Methods: The authors designed and simulated a compact stationary multipinhole SPECT insert based on digital silicon photomultiplier detector modules, which have shown to be MR-compatible and have an excellent intrinsic resolution (0.5 mm) when combined with a monolithic 2 mm thick LYSO crystal. First, the authors optimized the different parameters of the SPECT system to maximize sensitivity for a given target resolution of 7.2 mm in the center of the field-of-view, given the spatial constraints of the MR system. Second, the authors performed noiseless simulations of two multipinhole configurations to evaluate sampling and reconstructed resolution. Finally, the authors performed Monte Carlo simulations and compared the SPECT insert with a clinical system with ultrahigh-resolution (UHR) fan beam collimators, based on contrast-to-noise ratio and a visual comparison of a Hoffman phantom with a 9 mm cold lesion. Results: The optimization resulted in a stationary multipinhole system with a collimator radius of 150.2 mm and a detector radius of 172.67 mm, which corresponds to four rings of 34 diSPM detector modules. This allows the authors to include eight rings of 24 pinholes, which results in a system volume sensitivity of 395 cps/MBq. Noiseless simulations

  15. Collimator design for a multipinhole brain SPECT insert for MRI

    Van Audenhaege, Karen; Van Holen, Roel; Vanhove, Christian; Vandenberghe, Stefaan [Department of Electronics and Information Systems, Ghent University-iMinds Medical IT, MEDISIP-IBiTech, De Pintelaan 185 block B/5, Ghent B-9000 (Belgium)

    2015-11-15

    Purpose: Brain single photon emission computed tomography (SPECT) imaging is an important clinical tool, with unique tracers for studying neurological diseases. Nowadays, most commercial SPECT systems are combined with x-ray computed tomography (CT) in so-called SPECT/CT systems to obtain an anatomical background for the functional information. However, while CT images have a high spatial resolution, they have a low soft-tissue contrast, which is an important disadvantage for brain imaging. Magnetic resonance imaging (MRI), on the other hand, has a very high soft-tissue contrast and does not involve extra ionizing radiation. Therefore, the authors designed a brain SPECT insert that can operate inside a clinical MRI. Methods: The authors designed and simulated a compact stationary multipinhole SPECT insert based on digital silicon photomultiplier detector modules, which have shown to be MR-compatible and have an excellent intrinsic resolution (0.5 mm) when combined with a monolithic 2 mm thick LYSO crystal. First, the authors optimized the different parameters of the SPECT system to maximize sensitivity for a given target resolution of 7.2 mm in the center of the field-of-view, given the spatial constraints of the MR system. Second, the authors performed noiseless simulations of two multipinhole configurations to evaluate sampling and reconstructed resolution. Finally, the authors performed Monte Carlo simulations and compared the SPECT insert with a clinical system with ultrahigh-resolution (UHR) fan beam collimators, based on contrast-to-noise ratio and a visual comparison of a Hoffman phantom with a 9 mm cold lesion. Results: The optimization resulted in a stationary multipinhole system with a collimator radius of 150.2 mm and a detector radius of 172.67 mm, which corresponds to four rings of 34 diSPM detector modules. This allows the authors to include eight rings of 24 pinholes, which results in a system volume sensitivity of 395 cps/MBq. Noiseless simulations

  16. Brain FDG-PET Scan and Brain Perfusion SPECT in the Diagnosis of Neuroacanthocytosis Syndromes

    Eylem Değirmenci

    2015-06-01

    Full Text Available Neuroacanthocytosis syndromes (NA include autosomal recessive chorea-acanthocytosis and X-linked McLeod syndrome consisting of a choreatic movement disorder, psychiatric manifestations and cognitive decline, and additional multi-system features including myopathy and axonal neuropathy. Fluor 18 -2-fluoro-2-deoxyglucose (18F-FDG-PET positron emission tomography (PET and technetium 99m -d, l-hexamethyl-propylene amine oxime (99mTc-HMPAO brain single photon emission computed tomography (SPECT have been increasingly used for the detection of neurologic disorders, such as dementia, epilepsy, and movement disorders. In this case report, we report two patients with neuroacanthocytosis syndromes with the imaging features of brain metabolism by PET and brain perfusion by SPECT. Brain PET and brain SPECT findings of patients with neuroacanthocytosis syndromes were also reviewed.

  17. Anatomically standardized statistical mapping of 123I-IMP SPECT in brain tumors

    123I-iodoamphetamine Single Photon Emission Computed Tomography (IMP SPECT) is used to evaluate cerebral blood flow. However, application of IMP SPECT to patients with brain tumors has been rarely reported. Primary central nervous system lymphoma (PCNSL) is a rare tumor that shows delayed IMP uptake. The relatively low spatial resolution of SPECT is a clinical problem in diagnosing brain tumors. We examined anatomically standardized statistical mapping of IMP SPECT in patients with brain lesions. This study included 49 IMP SPECT images for 49 patients with brain lesions: 20 PCNSL, 1 Burkitt's lymphoma, 14 glioma, 4 other tumor, 7 inflammatory disease and 3 without any pathological diagnosis but a clinical diagnosis of PCNSL. After intravenous injection of 222 MBq of 123I-IMP, early (15 minutes) and delayed (4 hours) images were acquired using a multi-detector SPECT machine. All SPECT data were transferred to a newly developed software program iNeurostat+ (Nihon Medi-physics). SPECT data were anatomically standardized on normal brain images. Regions of increased uptake of IMP were statistically mapped on the tomographic images of normal brain. Eighteen patients showed high uptake in the delayed IMP SPECT images (16 PCNSL, 2 unknown). Other tumor or diseases did not show high uptake of delayed IMP SPECT, so there were no false positives. Four patients with pathologically proven PCNSL showed no uptake in original IMP SPECT. These tumors were too small to detect in IMP SPECT. However, statistical mapping revealed IMP uptake in 18 of 20 pathologically verified PCNSL patients. A heterogeneous IMP uptake was seen in homogenous tumors in MRI. For patients with a hot IMP uptake, statistical mapping showed clearer uptake. IMP SPECT is a sensitive test to diagnose of PCNSL, although it produced false negative results for small posterior fossa tumor. Anatomically standardized statistical mapping is therefore considered to be a useful method for improving the diagnostic

  18. Multipinhole collimator with 20 apertures for a brain SPECT application

    Lee, Tzu-Cheng; Ellin, Justin R.; Shrestha, Uttam; Seo, Youngho, E-mail: youngho.seo@ucsf.edu [Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94107 (United States); Huang, Qiu [School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030 (China); Gullberg, Grant T. [Department of Radiotracer Development and Imaging Technology, Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California 94702 (United States)

    2014-11-01

    Purpose: Several new technologies for single photon emission computed tomography (SPECT) instrumentation with parallel-hole collimation have been proposed to improve detector sensitivity and signal collection efficiency. Benefits from improved signal efficiency include shorter acquisition times and lower dose requirements. In this paper, the authors show a possibility of over an order of magnitude enhancement in photon detection efficiency (from 7.6 × 10{sup −5} to 1.6 × 10{sup −3}) for dopamine transporter (DaT) imaging of the striatum over the conventional SPECT parallel-hole collimators by use of custom-designed 20 multipinhole (20-MPH) collimators with apertures of 0.75 cm diameter. Methods: Quantifying specific binding ratio (SBR) of {sup 123}I-ioflupane or {sup 123}I-iometopane’s signal at the striatal region is a common brain imaging method to confirm the diagnosis of the Parkinson’s disease. The authors performed imaging of a striatal phantom filled with aqueous solution of I-123 and compared camera recovery ratios of SBR acquired between low-energy high-resolution (LEHR) parallel-hole collimators and 20-MPH collimators. Results: With only two-thirds of total acquisition time (20 min against 30 min), a comparable camera recovery ratio of SBR was achieved using 20-MPH collimators in comparison to that from the LEHR collimator study. Conclusions: Their systematic analyses showed that the 20-MPH collimator could be a promising alternative for the DaT SPECT imaging for brain over the traditional LEHR collimator, which could give both shorter scan time and improved diagnostic accuracy.

  19. Multipinhole collimator with 20 apertures for a brain SPECT application

    Purpose: Several new technologies for single photon emission computed tomography (SPECT) instrumentation with parallel-hole collimation have been proposed to improve detector sensitivity and signal collection efficiency. Benefits from improved signal efficiency include shorter acquisition times and lower dose requirements. In this paper, the authors show a possibility of over an order of magnitude enhancement in photon detection efficiency (from 7.6 × 10−5 to 1.6 × 10−3) for dopamine transporter (DaT) imaging of the striatum over the conventional SPECT parallel-hole collimators by use of custom-designed 20 multipinhole (20-MPH) collimators with apertures of 0.75 cm diameter. Methods: Quantifying specific binding ratio (SBR) of 123I-ioflupane or 123I-iometopane’s signal at the striatal region is a common brain imaging method to confirm the diagnosis of the Parkinson’s disease. The authors performed imaging of a striatal phantom filled with aqueous solution of I-123 and compared camera recovery ratios of SBR acquired between low-energy high-resolution (LEHR) parallel-hole collimators and 20-MPH collimators. Results: With only two-thirds of total acquisition time (20 min against 30 min), a comparable camera recovery ratio of SBR was achieved using 20-MPH collimators in comparison to that from the LEHR collimator study. Conclusions: Their systematic analyses showed that the 20-MPH collimator could be a promising alternative for the DaT SPECT imaging for brain over the traditional LEHR collimator, which could give both shorter scan time and improved diagnostic accuracy

  20. Thallium-201 brain SPECT to diagnose aggressiveness of meningiomas

    This investigation was conducted to determine the ability of 201Tl brain SPECT with respect to pre-operative prediction of lesional aggressiveness of meningioma. Fifty-nine lesions in 42 patients were examined. Early (15 min) and late (3 h) SPECT were obtained. Early uptake ratio (ER; lesion to normal brain average count ratio), late uptake ratio (LR) and the ratio of LR to ER (L/E ratio) were calculated. Twenty-three lesions exhibited malignant features based on histologic or clinical course such as recurrence or skull invasion. Both ER and LR of malignant meningiomas were significantly higher than those in thirty-six benign lesions. Benign lesions were classified into two groups for further analysis: meningotheliomatous type, which is the most common histology, and benign lesions other than the meningotheliomatous (other benign) type. ER in other benign type was lower than the meningotheliomatous and the malignant type. LR afforded differentiation of the malignant type from the two benign types. These two benign types could be distinguished on the basis of the L/E ratio. These results indicate that high pre-operative ER and LR values in patients with meningioma are indicators of the aggressiveness of lesions, i.e., malignant meningioma, recurrence or skull invasion. (author)

  1. Optimization of Butterworth filter for brain SPECT imaging

    A method has been described to optimize the cutoff frequency of the Butterworth filter for brain SPECT imaging. Since a computer simulation study has demonstrated that separation between an object signal and the random noise in projection images in a spatial-frequency domain is influenced by the total number of counts, the cutoff frequency of the Butterworth filter should be optimized for individual subjects according to total counts in a study. To reveal the relationship between the optimal cutoff frequencies and total counts in brain SPECT study, we used a normal volunteer and 99mTc hexamethyl-propyleneamine oxime (HMPAO) to obtain projection sets with different total counts. High quality images were created from a projection set with an acquisition time of 300-seconds per projection. The filter was optimized by calculating mean square errors from high quality images visually inspecting filtered reconstructed images. Dependence between total counts and optimal cutoff frequencies was clearly demonstrated in a nomogram. Using this nomogram, the optimal cutoff frequency for each study can be estimated from total counts, maximizing visual image quality. The results suggest that the cutoff frequency of Butterworth filter should be determined by referring to total counts in each study. (author)

  2. Cortical region of interest definition on SPECT brain images using X-ray CT registration

    We present a method for brain single photon emission computed tomography (SPECT) analysis based on individual registration of anatomical (CT) and functional (133Xe regional cerebral blood flow) images and on the definition of three-dimensional functional regions of interest. Registration of CT and SPECT is performed through adjustment of CT-defined cortex limits to the SPECT image. Regions are defined by sectioning a cortical ribbon on the CT images, copied over the SPECT images and pooled through slices to give 3D cortical regions of interest. The proposed method shows good intra- and interobserver reproducibility (regional intraclass correlation coefficient ≅0.98), and good accuracy in terms of repositioning (≅3.5 mm) as compared to the SPECT image resolution (14 mm). The method should be particularly useful for analysing SPECT studies when variations in brain anatomy (normal or abnormal) must be accounted for. (orig.)

  3. Early dynamic Thallium-201 SPECT in evaluation of brain tumors

    Purpose: We performed early dynamic 201TlCl SPECT studies on patients with brain tumors to determine the value of 201TlCl dynamics for 15 minutes in distinguishing and evaluating the histologic grade of brain tumors. Method: SPECT studies were performed on 69 patients with brain tumors prior to surgical resection. Histological diagnosis was as follows: 28 patients with glioblastoma (grade IV), 8 patients with anaplastic astrocytoma (grade III), 5 patients with grade II astrocytoma, 1 patients with pilocytic astrocytoma (grade I), and 27 patients with meningioma. Pilocytic astrocytoma and grade II astrocytoma were grouped together as low-grade gliomas. Results: In glioblastomas, the Time-activity ratios(TARs) increased significantly at 6 min (99.2±6.0%, p<0.0001 ), 9 min (103.0±4.6%, p<0.0001), 12 min (102.1±6.4%, p<0.01), and 15 min (102.0±5.0%, p<0.001) after 201TlCl administration when compared to the TAR at 3 min (93.7±6.9%). Unchanged radioactivity was observed on the time-activity curve in anaplastic astrocytomas (3 min: 106.0±17.8%, 6 min: 103.8±9.4%, 9 min: 99.1±6.3%, 12 min: 95.0±11.0%, 15 min: 96.0±13.0%). The TARs decreased significantly at 6 min (104.0±7.1%, p<0.05), 9 min (96.1±4.9%, p<0.02), 12 min(95.0±6.5%, p<0.05), and 15 min (89.8±12.8%, p<0.05) compared to the TAR at 3 min (113.9±9.5%) in low grade gliomas. In meningiomas, the TARs decreased at 12 min (94.0±9.1%, p<0.01), and 15 min (93.6±12.8%, p<0.02) compared to the TAR at 3 min (108.6±18.5%) respectively. Conclusion: In this early dynamic SPECT study, the entire duration of the examination is short, 15 minutes, a period similar to other general laboratory tests. Moreover, there is no need for adjustments of the imaging location with this method since continuous scanning is utilized. This examination method indicated not only 201Tl uptake but accumulative dynamics and also offer more accurate assessment in the diagnosis of brain tumors

  4. A new modular detector for a cylindrical brain SPECT system

    A new detector module has been developed for a prototype system, McSPECT 2, which is being constructed for high-resolution clinical brain imaging. The detector module is the building block of the cylindrical detector system of the McSPECT 2. Each detector module contains 5 NaI(Tl) bars and is backed by a glass window in an aluminum housing. Each detector module is associated with 6 PMTs to form a functional unit for position estimation. Bench-top tests performed on a sample unit demonstrated an average of 10.5% local energy resolution (ER) at 140 keV. Centroid calculations were applied in both orthogonal directions of the module for position estimation. In the longitudinal direction, a two-step centroid method yields a 13 cm UFOV (useful field-of-view) along the bar and an 11 cm CFOV (center FOV), with intrinsic spatial resolution of < 5.5 and 3.8 ± 0.3 mm FWHM, respectively. In the transverse direction, the task of identifying the bar detector involved in an event is simplified, with an accuracy better than 99% when photons are incident normally

  5. Evaluation of brain tumor using technetium-99m-tetrofosmin SPECT. Initial experience

    Technetium-99m-Tetrofosmin (TF) is the tracer for single photon emission computed tomography (SPECT). It is commercially available in Japan and covered by Japanese health insurance only for ischemic heart diseases. In other countries, TF has been used for imaging of various brain tumors. We examined TF SPECT in patients with brain tumor and compared the image findings with other radiological image findings. The study population included 11 patients (4 men and 7 women) aged 48-87 years. The histological tumor diagnoses were as follows: glioblastoma multiforme (GBM; n=7), anaplastic oligoastrocytoma (n=1), meningioma (n=1), and metastasis (n=2). SPECT images were acquired using multidetector SPECT camera (E.CAM, Siemens) at 15 min and 3 h after intravenous injection of 740MBq of TF or 74MBq of Thallium chloride (Tl). The tracer uptakes of TF and Tl were almost similar. Both TF and Tl delayed SPECT images showed hot uptake in the tumors of GBM patients. In meningioma patients, both TF and Tl early images showed hot uptake, whereas the tracers were washed out in delayed images. TF SPECT images were clearer than Tl SPECT images. There was physiological uptake of TF in the normal choroid plexus; this finding helps in understanding the spatial correlation between the tumors and ventricles. No side effects with TF injection were observed. TF SPECT is better and more useful than Tl SPECT to diagnose location, extent, malignancy, and viability of tumors as well as the effects of anticancer therapies. (author)

  6. SPECT brain perfusion findings in mild or moderate traumatic brain injury

    Background: The purpose of this manuscript is to present the findings in the largest series of SPECT brain perfusion imaging reported to date for mild or moderate traumatic brain injury. PATIENTS AND METHODS: This is a retrospective evaluation of 228 SPECT brain perfusion-imaging studies of patients who suffered mild or moderate traumatic brain injury with or without loss of consciousness (LOC). All patients had no past medical history of previous brain trauma, neurological, or psychiatric diseases, HIV, alcohol or drug abuse. The patient population included 135 males and 93 females. The ages ranged from 11-88 years (mean 40.8). The most common complaints were characteristic of the postconcussion syndrome: headaches 139/228 (61%); dizziness 61/228 (27%); and memory problems 63/228 (28%). LOC status was reported to be positive in 121/228 (53%), negative in 41/228 (18%), and unknown for 63/228 (28%). RESULTS: Normal studies accounted for 52/228 (23%). For abnormal studies (176/228 or 77%) the findings were as follows: basal ganglia hypoperfusion 338 lesions (55.2%); frontal lobe hypoperfusion 146 (23.8%); temporal lobes hypoperfusion 80 (13%); parietal lobes hypoperfusion 20 (3.7%); insular and or occipital lobes hypoperfusion 28 (4.6%). Patients' symptoms correlated with the SPECT brain perfusion findings. The SPECT BPI studies in 122/228 (54%) were done early within 3 months of the date of the accident, and for the remainder, 106/228 (46%) over 3 months and less than 3 years from the date of the injury. In early imaging, 382 lesions were detected; in 92 patients (average 4.2 lesions per study) imaging after 3 months detected 230 lesions: in 84 patients (average 2.7 lesions per study). CONCLUSIONS: Basal ganglia hypoperfusion is the most common abnormality following mild or moderate traumatic brain injury (p = 0.006), and is more common in patients complaining of memory problem (p = 0.0005) and dizziness (p = 0.003). Early imaging can detect more lesions than

  7. Cerebral perfusion changes in traumatic diffuse brain injury. IMP SPECT studies

    Diffuse brain injury (DBI) is characterized by axonal degeneration and neuronal damage which cause diffuse brain atrophy. We have investigated the time course of abnormalities in cerebral perfusion distribution in cases of DBI by using Iodine-123-IMP SPECT, and the relationship to the appearance of diffuse brain atrophy. SPECT scans were performed on eight patients with diffuse brain injury due to closed cranial trauma in acute and chronic stages. All patients showed abnormalities in cerebral perfusion with decreases in perfusion, even in non-depicted regions on MRI, and the affected areas varied throughout the period of observation. Diffuse brain atrophy appeared in all patients. In some patients, diffuse brain atrophy was observed at or just after the time when the maximum number of lesions on SPECT were seen. The abnormalities in cerebral perfusion in cases of DBI might therefore be related to axonal degeneration and neuronal damage which causes diffuse brain atrophy. (author)

  8. Herpes simplex encephalitis: increased retention of Tc-99m HMPAO on acetazolamide enhanced brain perfusion SPECT

    We present an interesting case of herpes simplex encephalitis, which showed increased upta unilateral temporal cortex on brain perfusion SPECT using Tc-99m HMPAO, but in bilateral tem cortex after acetazolamide administration. A 42-year-old man was admitted via emergency room, due to rapidly progressing hea disorientation and mental changes. On neurologic examination, neck stiffness and Kernig sign noted. CSF examination showed pleocytosis with lymphcyte predominance. MRI showed swelling bilateral temporal lobe with left predominance, suggestive of herpes simplex encephalitis. Baseline/ Acetazolamide brain perfusion SPECT were acquired consecutively at the same position IV administration of 740MBq and additional 1480 MBq of Tc-99m HMPAO respectively. The temporal and inferior frontal cortex showed markedly increased perfusion on the baseline acetazolamide-enhanced SPECT images. The right temporal cortex showed normal uptake on the b SPECT images, and markedly increased uptake after acetazolamide administration, which seemed to the abundant vascularity at the acute inflammation site without marked brain damage. The fo brain perfusion SPECT after 6 months showed perfusion defect in left temporal cortex but norm perfusion in right temporal cortex. Therefore, we can conclude that baseline SPECT is helpful for the prediction of the prognosis acetazolamide SPECT for the evaluation of the extent of herpes simples encephalitis

  9. Baseline and cognition activated brain SPECT imaging in depression

    Purpose: To evaluate the regional cerebral blood flow (rCBF) abnormalities through the semiquantitative analysis of the baseline and cognition activated rCBF imaging in unmedicated depressed patients. Methods: 27 depressed patients unmedicated by anti-depressants were enrolled. The diagnosis (depression of moderate degree with somatization) was confirmed by the ICD-10 criteria. 15 age matched normal controls were studied under identical conditions. Baseline and cognition activated 99mTc-ECD SPECT were performed on 21 of the 27 patients with depression and 13 of the 15 normal controls. Baseline 99mTc-ECD SPECT alone were performed on the rest 6 patients with depression and 2 normal controls. The cognitive activation is achieved by Wisconsin Card Sorting Test (WCST). 1110 MBq of 99mTc-ECD was administered by intravenous bolus injection 5 minutes after the onset of the WCST. Semi-quantitative analysis was conducted with the 7th, 8th, 9th, 10th, 11th slices of the transaxial imaging. rCBF ratios of every ROI were calculated using the average tissue activity in the region divided by the maximum activity in the cerebellum. Results: 1) The baseline rCBF of left frontal (0.720) and left temporal lobe (0.720) were decreased significantly in depressed patients comparing with those of the control subjects. 2) The activated rCBF of left frontal lobe (0.719) and left temporal lobe (0.690), left parietal lobe (0.701) were decreased evidently than those of the controls. Conclusions: 1) Hypoperfusions of left frontal and left temporal cortexes were identified in patients with depression. 2) The hypoperfusion of left frontal and left temporal cortexes may be the cause of cognition disorder and depressed mood in patients with depression. 3) Cognition activated brain perfusion imaging is helpful for making a more accurate diagnosis of depression

  10. Assessment of brain SPECT neuropsychiatric involvement in collagen-vascular diseases

    Objective: To study the value of brain SPECT in the diagnosis and follow up of SNC involvement in systemic connective tissue diseases (SCTD) with neuropsychiatric symptoms (NPS). Materials and methods: We retrospectively analyzed 31 consecutive patients with SCTD presenting with NPS who underwent 99mTc-ECD SPECT and statistical surface maps. 21 patients had systemic lupus erythematosus and 3 had Behcet disease. Results were compared to those of CT (18/31), MRI (8/31) and neuropsychological examination (NPE). 6 patients had follow-up SPECT scans. Results: Twenty-eight patients had abnormal SPECT studies. CT was abnormal in 3/18 patients (sensitivity 90.3% vs. 16.7%; p<0.001). MRI showed alterations in 5/8 patients and NPE in 7/10. Although all these patients presented abnormal SPECT scans, sensitivity values were not statistically different. Patients with major NPS presented more extensive perfusion defects (p<0.035). Patients with follow-up SPECT scans showed perfusion improvement with response to treatment and progression of the alterations when symptoms relapsed. Conclusion:Brain SPECT presents high sensitivity for the detection of neurological involvement in SCTD. SPECT usefulness may extend to follow-up and evaluation of response to treatment

  11. Preoperative localization of epileptic foci with SPECT brain perfusion imaging, electrocorticography, surgery and pathology

    Objective: The value of preoperative localization of epileptic foci with SPECT brain perfusion imaging was investigated. Methods: The study population consisted of 23 patients with intractable partial seizures which was difficult to control with anticonvulsant for long period. In order to preoperatively locate the epileptic foci, double SPECT brain perfusion imaging was performed during interictal and ictal stage. The foci were confirmed with electrocorticography (EcoG), surgery and pathology. Results: The author checked with EcoG the foci shown by SPECT, 23 patients had all typical spike discharge. The regions of radioactivity increase in ictal matched with the abnormal electrical activity areas that EcoG showed. The spike wave originated in the corresponding cerebrum cortex instead of hyperplastic and adherent arachnoid or tumor itself. Conclusions: SPECT brain perfusion imaging contributes to distinguishing location, size, perfusion and functioning of epileptogenic foci, and has some directive function on to making out a treatment programme at preoperation

  12. Functional brain imaging with SPECT in normal again and dementia. Methodological, pathophysiological, and diagnostic aspects

    New developments in instrumentation, radiochemistry, and data analysis, particularly the introduction of 99mTc-labeled brain-retained tracers for perfusion studies, have opened up a new era of single photon emission computed tomography (SPECT). In this review critical methodological issues relating to the SPECT instrument, the radioactive tracers, the scanning procedure, the data analysis and interpretation of data, and subject selection are discussed together with the changes in regional cerebral blood flow (rCBF) observed in normal aging. An overview is given of the topography and the pathophysiological and diagnostic significance of focal rCBF deficits in Alzheimer's disease and in other dementia disorders, in which SPECT is capable of early or preclinical disease detection. In Alzheimer's disease, the diagnostic sensitivity and specificity of focal rCBF deficits measured with SPECT and brain-retained tracers are very high, in particular when combined with medial temporal lob atrophy on CT. Together with neuropsychological testing, SPECT serves to map the topography of brain dysfunction. Thus, in the clinical setting, SPECT provides information that is supplemental to that obtained in other studies. Future applications include neuroreceptor studies and treatment studies, in which SPECT may serve as a diagnostic aid in the selection of patients and as a potential mean for monitoring treatment effects. Although positron emission tomography is the best characterized tool for addressing some of these clinical and research issues in dementia, only the less expensive and technically simpler SPECT technique will have the potential of being available as a screening diagnostic instrument in the clinical setting. It is concluded that, properly approached, functional brain imaging with SPECT represents an important tool in the diagnosis, management, and research of dementia disorders. (au) 251 refs

  13. Tc-99m-MIBI brain SPECT in differentiating tumor recurrences from necrosis

    Brain SPECT using 99m-TC MIBI can distinguish between local tumor recurrence and radio necrosis of the primary brain tumor, whereas CT scan and MRI do not have this ability. 1. Is it possible to search for tumoral cells in the brain by using TC-99m MIBI? 2. How sensitive and specific is the SPECT in distinguishing the presence of active tumor in the brain and differentiating it from post-therapy necrosis? 3. Is it feasible to substitute this diagnostic modality for stereotactic biopsy surgery? Patients who presented to the neurosurgery clinic with the clinical manifestations of brain tumor relapse between 22nd August 1999 and 1.; February 2000 and were candidates for stereotactic biopsy were chosen. A 99m-TC MIBI SPECT was performed before biopsy. The total number of patients was 13. Five patients had the diagnosis of brain tumor by surgery and biopsy and had undergone a course of radiotherapy and chemotherapy. These patients were normal clinically and MIBI SPECT was done for the purpose of follow-up. Clinical manifestations consisted of, Weakness, Vertigo visual disorders, loss of consciousness, headache, aphasia and hemiparesis. The primary tumors were composed of a variety of lei sons including: grade I, II astrocytoma (62.5%), glioblastoma (25%) and medulloblastoma (12.5%). eight patients who had MIBI SPECT firstly and then had biopsy, brain tumor relapse was reported by both biopsy and SPECT in seven patients. This proved a 100% sensitivity and a 100% specificity for MIBI SPECT in differentiating, between tumor relapse and necrosis, a result comparable to stereotactic biopsy. Also in 5 patients with clinical evidence of remission, MIBI SPECT was negative for tumor recurrence in all. Patients who present with the clinical manifestations of brain tumor relapse, usually have a history of surgery, radiotherapy or chemotherapy and any invasive procedures like stereotactic biopsy on these patients carries a high risk for anesthesia and surgery, besides being costly

  14. Utility of 99mTc-GHA Brain SPECT in the grading of brain tumors

    Full text: Brain tumors are of diverse histological types, the most common being derived from glial tissue. The clinical management and prognosis of brain tumor patients is dependent on accurate neuro-pathologic diagnosis and grading. Radiological imaging is not always a good modality for assessing the exact nature and grade of a malignant tumor. Magnetic resonance imaging (MRI) has a very high soft tissue resolution and is helpful in classifying the grade of tumor. Radionuclide imaging techniques that can reveal metabolic activity within tumor cells are very helpful in predicting the degree of malignancy. Usefulness of Tl-201 SPECT and FDG PET studies have been widely reported to evaluate malignant lesions by measuring increased regional glucose metabolism and amino acid uptake. 99mTc-GHA (Glucoheptonate), more or less analogous to 18F-FDG, may show increased glucose metabolism and help in grading tumors. This study was carried out to determine the utility of 99mTc-GHA SPECT for grading cerebral gliomas. Nineteen patients (12M, 7F) aged 22 to 51 years (36.1 ± 8.3) diagnosed clinically and radiologically to have a brain tumor were evaluated with 99mTc-GHA brain SPECT. All the patients had undergone CT/ MRI examination prior to the brain SPECT study. No patient had undergone surgery, radiation therapy or chemotherapy before the imaging studies. Brain SPECT was performed twice, i.e 40 min and 3 hours after intravenous administration of 20 mCi of Tc99m-GHA under a dual head SPECT gamma camera (Ecam, Siemens), with a low energy high-resolution collimator. A total of 128 frames of 30 seconds each, 64 per detector, were acquired in 128 x 128 matrix, with 360-degree rotation in step and shoot mode. Reconstruction of the SPECT data was done using standard software. Abnormal concentration of tracer at the tumor site was compared to normal uptake on the contralateral side, and ratios obtained for early (40 min) and delayed (3 hours) uptake of tracer. Retention ratio (RR), a

  15. MRI and brain spect findings in patients with unilateral temporal lobe epilepsy and normal CT scan

    P.G. Carrilho

    1994-06-01

    Full Text Available 26 patients with temporal lobe epilepsy clinically documented by several abnormal interictal surface EEGs with typical unitemporal epileptiform activity and a normal CT scan were studied. Interictal99mTC HMPAO brain SPECT and MRI were performed in all subjects. Abnormalities were shown in 61.5% of MRI (n=16 and 65.4% of SPECT (n=17. Hippocampal atrophy associated to a high signal on T2-weighted MRI slices suggesting mesial temporal sclerosis was the main finding (n=12; 75% of abnormal MRI. MRI correlated well to surface EEG in 50% (n=13. There was also a good correlation between MRI and SPECT in 30.7% (n=8. SPECT and EEG were in agreement in 57.7% (n=l5. MRI, SPECT and EEG were congruent in 26.9% (n=7. These results support the usefulness of interictal brain SPECT and MRI in detecting lateralized abnormalities in temporal lobe epilepsy. On the other hand, in two cases, interictal SPECT correlated poorly with surface EEG. This functional method should not be used isolately in the detection of temporal lobe foci. MRI is more useful than CT as a neuroimaging technique in temporal lobe epilepsy. It may detect small structural lesions and mesial temporal lobe sclerosis which are not easily seen with traditional CT scanning.

  16. Evaluation of peritumoral area associated with brain tumor in posterior cranial fossa using three dimensional SPECT

    We measured peritumoral hypoperfusion volume associated with brain tumor in posterior cranial fossa using SPECT and compared the result with volumes of tumor and peritumoral edema on MRI. Seventeen patients with brain tumor in posterior cranial fossa, who underwent 123 I-IMP SPECT and MRI before operation, were studied. The SPECT images were performed in three dimension using a panning visualization software (application visualization system medical viewer: AVS-MV). The peritumoral hypoperfusion area on three dimensional SPECT was larger than the volume of edema on MRI with a statistical different (p<0.001). Acoustic tumor cases showed a good correlation between the volume of peritumoral hypoperfusion area on three dimensional SPECT and the volume of edema on MRI. These results suggest tumor volume in posterior cranial fossa affects cerebral circulation. It is assumed that pressure exerted by the tumor may contribute to the reduction in cerebral blood flow. The large amount of data provided by three dimensional SPECT images, gives reliable results and furthermore, makes objective evaluation possible because it eliminates the need to set region of interest (ROI) in the analysis. The application of SPECT to assess the extent of hypoperfusion volume, is considered a new and clinically useful tool. (author)

  17. Brain activation study during urine withhold by 99Tcm-HMPAO SPECT brain imaging

    Objective: Lose of urinary continence control is related with the pathological process of many brain damages. The aim of this study was to identify cerebral activation areas during withholding urine in healthy subjects with cerebral perfusion agent [99Tcm-hexamethylpropylene amine oxime (HMPAO)]. Methods: Fifteen right-handed healthy male volunteers (age ranged 24 to 45 years old) was recruited. All had two brain perfusion SPECT scans (15 volunteers with 30 scans). One was at resting state with empty bladder and the other was at urine withholding state with full bladder. The images were analyzed by neurological statistical image analysis software (NEUROSTAT) and was displayed on Z-score images at a significance threshold of P<0.05 with correction for multiple comparisons. Results: As compared with resting, the urine withholding state showed a significant increase cerebral perfusion in bilateral inferior frontal gyri, the right superior and middle temporal gyri, with the most significant in the right inferior frontal gyms. Conclusions: Although the control of urinary continence in healthy men was associated with bilateral inferior frontal gyri and the right superior and middle temporal gyri, the results showed that the right inferior frontal gyms might also be important. Moreover, the combination of brain perfusion SPECT and NEUROSTAT was a rather easy method for further understanding the mechanism of urinary control in brain and could be popularized as a research tool for clinical use. (authors)

  18. Interictal brain SPECT in patients with medically refractory temporal lobe epilepsy

    The brain single photon emission computed tomography (SPECT) is s functional neuroimaging method that can detect localized changes in cerebral blood flow. The temporal lobe epilepsy (TLE) is the most common epileptic syndrome in adults, and more than 50% are medically refractory. The SPECT can contribute to investigation of epileptogenic focus and is one of the methods of pre-surgical evaluation of these patients. (author)

  19. Validation of automatic SPECT-to-MRI registration in brain studies

    Full text: Registration of brain SPECT to modalities with high anatomical resolution is becoming increasingly important for the accurate quantification of brain SPECT. The 'AMIR' program (Ardekani et al, JCAT, 1995, 19, 615) uses an automatic algorithm which does not require fiducial markers or manual landmark selection, but uses the structures within the whole brain to achieve registration. This has been validated for PET to MRI but not SPECT to MRI registration. We attached 6 external markers to each of two subjects who underwent SPECT and MRI scanning within a 2 hour period. In each marker, a 5 microliter cavity (2mm x 2mm cylinder) located 5.5 mm from the skin was charged with 80 kBq Tc-99m mixed with 0.5 millimolar gadodiamide MRI contrast SPECT with 3.56 mm voxel size was acquired on a triple headed system with ultra-high resolution fan beam collimators. After Butterworth pre-filtering (cutoff 0.7 cycles/cm, order 6.0) and lower window scatter subtraction, projections were rebinned and reconstructed with uniform attenuation correction. The SPECT images were registered to 124x128x128 MRI T1 images of the brain with voxel size 1 .72x1 .72x1.50 mm. To measure registration accuracy, an IDL program was written to compute the relative location in the two modalities of each source using a 'center-of-gravity' algorithm within 7x7x7 pixel (SPECT) and 3x3x3 pixel (MRI) volumes around the manually selected central pixels. The mean error in the point source locations after registration was 2.0 mm (maximum 2.9 mm) which compares favourably with the published PET-MRI mean error of 2.8 mm. Thus 'AMIR' provides accurate SPECT to MRI registration

  20. Preoperative evaluation of brain lesion with {sup 201}TI brain SPECT: is it useful to differentiate benign and malignant lesions?

    Sohn, Hyung Sun; Kim, Euy Neyng; Kim, Sung Hoon; Chung, Yong An; Chung, Soo Kyo; Hong, Yong Gil; Lee, Youn Soo [College of Medicine, The Catholic Univ., Seoul (Korea, Republic of)

    2000-10-01

    Thallium-201 ({sup 201}TI) brain SPECT, which can represent cellular activity of brain lesions, may provide more useful information in differentiating between benign and malignant brain lesions more so than CT or MRI, that merely represents anatomic changes or breakdown of blood brain barrier. We used {sup 201}TI brain SPECT prospectively to evaluate the utility of {sup 201}TI-indices as an indicator of benign or malignant lesions. We studied 28 patients. There were 13 cases of benign lesions (3: nonspecific benign lesion, 3: meningioma, 2: low grade glioma, 1: tuberculoma, central neurocytoma, hemangioblastoma, radiation necrosis, and choroid plexus papilloma) and 15 cases of malignant lesions (6: glioblastoma multiforme, 5: anaplastic glioma, 2: medulloblastoma, 1: metastasis and lymphoma). In all patients, CT and/or MRI were obtained and then {sup 201}TI brain SPECT was obtained with measuring mean {sup 201}TI index and peak {sup 201}TI index. An unpaired t-test was performed to compare the {sup 201}TI-indices and pathologic diagnoses to evaluate the utility of {sup 201}TI-indices as an indicator of benign or malignant lesions. There were no statistically significant difference in {sup 201}TI-indices between benign and malignant brain lesions (P>0.05). These results demonstrated that we could not use {sup 201}TI indices on brain SPECT alone as an indicator of benign or malignant brain lesions.

  1. Preoperative evaluation of brain lesion with 201TI brain SPECT: is it useful to differentiate benign and malignant lesions?

    Thallium-201 (201TI) brain SPECT, which can represent cellular activity of brain lesions, may provide more useful information in differentiating between benign and malignant brain lesions more so than CT or MRI, that merely represents anatomic changes or breakdown of blood brain barrier. We used 201TI brain SPECT prospectively to evaluate the utility of 201TI-indices as an indicator of benign or malignant lesions. We studied 28 patients. There were 13 cases of benign lesions (3: nonspecific benign lesion, 3: meningioma, 2: low grade glioma, 1: tuberculoma, central neurocytoma, hemangioblastoma, radiation necrosis, and choroid plexus papilloma) and 15 cases of malignant lesions (6: glioblastoma multiforme, 5: anaplastic glioma, 2: medulloblastoma, 1: metastasis and lymphoma). In all patients, CT and/or MRI were obtained and then 201TI brain SPECT was obtained with measuring mean 201TI index and peak 201TI index. An unpaired t-test was performed to compare the 201TI-indices and pathologic diagnoses to evaluate the utility of 201TI-indices as an indicator of benign or malignant lesions. There were no statistically significant difference in 201TI-indices between benign and malignant brain lesions (P>0.05). These results demonstrated that we could not use 201TI indices on brain SPECT alone as an indicator of benign or malignant brain lesions

  2. 201Tl brain SPECT in differentiating central nervous system lymphoma from toxoplasmosis in AIDS patients

    In AIDS patients, toxoplasmosis and lymphoma are the leading causes of CNS mass lesions. It is important to make the correct diagnosis expeditiously, since the two diseases require markedly different treatments and have different prognoses. In general, CT and MR imaging have failed to provide specific distinguishing characteristics to differentiate CNS lymphoma from toxoplasmosis, and it is difficult to differentiate these entities clinically. We performed 201Tl brain SPECT in order to differentiate two diseases. Counts ratio of a lesion to the normal brain (L/N ratio) was elevated in patients of lymphoma compared in patients of toxoplasmosis. 201Tl brain SPECT is useful to differentiate CNS lymphoma from toxoplasmosis. (author)

  3. The clinical usefulness of Tc-99m ECD brain SPECT in acute measles encephalitis

    Lim, Seok Tae; Sohn, Myung Hee [School of Medicine, Chonbuk National Univ., Chonju (Korea, Republic of)

    2003-08-01

    Since the prognosis of measles encephalitis is poor, early diagnosis and proper management are very important to improve clinical outcomes. We compared Tc-99m ECD brain SPECT (SPECT) with MR imaging (MRI) for the detection of acute measles encephalitis. Eleven patients (M : F=4 : 7, age range 18 months-14 yrs) with acute measles encephalitis were enrolled in this studies. All of them underwent both MRI and SPECT. The results of SPECT were scored from 0 (normal) to 3 (most severe defect) according to perfusion state. We compared two image modalities for the detection of brain abnormality in acute measles encephalitis. Seven of 11 patients (63.6%) revealed high signal intensity in the white matter on T2WI of MRI, on the other hand all patients (100%) showed hypoperfusion on SPECT. Severe perfusion deficits above score 2 were located with decreasing frequencies in the frontal lobe (81.8%), temporal lobe (72.7%), occipital lobe (27.3%), basal ganglia (27.3%), and parietal lobe (9.1%). We conclude that SPECT is more useful than MRI for the detection of brain involvement in patients with acute measles encephalitis.

  4. Cerebral infarction mimicking brain tumor on Tc-99m tetrofosmin brain SPECT imaging

    Kim, Soon [College of Medicine, Dongguk Univ., Gyeongju (Korea, Republic of); Zeon, Seok Kil; Won, Kyoung Sook [School of Medicine, Keimyung Univ., Daegu (Korea, Republic of)

    2004-06-01

    A 43-year-old man was presented with persistent headache for two weeks. T2 weighted MR imaging showed high signal intensity with surrounding edema in the left frontal lobe. These findings were considered with intracranial tumor such as glioma or metastasis. Tc-99m tetrofosmin SPECT showed focal radiotracer accumulation in the left frontal lobe. The operative specimen contained cerebral infarction with organizing leptomeningeal hematoma by pathologist. Another 73-year-old man was hospitalized for chronic headache. Initial CT showed ill-defined hypodensity with mass effect in the right parietal lobe. Tc-99m tetrofosmin SPECT showed focal radiotracer uptake in the right parietal lobe. These findings were considered with low-grade glioma or infarction. Follow-up CT after 5 months showed slightly decreased in size of low density in the right parietal lobe, and cerebral infarction is more likely than others. Tc-99m tetrofosmin has been proposed as a cardiotracer of myocardial perfusion imaging and an oncotropic radiotracer. Tc-99 tetrofosmin SPECT image provides a better attractive alternative agent than TI-201 as a tumor-imaging agent, with characteristics such as high-energy flux, short half-life, favorable biodistribution, dosimetry and lower background radioactivity. We have keep in mind on the analysis of Tc-99m tetrofosmin imaging when cerebral infarction is being differentiated from brain tumor.

  5. Mechanism of brain damaging by rapid evacuation decompression of epidural hematoma explored with dynamic brain SPECT imaging

    Objective: To explore the value of dynamic brain SPECT imaging in clarifying the major mechanism of obstinate brain edema following evacuation of epidural hematoma. Methods: The dynamic brain SPECT imaging was performed on New Zealand rabbit model of epidural hematoma. The changes of their intracellular [Ca2+], and brain tissue water content were measured, and the correlation between them was analyzed. Results: It is showed that the severe hypoperfusion occurred on compressing parietal lobe for 30 min and hyper-reperfusion occurred 10 min after decompression on dynamic brain SPECT imaging and on its time-radioactivity curve. [Ca2+] increased remarkably after being pressed. There was a short-term decreasing following decompression and then increased gradually reaching the peak at 24 h. The correlation between [Ca2+] and brain tissue water content was with magnificent value (r=0.469, P<0.01). Conclusions: These findings indicate there exists severe reperfusion injury, which is the major mechanism of obstinate brain edema after evacuation of epidural hematoma. The dynamic brain SPECT imaging can show the image evidence of reperfusion clearly and non-invasively. (authors)

  6. Brain SPECT perfusion in children and adolescents poly drug abusers

    Polydrug abuse in children and adolescents is a major social problem. Aim: The aim of this study was to evaluate brain perfusion in polydrug abuser adolescents with brain SPECT imaging (BSI) using 99mTc-HMPAO. Materials and Methods: Sixteen male polydrug abuser patients (11 to 18 years) were submitted to BSI. Forty-eight normal individuals (26 males, 22 females; 18 to 31 years) were used as a control group. Images were performed after an intravenous injection of 99mTc-HMPAO in a dark, quiet room. Images were acquired in a camera-computer system equipped with a fan beam collimator. The images were reconstructed in the transaxial, coronal and sagittal views and submitted to semi-quantitative analysis using the thalami as reference, by placing regions of interest (ROIs) in the cerebral and cerebellar cortices. Patients were also submitted to neuropsychology tests and neurologic examination. Results: Significant hypoperfusion was found in the inferior portion of the frontal lobes (left and right: p<0.0001), temporal lobes (left lateral: p=0.0392; right lateral: p=0.0044; left and right mesial: p<0.0005), right parietal lobe (p=0.025), visual cortex (p=0.0013), pons (p = 0.0002), cerebellar hemispheres (left: p=0.0216; right: p=0.0005) and vermis (p=0.0015). An inverse relationship was observed between the degree of perfusion and the duration of drug abuse in the inferior left frontal lobe (? = -0.55; p=0.0255), superior right frontal lobe (? = -0.51; p=0.043), lateral right temporal lobe (? = -0.58; p=0.0172), mesial left temporal lobe (? -0.52; p=0.0384), left parietal lobe (? = -0.51; p=0.0416), basal ganglia (left: ? = -0.70; p=0.0022; right: ? = -0.65; p=0.0056) and cingulate gyrus (? = -0.66; p=0.0054). A significant correlation was observed between the perfusion of the temporal lobes with the Bender-Koppits test (left and right lateral: p=0.0559). Significant correlation was also noted between the perfusion of the lateral left temporal lobe (p=0.0559), parietal

  7. Data-driven motion correction in brain SPECT

    Patient motion can cause image artifacts in SPECT despite restraining measures. Data-driven detection and correction of motion can be achieved by comparison of acquired data with the forward-projections. By optimising the orientation of the reconstruction, parameters can be obtained for each misaligned projection and applied to update this volume using a 3D reconstruction algorithm. Digital and physical phantom validation was performed to investigate this approach. Noisy projection data simulating at least one fully 3D patient head movement during acquisition were constructed by projecting the digital Huffman brain phantom at various orientations. Motion correction was applied to the reconstructed studies. The importance of including attenuation effects in the estimation of motion and the need for implementing an iterated correction were assessed in the process. Correction success was assessed visually for artifact reduction, and quantitatively using a mean square difference (MSD) measure. Physical Huffman phantom studies with deliberate movements introduced during the acquisition were also acquired and motion corrected. Effective artifact reduction in the simulated corrupt studies was achieved by motion correction. Typically the MSD ratio between the corrected and reference studies compared to the corrupted and reference studies was > 2. Motion correction could be achieved without inclusion of attenuation effects in the motion estimation stage, providing simpler implementation and greater efficiency. Moreover the additional improvement with multiple iterations of the approach was small. Improvement was also observed in the physical phantom data, though the technique appeared limited here by an object symmetry. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  8. SPM analysis of cerebrovascular reserve capacity after stimulation with acetazolamide measured by Tc-99m ECD SPECT in normal brain MRI patient

    This study was undertaken to evaluate normal response of acetazolamide in normal individuals, whose brain MRI is normal, using SPM99. In total, 10 Tc- 99m ECD brain SPECT were evaluated retrospectively. The half of the patients were male. Their mean age was 47.1 years old with a range of 33-61 years. They all visited our neurology department to evaluate stroke symptom. Their brain MRI was normal. Rest/acetazolamide brain SPECT was perfomed using Tc-99m ECD and the sequential injection and subtraction method. SPECT was acquired using fanbeam collimators and triple-head gamma camera (MultiSPECT III, Siemens medical systems, Inc. Hoffman Estates, III, USA). Chang's attenuation correction was applied their brain SPECT revealed normal rCBF pattern in visual analysis by two nuclear physician and they were diagnosed clinically normal. Using SPM method, we compared rest brain SPECT images with those of acetazolamide brain SPECT and measured the extent of the area with significant perfusion change (P<0.05) in predefined 34 cerebral regions. Acetazolamide brain SPECT showed no significant decreased region in comparison to rest brain SPECT. Only small portion of left mid temporal gyrus revealed increased rCBF on acetazolamide brain SPECT in comparison to rest brain SPECT. It apperas that there is no significant change in rCBF between rest and acetazolamide brain SPECT using Tc-99m ECD. The small number of this study is limitation of our study

  9. Evaluation of Gilles de la Tourette syndrome with [99mTc] HMPAO Brain SPECT

    Gilles de la Tourette syndrome (GLTS) is a disorder characterized by tics and several behavioral disturbances. Although GLTS is a relatively common disorder, little is known about its pathophysiology. Previous studies with SPECT and PET were performed in a small number of patients and have shown some discordant data. The aim of this study is to evaluate brain perfusion abnormalities in patients with GLTS and to correlate them with the clinical manifestations of the syndrome. Twenty-eight patients were submitted to brain [99mTc]-HMPAO SPECT. 82 percent of the patients had abnormal studies. The most frequent finding was perfusion abnormalities in the thalami in 16 patients (57 percent) and 85 percent of patients with hyperperfusion of one or both thalami had complex motor tics. This investigation has demonstrated that brain perfusion SPECT is able to identify cortical perfusion abnormalities, associated with clinical symptoms in patients with GLTS. These abnormalities involve the pre-frontal-striatal-thalamic-cortical pathways (Au)

  10. Tc-99m ECD brain SPECT in MELAS syndrome and mitochondrial myopathy: comparison with MR findings

    Park, Sang Joon; Ryu, Young Hoon; Jeon, Tae Joo; Kim, Jai Keun; Nam, Ji Eun; Yoon, Pyeong Ho; Yoon, Choon Sik; Lee, Jong Doo [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of)

    1998-08-01

    We evaluated brain perfusion SPECT findings of MELAS syndrome and mitochondrial myopathy in correlation with MR imaging in search of specific imaging features. Subjects were five patients (four females and one male; age range, 1 to 25 year) who presented with repeated stroke like episodes, seizures or developmental delay or asymptomatic but had elevated lactic acid in CSF and serum. Conventional non-contrast MR imaging and Tc-99m-ethyl cysteinate dimer (ECD) brain perfusion SPECT were performed and imaging features were analyzed. MRI demonstrated increased T2 signal intensities in the affected areas of gray and white matters mainly in the parietal (4/5) and occipital lobes (4/5) and in the basal ganglia (1/5), which were not restricted to a specific vascular territory. SPECT demonstrated decreased perfusion in the corresponding regions of MRI lesions. In addition, there were perfusion defects in parietal (1 patient), temporal (2), and frontal (1) lobes and basal ganglia (1) and thalami (2). In a patient with mitochondrial myopathy who had normal MRI, decreased perfusion was noted in left parietal area and bilateral thalami. Tc-99m ECD SPECT imaging in patients with MELAS syndrome and mitochondrial myopathy showed hypoperfusion of parieto-occipital cortex, basal ganglia, thalamus and temporal cortex, which were not restricted to a specific vascular territory. There were no specific imaging features on SPECT. The significance of abnormal perfusion on SPECT without corresponding MR abnormalities needs to be evaluated further in larger number of patients.

  11. A study of 99mTc-HM-PAO brain SPECT in the senile parkinson's disease

    Thirty-three cases of senile Parkinson's disease (PD) imaged by 99mTc-HM-PAO brain SPECT were reported. 66.7% of the patients had cortical hypoperfusion and 18.2% showed asymmetrical hypoperfusion in the basal ganglia. Such a finding was not related with the Hoehn-Yahr stage and the laterality of motor symptoms. If complicated with dementia, the SPECT brain imaging showed similar pattern in Alzheimer's disease with diffuse hypoperfusion in cortical area reflecting widespread pathological changes in tremor paralysis

  12. Predictive value of brain SPECT with 99 technetium - MIBI for differentiation of histologic grade brain gliomas

    Diagnosis and treatment of primary tumors of the nervous system remain difficult and are a challenge to be addressed in a multidisciplinary way. In order to determine the usefulness of brain SPECT 99Tc MIBI to differentiate histologic grade brain gliomas - Frequently brain tumors - they were studied 68 patients with this technique. A dynamic study first step in AP and lateral view was performed, and a SPECT at 20 minutes post-administration and at 2 hours late views. the post-surgical histological study of injuries was used as control. several imaging parameters such as the absolute activity of 99mTc-MIBI were calculated both early and late phase, cortex contralateral tumor rates; pituitary tumor; choroid plexus tumor and Reason Late / Early phase tumor index / contralateral cortex tumor volume functional phase, the volume concentration of MIBI activity in the tumor and the retention rate of the radiopharmaceutical. Of the 68 patients studied, 11 were high-grade tumors and 57 low grade. The cortex contralateral tumor in late stage index showed a negative satisfactory sensitivity of 98.6% and specificity 77.1%, positive predictive value (PPV) of 48.2% and (NPV) of 99.8%. The reason late stage / early in the index tumor / contralateral cortex showed values ​​in turn 96.3%, 98.7%, 98.8% and 98.8% sensitivity, specificity, PPV and NPV respectively. The retention rate showed a 99% sensitivity, 89% specificity and PPV, NPV of 95% and 99% respectively. Conclusion: The combination cortex contralateral tumor rate in late stage, the reason late stage / early stage tumor index / contralateral cortex and the retention rate of the radiopharmaceutical are the most useful parameters to predict histologic grade of brain gliomas. (author)

  13. The role of Tc-99m HMPAO brain perfusion SPECT in the psychiatric disability evaluation of patients with chronic traumatic brain injury

    We studied whether brain perfusion SPECT is useful in the psychiatric disability evaluation of patients with chronic traumatic brain injury (TBI). Sixty-nine patients (M:F=58:11, age 39 ± 14 years) who underwent Tc-99m HMPAO brain SPECT, brain MRI and neuropsychological (NP) tests during hospitalization in psychiatric wards for the psychiatric disability evaluation were included; the severity of injury was mild in 31, moderate in 17 and severe in 21. SPECT, MRI, NP tests were performed 6 ∼ 61 months (mean 23 months) post-injury. Diagnostic accuracy of SPECT and MRI to show hypoperfusion or abnormal signal intensity in patients with cognitive impairment represented by NP test results were compared. Forty-two patients were considered to have cognitive impairment on NP tests and 27 not. Brain SPECT showed 71% sensitivity and 85% specificity, while brain MRI showed 62% sensitivity and 93% specificity (p>0.05, McNemar test). SPECT found more cortical lesions and MRI was superior in detecting white matter lesions. sensitivity and specificity of 31 mild TBI patients were 45%, 90% for SPECT and 27%, 100% for MRI (p>0.05, McNemar test). Among 41 patients with normal brain MRI, SEPCT showed 63% sensitivity (50% for mild TBI) and 88% specificity (85% for malingerers). Brain SPECT has a supplementary role to neuropsychological tests in the psychiatric disability evaluation of chronic TBI patients by detecting more cortical lesions than MRI

  14. The clinical evaluation of Nimodipine treatment by SPECT brain perfusion imaging

    PURPOSE: Clinical evaluation of patients with cerebropathy by SPECT brain perfusion imaging before and after Nimodipine treatment were studied. METHODS: 53 patients were divided into 3 groups: 26 migraine (interictal), 19 cerebral ischemia (11 TIA and 8 cerebral infarction) and 8 brain trauma. SPECT brain perfusion imaging was performed before and after Nimodipine treatment, and quantitative analysis was processed with normal/focus mirror regions ratio on transverse images. RESULTS: Before Nimodipine administration, the focal defects with various magnitude were showed by SPECT, and after treatment with Nimodipine, the original focal defects were filled in varying degree. The rate of significant filling, filling, total filling and non-filling were 27.3%, 57.5%, 84.8% and 15.2% respectively in migraine, 64.3%, 28.5%, 92.8% and 7.2% respectively in TIA and 20%, 60%, 80% and 20% respectively in cerebral infarction, whereas in brain traumas, filling rate was 100%. CONCLUSION: Most patients have various improvement of the focal defect after Nimodipine treatment. Therefore, SPECT brain perfusion imaging can be used to observe and evaluate the therapeutic effects of Nimodipine

  15. Cerebral abnormalities in cocaine abusers: Demonstration by SPECT perfusion brain scintigraphy. Work in progress

    Single photon emission computed tomography (SPECT) perfusion brain scans with iodine-123 isopropyl iodoamphetamine (IMP) were obtained in 12 subjects who acknowledged using cocaine on a sporadic to a daily basis. The route of cocaine administration varied from nasal to intravenous. Concurrent abuse of other drugs was also reported. None of the patients were positive for human immunodeficiency virus. Brain scans demonstrated focal defects in 11 subjects, including seven who were asymptomatic, and no abnormality in one. Among the findings were scattered focal cortical deficits, which were seen in several patients and which ranged in severity from small and few to multiple and large, with a special predilection for the frontal and temporal lobes. No perfusion deficits were seen on I-123 SPECT images in five healthy volunteers. Focal alterations in cerebral perfusion are seen commonly in asymptomatic drug users, and these focal deficits are readily depicted by I-123 IMP SPECT

  16. Interictal brain SPECT in patients with medically refractory temporal lobe epilepsy; SPECT cerebral interictal em pacientes com epilepsia do lobo temporal de dificil controle

    Andraus, Maria Emilia Cosenza

    2000-06-01

    The brain single photon emission computed tomography (SPECT) is s functional neuroimaging method that can detect localized changes in cerebral blood flow. The temporal lobe epilepsy (TLE) is the most common epileptic syndrome in adults, and more than 50% are medically refractory. The SPECT can contribute to investigation of epileptogenic focus and is one of the methods of pre-surgical evaluation of these patients. (author)

  17. The Performance of Ictal Brain SPECT Localizing for Epileptogenic Zone in Neocortical Epilepsy

    The epileptogenic zones should be localized precisely before surgical resection of these zones in intractable epilepsy. The localization is more difficult in patients with neocortical epilepsy than in patients with temporal lobe epilepsy. This study aimed at evaluation of the usefulness of ictal brain perfusion SPECT for the localization of epileptogenic zones in neocortical epilepsy. We compared the performance of ictal SPECT with MRI referring to ictal scalp electroencephalography (sEEG). Ictal 99mTc-HMPAO SPECT were done in twenty-one patients. Ictal EEG were also obtained during video monitoring. MRI were reviewed. According to the ictal sEEG and semiology, 8 patients were frontal lobe epilepsy, 7 patients were lateral temporal lobe epilepsy, 2 patients were parietal lobe epilepsy, and 4 patients were occipital lobe epilepsy. Ictal SPECT showed hyperperfusion in 14 patients(67%) in the zones which were suspected to be epileptogenic according to ictal EEG and semiology. MRI found morphologic abnormalities in 9 patients(43%). Among the 12 patients, in whom no epileptogenic zones were revealed by MR1, ictal SPECT found zones of hyperperfusion concordant with ictal sEEG in 9 patients(75%). However, no zones of hyperperfusion were found in 4 among 9 patients who were found to have cerebromalacia, abnormal calcification and migration anomaly in MRI. We thought that ictal SPECT was useful for localization of epileptogenic zones in neocortical epilepsy and especially in patients with negative findings in MRI.

  18. Clinical Utility of '99mTc-HMPAO Brain SPECT Findings in Chronic Head Injury

    Minima deterioration of cerebral perfusion or microanatomical changes were undetectable on conventional Brain CT or MRI. So evaluation of focal functional changes of the brain parenchyme is essential in chronic head injury patients, who did not show focal anatomical changes on these radiological studies. However, the patients who had longstanding neurologic sequelae following head injury, there had been no available imaging modalities for evaluating these patients precisely. Therefore we tried to detect the focal functional changes on the brain parenchyme using 99mTc-HMPAO Brain SPECT on the patients of chronic head injuries. Twenty three patients who had suffered from headache, memory dysfunction, personality change and insomnia lasting more than six months following head injury were included in our cases, which showed no anatomical abnormalities on Brain CT or MRI. At first they underwent psychological test whether the symptoms were organic or not. Also we were able to evaluate the cerebral perfusion changes with 99mTc-HMPAO Brain SPECT in 22 patients among the 23, which five patients were focal and 17 patients were nonfocally diffuse perfusion changes. Thus we can predict the perfusion changes such as local vascular deterioration or functional defects using 99mTc-HMPAO Brain SPECT in the patients who had suffered from post-traumatic sequelae, which changes were undetectable on Brain CT or MRI.

  19. The study of low level laser irradiation therapy on brain infarction with SPECT

    Xiao Xuechang; Jia Shaowei; Zleng Xiyuan

    2000-01-01

    Objective: Effect of rCBF and brain function on ILIB treating brain infarction will be investigated by SPECT brain perfusion imaging. Method: 3 1 patients with brain infarction, 17 patients were treated by ILIB on standard pharmaceutial treatment. SPECT brain perfusion imaging was performed before and after ILIB therapy with comparison of oneself. They were quantified with BFCR% model effect during ILIB in 14 patients were observed. Result: ILIB 30 rnme SPECT showed the improvement of rCBF and cerebral function in 14 patients with brain infarction, and in 17 patients locus were prominence than mirror regions att er ILIB therapy, both are higher singnitficant difference ( t=4.4052, P<0.0001 ), but mirror regions were not singnificant difference before and after ILIB (t=1.6995, P>0.05). BFCR% quantitative results of locus were higher mirror regions, and higher singnificant difference (t=4.5278 p<0.0001 )。 Conclusion: ILIB can improve the rCBF and cerebral function of patients with brain infarction, and provoke function of brain cells. Some new evidence was provided for ILIB treatment of cerebral ischemia

  20. Quantitative analysis of L-SPECT system for small animal brain imaging

    Rahman, Tasneem; Tahtali, Murat; Pickering, Mark R.

    2016-03-01

    This paper aims to investigate the performance of a newly proposed L-SPECT system for small animal brain imaging. The L-SPECT system consists of an array of 100 × 100 micro range diameter pinholes. The proposed detector module has a 48 mm by 48 mm active area and the system is based on a pixelated array of NaI crystals (10×10×10 mm elements) coupled with an array of position sensitive photomultiplier tubes (PSPMTs). The performance of this system was evaluated with pinhole radii of 50 μm, 60 μm and 100 μm. Monte Carlo simulation studies using the Geant4 Application for Tomographic Emission (GATE) software package validate the performance of this novel dual head L-SPECT system where a geometric mouse phantom is used to investigate its performance. All SPECT data were obtained using 120 projection views from 0° to 360° with a 3° step. Slices were reconstructed using conventional filtered back projection (FBP) algorithm. We have evaluated the quality of the images in terms of spatial resolution (FWHM) based on line spread function, the system sensitivity, the point source response function and the image quality. The sensitivity of our newly proposed L- SPECT system was about 4500 cps/μCi at 6 cm along with excellent full width at half-maximum (FWHM) using 50 μm pinhole aperture at several radii of rotation. The analysis results show the combination of excellent spatial resolution and high detection efficiency over an energy range between 20-160 keV. The results demonstrate that SPECT imaging using a pixelated L-SPECT detector module is applicable in a quantitative study of mouse brain imaging.

  1. Analysis of brain SPECT with the statistical parametric mapping package SPM99

    Full text: The Statistical Parametric Mapping (SPM) package of the Welcome Department of Cognitive Neurology permits detection in the brain of different regional uptake in an individual subject or a population of subjects compared to a normal population. SPM does not require a-priori specification of regions of interest. Recently SPM has been upgraded from SPM96 to SPM99. Our aim was to vary brain SPECT processing options in the application of SPM to optimise the final statistical map in three clinical trials. The sensitivity of SPM depends on the fidelity of the preliminary spatial normalisation of each scan to the standard anatomical space defined by a template scan provided with SPM. We generated our own SPECT template and compared spatial normalisation to it and to SPM's internal PET template. We also investigated the effects of scatter subtraction, stripping of scalp activity, reconstruction algorithm, non-linear deformation and derivation of spatial normalisation parameters using co-registered MR. Use of our SPECT template yielded better results than with SPM's PET template. Accuracy of SPECT to MR co-registration was 2.5mm with SPM96 and 1.2mm with SPM99. Stripping of scalp activity improved results with SPM96 but was unnecessary with SPM99. Scatter subtraction increased the sensitivity of SPM. Non-linear deformation additional to linear (affine) transformation only marginally improved the final result. Use of the SPECT template yielded more significant results than those obtained when co registered MR was used to derive the transformation parameters. SPM99 is more robust than SPM96 and optimum SPECT analysis requires a SPECT template. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  2. Brain SPECT in childhood; Temp cerebrale chez l'enfant

    Tranquart, F.; Saliba, E.; Prunier, C.; Baulieu, F.; Besnard, J.C.; Guilloteau, D.; Baulieu, J.L. [Hopital Bretonneau, Service de Medecine Nucleaire, Unite Inserm 316, 37 - Tours (France)

    2001-04-01

    The modalities and the indications of perfusion and neurotransmission SPECT in childhood are presented. The perfusion as well as neurotransmission tracers have not yet authorization for use in children; they have to be used by prescription of magistral preparation or in research protocols. The radioprotection rules have to be strictly respected. The most frequent indication of perfusion SPECT is pharmacologically resistant epilepsy; the ictal SPECT before surgery allows the localization of the epileptogenic focus. Other indications are relevant in the prognosis of neonatal anoxia and encephalitis. In psychiatric disorders, especially in autism, the interest is the physiopathological approach of the brain dysfunctions. The neurotransmission SPECT is emerging as a consequence of the development of new radiotracer, as the dopaminergic system ligands. The decrease of the dopamine D2 receptors in the striatum can be imaged and quantified in the neonate. The lesions of dopamine system seem to be a consequence of the neonatal hypoxia-ischemia and it is predictive of motor sequelae. Brain SPECT should become a routine examination in child neurologic and psychiatric disorders. (authors)

  3. Determination of hyperactive areas of Cortex Cerebri with using brain SPECT study

    The aim of this study was the assessment of the ability to apply of SPECT technique to determination of hyperactive areas of cortex cerebri. Analysis included 50 patients (mean aged 44 - 58). Brain SPECT scanning was performed after 1 hour after the intravenous injection of 740 MBq of ethylcisteinate dimmer labeled 99m Technetium (99mTc-ECD) with the use one-head gamma camera with a low-energy, ultra-high resolution collimator. Qualitative and quantitative analysis was performed using specialised software. In 20 cases normal biodistribution of the radiotracer was observed (hyperactive areas in cerebellum and occiput). In patients with psychiatric and neurological disturbances hyperactive areas were visualized in 25 cases in temporal lobes, in 4 cases in parietal lobes and in 1 patient in frontal area and basal ganglia. It is concluded that a number of factors limit the wide-scale use of SPECT, including the sophistication of imaging equipment (single-head cameras are inferior to the newer multihead units) and the experience of the physicians interpreting the scans and utilizing the data. In many diseases physicians do not know which areas of the patient's brain according disorders. Brain SPECT study can be a very useful tool to evaluation of hyperactive areas of cortex cerebri. This technique visualization of cortex cerebri completes standard analysis of disorders of brain activity

  4. Predictive value of brain perfusion SPECT for ketamine response in hyperalgesic fibromyalgia

    Guedj, Eric; Cammilleri, Serge; Colavolpe, Cecile; Taieb, David; Laforte, Catherine de; Mundler, Olivier [Centre Hospitalo-Universitaire de la Timone, Service Central de Biophysique et de Medecine Nucleaire, Assistance Publique des Hopitaux de Marseille, Marseille Cedex 5 (France); Niboyet, Jean [Clinique La Phoceanne, Unite d' Etude et de Traitement de la Douleur, Marseille (France)

    2007-08-15

    Ketamine has been used successfully in various proportions of fibromyalgia (FM) patients. However, the response to this specific treatment remains largely unpredictable. We evaluated brain SPECT perfusion before treatment with ketamine, using voxel-based analysis. The objective was to determine the predictive value of brain SPECT for ketamine response. Seventeen women with FM (48 {+-} 11 years; ACR criteria) were enrolled in the study. Brain SPECT was performed before any change was made in therapy in the pain care unit. We considered that a patient was a good responder to ketamine if the VAS score for pain decreased by at least 50% after treatment. A voxel-by-voxel group analysis was performed using SPM2, in comparison to a group of ten healthy women matched for age. The VAS score for pain was 81.8 {+-} 4.2 before ketamine and 31.8 {+-} 27.1 after ketamine. Eleven patients were considered ''good responders'' to ketamine. Responder and non-responder subgroups were similar in terms of pain intensity before ketamine. In comparison to responding patients and healthy subjects, non-responding patients exhibited a significant reduction in bilateral perfusion of the medial frontal gyrus. This cluster of hypoperfusion was highly predictive of non-response to ketamine (positive predictive value 100%, negative predictive value 91%). Brain perfusion SPECT may predict response to ketamine in hyperalgesic FM patients. (orig.)

  5. Predictive value of brain perfusion SPECT for ketamine response in hyperalgesic fibromyalgia

    Ketamine has been used successfully in various proportions of fibromyalgia (FM) patients. However, the response to this specific treatment remains largely unpredictable. We evaluated brain SPECT perfusion before treatment with ketamine, using voxel-based analysis. The objective was to determine the predictive value of brain SPECT for ketamine response. Seventeen women with FM (48 ± 11 years; ACR criteria) were enrolled in the study. Brain SPECT was performed before any change was made in therapy in the pain care unit. We considered that a patient was a good responder to ketamine if the VAS score for pain decreased by at least 50% after treatment. A voxel-by-voxel group analysis was performed using SPM2, in comparison to a group of ten healthy women matched for age. The VAS score for pain was 81.8 ± 4.2 before ketamine and 31.8 ± 27.1 after ketamine. Eleven patients were considered ''good responders'' to ketamine. Responder and non-responder subgroups were similar in terms of pain intensity before ketamine. In comparison to responding patients and healthy subjects, non-responding patients exhibited a significant reduction in bilateral perfusion of the medial frontal gyrus. This cluster of hypoperfusion was highly predictive of non-response to ketamine (positive predictive value 100%, negative predictive value 91%). Brain perfusion SPECT may predict response to ketamine in hyperalgesic FM patients. (orig.)

  6. False positive Tc-99m tetrofosmin brain tumor SPECT imaging in cerebral infarction

    Aim: The Tc-99m tetrofosmin brain SPECT imaging is known to be useful for the therapeutic efficacy evaluation of brain tumor, follow-up study for the detection of tumor recurrence and differential diagnosis between radiation necrosis and recurred brain tumor. We would like to report two cases of brain infarction in the brain tumor SPECT with Tc-99m tetrofosmin. Materials and Methods: Thirty-one patients with suspected brain tumor underwent Tc-99m tetrofosmin SPECT from March, 1997 to July, 2001. Each patient received 800 MBq tetrofosmin intravenously followed by SPECT using a dual-head gamma camera after the rest of 30 minutes. Regions of interest were outlined in the tumor area using a computer-automated program to include all counts above background activity. Mean tumor activity were obtained from this region of interest. The tumor region of interest was mirrored to the contralateral uninvolved cerebral hemisphere to obtain background control count activity. Then tumor to background activity ratios were calculated. Results: Two of 31 patients were cerebral infarction. In these patients the clinical and radiological findings necessitated more information about the nature of the lesion before treatment planning. One of two patients was 43 year-old male and the other patient was 73 year-old male. Both patients complained continuous severe headache for two weeks. Their MRI and CT findings suggested inconclusive brain tumor. Thus Tc-99m tetrofosmin brain SPECT was performed that revealed an abnormal uptake in the left frontal lobe in one patient and in the right parietal lobe in the other patient. The tumor to background activity ratios were 10.0 and 3.35, respectively. Cerebral infarction was finally confirmed by excisional biopsy in the former patient and by follow-up CT after 5 months in the other patient. Conclusion: Two cases of intracranial Tc-99m tetrofosmin uptake, reported as positive tumor activity in patients with a final diagnosis of cerebral infarction

  7. {sup 99m}Tc-ECD brain perfusion SPECT in hyperalgesic fibromyalgia

    Guedj, Eric; Taieb, David; Cammilleri, Serge; Lussato, David; Laforte, Catherine de; Mundler, Olivier [Assistance Publique des Hopitaux de Marseille, Centre Hospitalo-Universitaire de la Timone, Service Central de Biophysique et de Medecine Nucleaire, Marseille Cedex 05 (France); Niboyet, Jean [Clinique La Phoceanne, Unite d' Etude et de Traitement de la Douleur, Marseille (France)

    2007-01-15

    Neuro-imaging studies with {sup 99m}Tc-HMPAO SPECT in fibromyalgia (FM) patients have reported only limited subcortical hypoperfusion. {sup 99m}Tc-ECD SPECT is known to provide better evaluation of areas of high cerebral blood flow and regional metabolic rate. We evaluated a homogeneous group of hyperalgesic patients with FM using {sup 99m}Tc-ECD SPECT. The aim of this study was to investigate brain processing associated with spontaneous pain in FM patients. Eighteen hyperalgesic FM women (mean age 49 years, range 25-63 years; American College of Rheumatology criteria) and ten healthy women matched for age were enrolled in the study. A voxel-by-voxel group analysis was performed using SPM2 (p<0.05, corrected for multiple comparisons). Visual Analogue Scale score for pain was 82{+-}4 at the time of the SPECT study. Compared with control subjects, we observed individual brain SPECT abnormalities in FM patients, confirmed by SPM2 analysis, with hyperperfusion of the somatosensory cortex and hypoperfusion of the frontal, cingulate, medial temporal and cerebellar cortices. In the present study, performed without noxious stimuli in hyperalgesic FM patients, we found significant hyperperfusion in regions of the brain known to be involved in the sensory dimension of pain processing and significant hypoperfusion in areas assumed to be associated with the affective-attentional dimension. As current pharmacological and non-pharmacological therapies act differently on the two components of pain, we hypothesise that SPECT could be a valuable and readily available tool to guide individual therapeutic strategy and provide objective follow-up of pain processing recovery under treatment. (orig.)

  8. Marchiafava-Bignami disease: a case studied with brain magnetic resonance and SPECT

    Objective: To show the correlation between brain magnetic resonance images (MRI) and single-photon-emission computed tomography (SPECT) in a patient with Marchiafava-Bignami (MB) disease. Background: MB disease is a rare disorder associated with chronic alcoholism. It is characterized by symmetric demyelination of corpus callosum (CC) and adjacent white matter. These lesions can be demonstrated both by computed tomography or/and MRI. Scarce information is available about MRI and SPECT according to the research done. Design/methods: A 79-year-old white man with a history of excessive alcohol consumption (predominantly wine) was admitted to our Institute. A decrease in his physical activity was evidenced in the two years prior to admission and in the last twelve months progressive dementia with hallucinations and severe apathy developed. On admission neurologic examination showed papillae pale in both eyes, left hearing loss, action tremor of upper limbs and proximal hyporeflexia with distal arreflexia of all four limbs was observed. Affectation of higher cortical functions was evident. Cerebrospinal fluid was normal and serology for syphilis and HIV were negative. Both renal and hepatic functions were normal. Brain MRI and SPECT were performed. The patient died 70 days after diagnosis of MB disease. Results: MRI scans of the brain showed multiple hyperintense T2-weighted lesions in white matter and basal ganglia. Cortical atrophy, especially in the fronto-temporal areas, and a CC thickness reduction were also observed. Sagittal view showed an irregular cavitation in the genu of the CC, hypointense and hyperintense on T1 and T2-weighted images respectively. The SPECT showed an abnormal low perfusion on both frontal lobes, left temporo-parietal lobes and right basal ganglia. Conclusion: The clinical features and MRI were consistent with the diagnosis of MB disease. MRI and SPECT studies showed the connection between the lesion in the CC and bilateral cortical

  9. 99mTc-ECD brain perfusion SPECT in hyperalgesic fibromyalgia

    Neuro-imaging studies with 99mTc-HMPAO SPECT in fibromyalgia (FM) patients have reported only limited subcortical hypoperfusion. 99mTc-ECD SPECT is known to provide better evaluation of areas of high cerebral blood flow and regional metabolic rate. We evaluated a homogeneous group of hyperalgesic patients with FM using 99mTc-ECD SPECT. The aim of this study was to investigate brain processing associated with spontaneous pain in FM patients. Eighteen hyperalgesic FM women (mean age 49 years, range 25-63 years; American College of Rheumatology criteria) and ten healthy women matched for age were enrolled in the study. A voxel-by-voxel group analysis was performed using SPM2 (p<0.05, corrected for multiple comparisons). Visual Analogue Scale score for pain was 82±4 at the time of the SPECT study. Compared with control subjects, we observed individual brain SPECT abnormalities in FM patients, confirmed by SPM2 analysis, with hyperperfusion of the somatosensory cortex and hypoperfusion of the frontal, cingulate, medial temporal and cerebellar cortices. In the present study, performed without noxious stimuli in hyperalgesic FM patients, we found significant hyperperfusion in regions of the brain known to be involved in the sensory dimension of pain processing and significant hypoperfusion in areas assumed to be associated with the affective-attentional dimension. As current pharmacological and non-pharmacological therapies act differently on the two components of pain, we hypothesise that SPECT could be a valuable and readily available tool to guide individual therapeutic strategy and provide objective follow-up of pain processing recovery under treatment. (orig.)

  10. Voxel-by-voxel analysis of brain SPECT perfusion in Fibromyalgia

    Guedj, Eric; Taïeb, David; Cammilleri, Serge; Lussato, David; de Laforte, Catherine; Niboyet, Jean; Mundler, Olivier

    2007-02-01

    We evaluated brain perfusion SPECT at rest, without noxious stiumuli, in a homogeneous group of hyperalgesic FM patients. We performed a voxel-based analysis in comparison to a control group, matched for age and gender. Under such conditions, we made the assumption that significant cerebral perfusion abnormalities could be demonstrated, evidencing altered cerebral processing associated with spontaneous pain in FM patients. The secondary objective was to study the reversibility and the prognostic value of such possible perfusion abnormalities under specific treatment. Eighteen hyperalgesic FM women (mean age 48 yr; range 25-63 yr; ACR criteria) and 10 healthy women matched for age were enrolled in the study. A voxel-by-voxel group analysis was performed using SPM2 ( p<0.05, corrected for multiple comparisons). All brain SPECT were performed before any change was made in therapy in the pain care unit. A second SPECT was performed a month later after specific treatment by Ketamine. Compared to control subjects, we observed individual brain SPECT abnormalities in FM patients, confirmed by SPM2 analysis with hyperperfusion of the somatosensory cortex and hypoperfusion of the frontal, cingulate, medial temporal and cerebellar cortices. We also found that a medial frontal and anterior cingulate hypoperfusions were highly predictive (PPV=83%; NPV=91%) of non-response on Ketamine, and that only responders showed significant modification of brain perfusion, after treatment. In the present study performed without noxious stimuli in hyperalgesic FM patients, we found significant hyperperfusion in regions of the brain known to be involved in sensory dimension of pain processing and significant hypoperfusion in areas assumed to be associated with the affective dimension. As current pharmacological and non-pharmacological therapies act differently on both components of pain, we hypothesize that SPECT could be a valuable and readily available tool to guide individual therapeutic

  11. Voxel-by-voxel analysis of brain SPECT perfusion in Fibromyalgia

    Guedj, Eric [Service Central de Biophysique et de Medecine Nucleaire, AP-HM Timone, Marseille (France)]. E-mail: eric.guedj@ap-hm.fr; Taieb, David [Service Central de Biophysique et de Medecine Nucleaire, AP-HM Timone, Marseille (France); Cammilleri, Serge [Service Central de Biophysique et de Medecine Nucleaire, AP-HM Timone, Marseille (France); Lussato, David [Service Central de Biophysique et de Medecine Nucleaire, AP-HM Timone, Marseille (France); Laforte, Catherine de [Service Central de Biophysique et de Medecine Nucleaire, AP-HM Timone, Marseille (France); Niboyet, Jean [Unite d' Etude et de Traitement de la Douleur, Clinique La Phoceanne, Marseille (France); Mundler, Olivier [Service Central de Biophysique et de Medecine Nucleaire, AP-HM Timone, Marseille (France)

    2007-02-01

    We evaluated brain perfusion SPECT at rest, without noxious stiumuli, in a homogeneous group of hyperalgesic FM patients. We performed a voxel-based analysis in comparison to a control group, matched for age and gender. Under such conditions, we made the assumption that significant cerebral perfusion abnormalities could be demonstrated, evidencing altered cerebral processing associated with spontaneous pain in FM patients. The secondary objective was to study the reversibility and the prognostic value of such possible perfusion abnormalities under specific treatment. Eighteen hyperalgesic FM women (mean age 48 yr; range 25-63 yr; ACR criteria) and 10 healthy women matched for age were enrolled in the study. A voxel-by-voxel group analysis was performed using SPM2 (p<0.05, corrected for multiple comparisons). All brain SPECT were performed before any change was made in therapy in the pain care unit. A second SPECT was performed a month later after specific treatment by Ketamine. Compared to control subjects, we observed individual brain SPECT abnormalities in FM patients, confirmed by SPM2 analysis with hyperperfusion of the somatosensory cortex and hypoperfusion of the frontal, cingulate, medial temporal and cerebellar cortices. We also found that a medial frontal and anterior cingulate hypoperfusions were highly predictive (PPV=83%; NPV=91%) of non-response on Ketamine, and that only responders showed significant modification of brain perfusion, after treatment. In the present study performed without noxious stimuli in hyperalgesic FM patients, we found significant hyperperfusion in regions of the brain known to be involved in sensory dimension of pain processing and significant hypoperfusion in areas assumed to be associated with the affective dimension. As current pharmacological and non-pharmacological therapies act differently on both components of pain, we hypothesize that SPECT could be a valuable and readily available tool to guide individual therapeutic

  12. Voxel-by-voxel analysis of brain SPECT perfusion in Fibromyalgia

    We evaluated brain perfusion SPECT at rest, without noxious stiumuli, in a homogeneous group of hyperalgesic FM patients. We performed a voxel-based analysis in comparison to a control group, matched for age and gender. Under such conditions, we made the assumption that significant cerebral perfusion abnormalities could be demonstrated, evidencing altered cerebral processing associated with spontaneous pain in FM patients. The secondary objective was to study the reversibility and the prognostic value of such possible perfusion abnormalities under specific treatment. Eighteen hyperalgesic FM women (mean age 48 yr; range 25-63 yr; ACR criteria) and 10 healthy women matched for age were enrolled in the study. A voxel-by-voxel group analysis was performed using SPM2 (p<0.05, corrected for multiple comparisons). All brain SPECT were performed before any change was made in therapy in the pain care unit. A second SPECT was performed a month later after specific treatment by Ketamine. Compared to control subjects, we observed individual brain SPECT abnormalities in FM patients, confirmed by SPM2 analysis with hyperperfusion of the somatosensory cortex and hypoperfusion of the frontal, cingulate, medial temporal and cerebellar cortices. We also found that a medial frontal and anterior cingulate hypoperfusions were highly predictive (PPV=83%; NPV=91%) of non-response on Ketamine, and that only responders showed significant modification of brain perfusion, after treatment. In the present study performed without noxious stimuli in hyperalgesic FM patients, we found significant hyperperfusion in regions of the brain known to be involved in sensory dimension of pain processing and significant hypoperfusion in areas assumed to be associated with the affective dimension. As current pharmacological and non-pharmacological therapies act differently on both components of pain, we hypothesize that SPECT could be a valuable and readily available tool to guide individual therapeutic

  13. Use of automated image registration to generate mean brain SPECT image of Alzheimer's patients

    The purpose of this study was to compute and compare the group mean HMPAO brain SPECT images of patients with senile dementia of Alzheimer's type (SDAT) and age matched control subjects after transformation of the individual images to a standard size and shape. Ten patients with Alzheimer's disease (age 71.6±5.0 yr) and ten age matched normal subjects (age 71.0±6.1 yr) participated in this study. Tc-99m HMPAO brain SPECT and X-ray CT scans were acquired for each subject. SPECT images were normalized to an average activity of 100 counts/pixel. Individual brain images were transformed to a standard size and shape with the help of Automated Image Registration (AIR). Realigned brain SPECT images of both groups were used to generate mean and standard deviation images by arithmetic operations on voxel based numerical values. Mean images of both groups were compared by applying the unpaired t-test on a voxel by voxel basis to generate three dimensional T-maps. X-ray CT images of individual subjects were evaluated by means of a computer program for brain atrophy. A significant decrease in relative radioisotope (RI) uptake was present in the bilateral superior and inferior parietal lobules (p<0.05), bilateral inferior temporal gyri, and the bilateral superior and middle frontal gyri (p<0.001). The mean brain atrophy indices for patients and normal subjects were 0.853±0.042 and 0.933±0.017 respectively, the difference being statistically significant (p<0.001). The use of a brain image standardization procedure increases the accuracy of voxel based group comparisons. Thus, intersubject averaging enhances the capacity for detection of abnormalities in functional brain images by minimizing the influence of individual variation. (author)

  14. Brain perfusion spect imaging with 99mTc-HM-PAO in Parkinson's disease

    Forty patients with Parkinson's disease were studied using 99mTc-HM-PAO brain perfusion SPECT. 62.5% (25 cases) showed abnormal blood perfusion. Among them 55% showed local decreased blood perfusion of cerebral cortex, 22% showed asymmetric decreased blood perfusion in basal gaglia, 10% showed decreased uptake of tracer in cerebellum. The pathophysiologic basis of the abnormality of brain blood perfusion were briefly discussed

  15. Vasculitis defects by brain SPECT in mixed connective tissue disease. A case report

    Full text: Cerebrovascular involvement including vasculitis in mixed connective tissue disease (MCTD) is reported to be uncommon. We describe the clinical findings and course of a 45 years old black women followed and diagnosed with depression and cognitive impairment including mental confusion, visual an auditive hallucination. Complete neuropsychological evaluation established the diagnosis of psychotic disorder. Laboratory tests, computed tomography of the skull were completely normal. The patient was referred to a brain SPECT which showed a focal area of decrease regional cerebral blood flow in right parietal-occipital region. Increasing the corticosteroids dose and with the use of neuroleptics, the patient improve clinically and the SPECT turned out to be normal

  16. Extraosseous accumulation of bone scanning agents in malignant brain tumors. Comparison to semi-quantitative evaluation with 99mTc SPECT/201Tl SPECT and histological findings

    Although 201Tl chloride (Tl) SPECT has been used in the differential diagnosis between recurrence of malignant brain tumor and necrosis after treatment, it is not generally recognized as a definite modality to distinguish them. We conducted a preliminary study using Tl SPECT and 99mTc-MDP or 99mTc-HMDP (Tc) SPECT because it has been said that extraosseous accumulation was caused by calcium deposits in necrotic tissues. In our study, for the purposes of clarifying the mechanism of extraosseous uptake and the correlation between extraosseous accumulation of bone-scanning agent and tumor viability in malignant brain tumors, we compared whether Tc uptake was correlated with the histopathological findings and further performed semi-quantitative evaluation between Tc SPECT and Tl SPECT. The correlation coefficients between the ratio of tumor to normal skull count obtained from Tc SPECT (Tc-T/N) and those of tumor to normal brain count (T/N) and to normal scalp count (T/S) both obtained from Tl SPECT were calculated. Using contrast enhanced CT (CE-CT) or contrast enhanced MRI (CE-MRI), 8 of 10 cases showed intensely ring-enhanced tumor with necrotic lesion. Histopathologically, 7 of 8 cases whose tumor had been resected before treatment had necrosis with increased vascularity or bleeding. Of the remaining 2 cases one case, malignant lymphoma had only hypervascularity by biopsy, while the other one was excluded for resection after treatment. Three of these 8 cases whose CE-CT or CE-MRI showed necrotic lesions exhibited Tc and Tl accumulations in the area corresponding to necrosis. In contrast, 2 showed no Tc nor Tl uptake. Tc-T/N had no significant correlation with any of early-, delayed-T/N or T/S. In conclusion, there was no significant correlation between Tc and Tl uptakes by malignant brain tumors in semi-quantitative evaluation. (author)

  17. Comparison of Tc-99m ECD brain SPECT between patients with delayed development and cerebral palsy

    Purpose: In previous study, thalamic or cerebellar hypoperfusion were reported in patients with cerebral palsy. This study was performed to evaluate cerebral perfusion abnormalities using Tc-99m ECD brain SPECT in patients with delayed motor development. Methods: Nineteen patients (9 boys, 10 girls, mean age 25.5 months) with delayed development underwent brain SPECT after injection of 185∼370 MBq of Tc-99m ECD. The imaging was obtained between 30 minutes and 1hr after injection. The patients were divided clinically as follows, patients with delayed development (n=5) and patients with cerebral palsy (n=14) who has delayed development and abnormal movement. The clinical subtypes of cerebral palsy were spastic quadriplegia (n=5), spastic diplegia (n=6) and spastic hemiplegia (n=3). In each group, decrease of cerebral perfusion was evaluated visually as mild, moderate and severe and quantitation of cerebral perfusion after Lassen's correction was also obtained. Results: SPECT findings showed normal or mildly decreased thalamic perfusion in patients with delayed development and severe decrease of thalamic or cerebellar perfusion in patients with spastic quadriplegia. In patients with spastic diplegia, mild decrease of perfusion was observed in thalamus. In quantified data, thalamic perfusion was lowest in patients with spastic quadriplegia and highest in patients with delayed development, but there were no statistically significant differences. Conclusion: Brain SPECT with Tc-99m ECD has a role in the detection of perfusion abnormalities in patients with delayed development and cerebral palsy

  18. Technetium-99mTc-HMPAO brain SPECT in antiphospholipid syndrome - preliminary data

    Background: Antiphospholipid syndrome (APS) is defined as the presence of repeated episodes of arterial or venous thrombosis, recurrent spontaneous abortions and throbocytopenia in patients with elevated antiphospholipid antibodies. An important feature of APS are cerebrovascular disorders of thrombotic origin. The aim of the study was to assess cerebral blood flow changes utilising brain SPECT HMPAO scanning. METHODS: Brain SPECT 99mTc-HMPAO scanning was performed in 20 patients with APS: 12 with systemic lupus erythematosus, 4 with Sneddon's syndrome, 2 with Sjoegren's syndrome, 2 with primary APS. 30 healthy volunteers served as a control group. RESULTS: 19 studies were abnormal, 1 normal. Abnormalities consisted of multifocal perfusion deficits and diffuse decrease of regional blood flow. The average number of focal perfusion deficits was 4.8±1.7. In 7 patients diffuse hypoperfusion of frontal lobes was seen, in 1 patient additionally hypoperfusion of temporal and occipital lobes. There was a correlation between the number of focal perfusion deficits and cognitive impairment in this group of patients. Correlation between SPECT images and clinical data was moderate in cerebellar syndrome and paresis, weak in persistent headache and vertigo. CONCLUSIONS: Those results indicate the high utility of CBF brain SPECT scanning in antiphospholipid syndrome. (author)

  19. Brain SPECT with 123I-isopropyl amphetamine in epilepsy

    Ten patients were studied with N-isopropyl I-123 p-iodoamphetamine. Single photon emission computed tomography (SPECT) was carried out by hand of a rotating gamma camera system (Gammatome T9000/CGR, high resolution collimator). During 1 rotation (3600) 64 frames (4k matrix) were acquired within 20 min 1 hour after injection of 6.5 mCi I-123 labeled amphetamine. The content of I-124 was less than 2%. After reconstruction of transverse slices coronar and sagittal reconstructions were rapidly performed using an array processor. Nine patients suffered from epilepsy and one from severe migraine. Excellent differentiation between gray and white matter of the cerebral cortex and the basal ganglia was evident in all of the cases. In 2 out of 3 patients with epilepsy and negative CT results SPECT revealed circumscribed areas with increased amphetamine uptake in accordance with the EEG findings. In 4 out of 6 cases with positive CT findings SPECT lesions with diminished amphetamine uptake could be established. One patient with severe migraine showed focal increased amphetamine uptake in accordance with the respective clinical results. (orig.)

  20. Evaluation of image quality and lesion detectability on I-123 IMP brain SPECT

    Influence of image quality on lesion detectability in I-123 IMP brain SPECT was discussed in forty-two cases with various cerebrovascular disorders. Fifty nine lesions, which were considered to show decreased uptake of I-123 IMP, were analyzed in this study. In all cases, SPECT examinations were started within 30 minutes after intravenous administration of 3 mCi of I-123 IMP. To determine the lesion detectability, fourteen radiologists from nine hospitals were gathered and film reading was carried out. To classify the image quality into valuable or not, findings of five points on SPECT image were visually evaluated: 1) uniformity of cortex accumulation, 2) separation of bilateral visual cortices, 3) density of white matter, 4) separation between basal ganglion and thalamus, 5) density of basal ganglion and thalamus. Mean lesion detections were 10.3/14 for the lesions of cerebral cortex, 9 for cerebellum, 3.58 for white matter and 3.22 for basal ganglion and thalamus, respectively. The detectability was certainly influenced by the image quality in the lesion of basal ganglion and thalamus, white matter and single lobe of cerebral cortex. We concluded that detection of small lesions and deep lesions with I-123 IMP SPECT was dependent on the image quality and the proposed classification of I-123 IMP SPECT image was useful for evaluating image quality from the points of view of the lesion detectability. (author)

  1. Investigation of olfactory function in normal volunteers by Tc-99m ECD brain SPECT: analysis using statistical parametric mapping

    The purpose of this study was to investigate olfactory function on Tc-99m ECD brain perfusion SPECT using statistical parametric mapping (SPM) analysis in normal volunteers. The study populations were 8 subjects matched healthy volunteers (male: 6, female: 2, age range: 24-52 years). We performed baseline brain perfusion SPECT using 15 mCi of Tc-99m ECD in the silent dark room. After 2 hours, we obtained brain perfusion SPECT using 30 mCi of Tc-99m ECD after olfactory stimuli (butanol 3% ) on the same condition. All of the SPECT images were spatially transformed to standard space, smoothed and globally normalized. The difference between two sets of brain perfusion SPECT was considered significant at a threshold of uncorrected P values less than 0.003. SPM analysis revealed significantly higher uptake in the cingulate gyrus of right limbic lobe and left middle temporal gyrus on post-stimulation SPECT. The baseline and post-stimulation brain perfusion SPECT can helpful in the evaluation of olfactory function. Moreover, this study would be utilized in the diagnosis of anosmia

  2. To SPECT diagnose of the brain tumour with Tc-MIBI

    In spite of the new diagnosing methods developed, the diagnosis of brain tumours - primary and metastasis - still represents a challenge and diagnosing problem. Therefore, we tried in our study to determine the value of Tc-MIBI as a new specific radiopharmaceutical in the tumour diagnosing. The examination was carried out by injecting in bolus 370 MBq of Tc-99m-MIBI under the gamma camera to be followed by a dynamic study on a computer - 60 images in 60 seconds - and the calculation of relative perfusion in the artery phase 3T out of the generated curve. After one hour we performed the SPECT study (60 images within 360 degrees) and made a reconstruction study of all standard sections and generated a 3D picture. The examination has been performed in 9 pts with brain tumour and 10 pts with no signs of brain tumour which were directed to the scintigraphy of myocardium with MIBI. In patients with a tumour 3T was 1.15 and 2.35., i.e. raised. SPECT 3D scintigram evidenced in all patients exactly localized sharp limits of the increased accumulation. In patients without signs of brain tumour 3T was between 0.92 and 1.05 i.e. normal, SPECT 3D scintigram detected no increased accumulation in the brain region. Conclusion: The preliminary study speaks in favour of the fact that a high possibility may be expected to diagnose brain tumours with the SPECT 3D study with Tc-MIBI. (author)

  3. Clinical application of brain SPECT imaging and rCBF measurement in alzeimers diseases and multi-intarcted dementia

    Brain SPECT imaging and rCBF measurement was performed in 10 normal controls and 25 patients including 17 Alzeimers Diseases (AD) and 8 Multi-intarcted Dementia (MID). The results showed that in SPECT imaging all of the patients visualized regional cerebral blood supply insufficiency, and also there was the presence of its own characteristic changes among AD and MID. Thereby SPECT imaging has important significance for the early and differential diagnosis for both diseases. rCBF can quantify the brain blood flow, it can be used not only for diagnostic purpose but also for the monitoring therapeutic effect during treatment. In combination with SPECT imaging, it was proved that the diagnostic effect can be improved. In conclusion, it was proved that the diagnostic effect can be improved. In conclusion, it is considered that in comparison with X-CT showing only anatomical abnormalities, SPECT and rCBF has better sensitivity and specificity

  4. Brain SPECT of chronic fatigue syndrome (CFS): a blinded visual analysis

    Full text: Chronic fatigue syndrome (CFS) is a debilitating and complex disorder characterised by profound fatigue and neuropsychiatric dysfunction. Previous studies with cerebral perfusion SPECT (rCBF) scans have yielded conflicting results. Most were performed with inhomogeneous patient populations and the findings were not based on a blinded visual analysis. To address this, HMPAO SPECT on a triple head gamma camera was performed on a group of 59 subjects. This group included 32 subjects (16-61 years, 24F and 8M) with moderate CFS based on the Fukuda criteria not on medication and not depressed and 27 normal volunteers (20-56 years, 16F and 11 M). Two blinded reviewers (RC and GC) separately assessed the SPECT studies. 28 brain structures were scored as either definitely abnormal(1), possibly abnormal(2) or normal(3-5). Abnormal results were only found in the temporal lobes and brainstem. The results (Sensitivity/Specificity) based on scores 1 or 2, show that that abnormal score yielded acceptable specificity but low sensitivity. Scores 1 or 2 improved sensitivity but reduced the specificity. This shows that visual analysis of brain SPECT is not a reliable discriminant test for CFS, although quantitative analysis with statistical parametric mapping (SPM) has demonstrated significant abnormalities. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  5. SPECT perfusion brain scintigraphy in dementia: early diagnostic and differential diagnostic

    The present review discusses the role of Single Photon Emission Computer Tomography (SPECT) and Positron Emission Tomography (PET) for the early detection and the differential diagnosis of the different types of dementia. The usefulness of the functional imaging is particularly emphasized in the detection of the early changes occurring in Alzheimer's diseases. The early diagnosis is a crucial factor for the treatment in the phase of reversible changes. The correlation between the severity of the diseases and the degree of hypoperfusion of the functional neuroimaging is also subject to review. SPECT and PET are of particular importance for the differential diagnosis of the various kinds of dementia. The imaging models are defined for the different stages of diseases. The functional imaging together with the clinical tests increase the diagnostic accuracy in Alzheimer's disease. The review presents the relation between the development of Alzheimer's disease and some risk factors. The review confirms the usefulness of SPECT and PET in the early diagnosis of Alzheimer's disease and the differential diagnosis of the different types of dementia which proves the SPECT appropriateness in the routine clinical practice. The brain structures are more advantageous than the other methods of visualisation (CT and MRI) for the detection of the functional disorders in the brain cortex in a number of diseases of the central nervous system. (author)

  6. Tc-99m-bicisate (ECD)-brain-SPECT in rapidly progressive dementia

    We present a 61-year-old male patient with progressive dementia. A brain SPECT with Tc-99m-bicisate was performed for confirmation of clinically suspected Alzheimer-dementia. At the time of the SPECT-investigation marked apraxia and aphasia besides severe dementia were present. Electrophysiological as well as anatomical neuroimaging findings showed non-diagnostic alterations. SPECT revealed distinct perfusion defects, which made Alzheimer Dementia unlikely. The further course of the patient was determined by rapidly progressive deterioration with development of akinetic mutism. Thereafter, increased levels of neuron-specific enolase as well as 14-3-3 proteins were found in the cerebro-spinal fluid (CSF). The patient finally died with signs of cerebral decortication. Due to the clinical course and the CSF-findings the patient's final diagnosis was Creutzfeld-Jakob-disease, nevertheless no autopsy was performed. The presented case report underscores the clinical utility of perfusion brain SPECT in the differential diagnosis of dementias. (orig.)

  7. Functional brain imaging study in patients with anxiety disorders using SPECT

    Objective: To evaluate the changes of brain function in patients with anxiety disorders. Methods: Regional cerebral perfusion was investigated using SPECT in 65 patients with anxiety disorders dragnosed according to the fourth edition of the diagnostic and statistical manual of mental disorder (DSMTD) criteria and in a matched control group of 21 healthy volunteers. 65 cases of the patients were further divided into: drug treated group (31 patients) and non-drug treated group (34 patients). The mean ages of the patients and the controls were (39.2±26.1) and (34.4±9.7) years, respectively. The severity of the anxiety was assessed using the 17-item Hamilton Anxiety scale (mean: 24.8±5.5 and 24.7±7.5, respectively). After administration of 740-925 MBq 99Tcm-ethylene cysteinate direct (ECD) brain SPECT image study was performed. For the semi- quantitative analysis of the data, the ratios of the mean counts/pixel in the different cerebral regions of interest (ROI) to that of cerebellum were calculated respectively as a regional perfusion index (RPI). Some patients had a repeated SPECT after three months of treatment. Results: 93.8% (61/65) patients had relative hypoperfusions in some cerebral regions. Compared with the control group, the patients had a significant decrease of regional cerebral blood flow (rCBF) in the bilateral frontal lobes, paralimbic system, temporal lobes and basal ganglia. The course of disease had negatively correlated with the changes of rCBF in both groups of patients. Follow-up SPECT study demonstrated increased rCBF related with the symptomatic improvement. Conclusions: Patients with anxiety disorders had profound dysfunction of the frontal and temporal cortices, and was closely related to the symptom and therapy. 99Tcm-ECD brain SPECT may offer the most accurate assessment of response to therapy. . (authors)

  8. Analysis of Regional Cerebral Blood Flow Using 99mTc-HMPAO Brain SPECT in Senile Dementia of Alzheimer Type

    99mTc-HMPAO brain SPECT studies were performed in 11 patients with Alzheimer's disease, 7 patients with psychological depression and 12 normal controls. Changes of regional cerebral blood flow was semiquantitatively analyzed and the results were as follows. 1) In 11 patients with Alzheimer's disease, significant reduction of regional cerebral blood flow was found In both temporoparietal areas. 2) Relative perfusion between cerebral hemispheres was rather symmetrical in patient with Alzheimer's disease. 3) All patients with depression showed normal SPECT findings. As for conclusion, 99mTc-HMPAO brain SPECT seemed to be a valuable method for clinical assessment and management of patients with Alzheimer's disease.

  9. Ultra-high-resolution brain SPECT imaging: Simulation results

    The spatial resolution in a reconstructed SPECT image is obviously influenced by the intrinsic resolution of the detector, but it is not generally recognized that the photon-counting efficiency of SPECT systems is also determined by the intrinsic resolution. In fact, it is often stated that increased intrinsic detector resolution is of little use since the overall resolution is limited by the collimator rather than the detector, and that collimator resolution cannot be increased without an unacceptable sacrifice in efficiency. In this paper, the authors attempt to demonstrate that improvements in detector resolution can lead to both improved spatial resolution in the image and improved counting efficiency compared to conventional systems. In this paper they report simulation studies that demonstrate the image quality that is attainable with such detectors. Reconstructions were performed using an iterative search algorithm on a custom-designed parallel computer. The imaging system was described by a calculated system matrix relating all voxels in the object space to all pixels on the detector. They found a resolution close to 2 mm on the reconstructed images obtained from these computer simulations with clinically reasonable exposure times. This resolution may be even further improved by optimization of the multiple-pinhole aperture. Thus the novel semiconductor modular gamma-camera design should provide a large improvement not only in detector resolution but also in reconstructed resolution

  10. Differential diagnosis in patients with ring-like thallium-201 uptake in brain SPECT

    Kinuya, Keiko; Ohashi, Masahiro; Itoh, Syotaro [Tonami General Hospital, Toyama (Japan)] (and others)

    2002-09-01

    This study was performed to investigate lesions with ring-like thallium-201 ({sup 201}Tl) uptake and to determine whether SPECT provides any information in differential diagnosis. A total of 244 {sup 201}Tl SPECT images were reviewed. In each study, early (15 min postinjection) and late (3 hr) brain SPECT images were obtained with 111 MBq of {sup 201}Tl. The early uptake ratio (ER; lesion to normal brain average count ratio) and the late uptake ratio (LR) and the L/E ratio (ratio of LR to ER) were calculated. Ring-like uptake was observed in pre-therapeutic 26 SPECT images, including ten glioblastoma multiformes (ER, 3.45{+-}0.64; LR, 2.74{+-}0.54; L/E ratio 0.80{+-}0.13), five meningiomas (6.48{+-}2.34; 4.41{+-}1.41; 0.72{+-}0.19), four metastatic lung cancers (3.47{+-}1.23; 2.40{+-}0.98; 0.70{+-}0.14), four brain abscesses (2.48{+-}1.06; 1.59{+-}0.30; 0.78{+-}0.15), one invasive lesion of squamous cell carcinoma from the ethmoid sinus (1.54; 1.52; 0.99), one medulloblastoma (3.53; 3.52; 1.00) and one hematoma (3.32; 2.36; 0.71). The ER of meningioma was significantly higher than those of glioblastoma multiforme (p<0.0005), metastatic lung cancer (p<0.005) and brain abscess (p<0.0005). There were no significant differences among these three entities. The LR of meningioma was significantly higher than those of glioblastoma multiforme (p<0.005), metastatic lung cancer (p<0.005) and brain abscess (p<0.0001). The LR of brain abscess was significantly lower than that of glioblastoma multiforme (p<0.05). The L/E ratio could not differentiate these four entities. High ER and high LR in a lesion with ring-like uptake is likely an indicator of meningioma. The LR of brain abscess was significantly lower than that of glioblastoma multiforme, but {sup 201}Tl SPECT has still difficulty in differentiating abscess from brain tumor. (author)

  11. Evaluation of seizure propagation on ictal brain SPECT using statistical parametric mapping in temporal lobe epilepsy

    Ictal brain SPECT has a high diagnostic sensitivity exceeding 90 % in the localization of seizure focus, however, it often shows increased uptake within the extratemporal areas due to early propagation of seizure discharge. This study aimed to evaluate seizure propagation on ictal brian SPECT in patients with temporal lobe epilepsy (TLE) by statistical parametric mapping (SPM). Twenty-one patients (age 27.14 5.79 y) with temporal lobe epilepsy (right in 8, left in 13) who had successful seizure outcome after surgery and nine normal control were included. The data of ictal and interictal brain SPECT of the patients and baseline SPECT of normal control group were analyzed using automatic image registration and SPM96 softwares. The statistical analysis was performed to compare the mean SPECT image of normal group with individual ictal SPECT, and each mean image of the interictal groups of the right or left TLE with individual ictal scans. The t statistic SPM [t] was transformed to SPM [Z] with a threshold of 1.64. The statistical results were displayed and rendered on the reference 3 dimensional MRI images with P value of 0.05 and uncorrected extent threshold p value of 0.5 for SPM [Z]. SPM data demonstrated increased uptake within the epileptic lesion in 19 patients (90.4 %), among them, localized increased uptake confined to the epileptogenic lesion was seen in only 4 (19%) but 15 patients (71.4%) showed hyperperfusion within propagation sites. Bi-temporal hyperperfusion was observed in 11 out of 19 patients (57.9%, 5 in the right and 6 in the left); higher uptake within the lesion than contralateral side in 9, similar activity in 1 and higher uptake within contralateral lobe in one. Extra-temporal hyperperfusion was observed in 8 (2 in the right, 3 in the left, 3 in bilateral); unilateral hyperperfusion within the epileptogenic temporal lobe and extra-temporal area in 4, bi-temporal with extra-temporal hyperperfusion in remaining 4. Ictal brain SPECT is highly

  12. Demonstration of cerebral abnormalities in cocaine abusers with SPECT perfusion brain scans

    This paper reports I-123 isopropyl iodoamphetamine (IMP) single-photon emission CT (SPECT) brain scans performed on cocaine users to investigate the effects of cocaine on the cerebral perfusion in a manner similar to previous CT, angiographic and positron-emission tomographic (PET) studies. Ten asymptomatic or mildly symptomatic cocaine users, two users with major neurovascular complications, and five normal subjects were studied with IMP SPECT. Rotating-brain images of the cerebral IMP uptake were displayed by using a distance-weighted surface-projection technique and were visually analyzed for focal cortical perfusion deficits. Eleven cocaine users had multiple scattered cortical IMP defects. Frontal lobe defects were most prominent. One user had confluent defects resembling swiss cheese. Concurrent CT scans available in nine patients were negative in seven and showed infarcts in two. No similar focal findings were visible in normals

  13. Functional brain substrate of quality of life in patients with schizophrenia: A brain SPECT multidimensional analysis.

    Faget-Agius, Catherine; Boyer, Laurent; Richieri, Raphaëlle; Auquier, Pascal; Lançon, Christophe; Guedj, Eric

    2016-03-30

    The aim of this study was to investigate the functional brain substrate of quality of life (QoL) in patients with schizophrenia. Participants comprised 130 right-handed patients with schizophrenia who underwent whole-brain single photon emission computed tomography (SPECT) with (99m)Tc-labeled ethylcysteinate dimer ((99m)Tc-ECD) for exploring correlations of regional cerebral blood flow (rCBF) with the eight dimensions score of the Schizophrenia Quality of Life questionnaire (S-QoL 18). A significant positive correlation was found between the global index of the S-QoL 18 and rCBF in the right superior temporal sulcus and between psychological well-being dimension and rCBF in Brodmann area (BA)6, BA8, BA9, and BA10 and between self-esteem dimension and rCBF in striatum and between family relationship dimension and rCBF in BA1, BA2, BA3, BA4, BA8, BA22, BA40, BA42 and BA44 and between relationship with friends dimension and rCBF in BA44 and between physical well-being dimension and rCBF in parahippocampal gyrus, and finally between autonomy dimension and rCBF in cuneus and precuneus. A significant negative correlation was found between resilience dimension and rCBF in precuneus and between sentimental life dimension and rCBF in BA10. Our findings provide neural correlates of QoL. Brain regions involved in cognitions, emotional information processing and social cognition underlie the different QoL dimensions. PMID:27000309

  14. Tl-201 SPECT for assessing tumor viability in recurrent malignant neoplasma of the brain and soft tissues

    This paper evaluates the usefulness of Tl-201 SPECT imaging in the detection of viable tumor vs necrosis and/or inflammation in brain and soft tissue tumors. Tl-201 SPECT, F-18-FDG PET, and CT with contrast medium were done 6 weeks prior to biopsy confirmation in 11 patients with suspected recurrent tumor (nine brain and two soft-tissue tumors). Tumor-nontumor ratios were obtained on attenuation-corrected transaxial images. The CT scans were reviewed prior to reading the SPECT and FDG PET scans. Seven of 11 patients had recurrent tumors (five brain and two soft tissue) on biopsy and all were positive on SPECT (mean ratio, 4.0 ± 0.8) and hypermetabolic on FDG PET scans. Two of seven had equivocal findings on CT

  15. Brain perfusion SPECT and EEG findings in Rett syndrome

    Thirteen patients (mean age 8.4 + 5.3 years) with Rett syndrome (RS) were studied with EEG and 99mTc-HMPAO SPECT. Eleven patients had background abnormalities and 10 patients paroxysmal activity in EEG. Hypoperfusion of varying severity was detected in 11 patients, 7 patients having multiple lesions. Bifrontal hypoperfusion, observed in 6 patients, was the most distinctive finding. Hypoperfusion was observed also in other cortical regions, except for the occipital lobes. There was no correlation between severity of the background abnormality or presence of paroxysmal activity in EEG and grade of hypoperfusion. There was, however, an association between the severity of hypoperfusion and early manifestation of symptoms in patients with RS. Whether this early-onset group of patients represents a different disease entity or only reflects disease variability the basic pathology being the same, is a possibility that deserves further clarification. (au) 37 refs

  16. Brain perfusion SPECT and EEG findings in Rett syndrome

    Lappalainen, R. [Children`s Castle Hospital, Dept. of Child Neurology, Helsinki (Finland); Liewendahl, K.; Nikkinen, P. [Univ. Central Hospital, Division of Nuclear Medicine, Laboratory Dept., Helsinki (Finland); Sainio, K.; Riikonen, R.S. [Univ. Central Hospital, Child Neurology, Helsinki (Finland)

    1997-01-01

    Thirteen patients (mean age 8.4 + 5.3 years) with Rett syndrome (RS) were studied with EEG and {sup 99m}Tc-HMPAO SPECT. Eleven patients had background abnormalities and 10 patients paroxysmal activity in EEG. Hypoperfusion of varying severity was detected in 11 patients, 7 patients having multiple lesions. Bifrontal hypoperfusion, observed in 6 patients, was the most distinctive finding. Hypoperfusion was observed also in other cortical regions, except for the occipital lobes. There was no correlation between severity of the background abnormality or presence of paroxysmal activity in EEG and grade of hypoperfusion. There was, however, an association between the severity of hypoperfusion and early manifestation of symptoms in patients with RS. Whether this early-onset group of patients represents a different disease entity or only reflects disease variability the basic pathology being the same, is a possibility that deserves further clarification. (au) 37 refs.

  17. Clinical significance of brain SPECT abnormalities of thalami and cerebellum in cerebral palsy with normal MRI

    Park, C. H.; Lim, S. Y.; Lee, I. Y.; Kim, O. H.; Bai, M. S.; Kim, S. J.; Yoon, S. N.; Cho, C. W. [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

    1997-07-01

    The cerebral palsy(CP) encephalopathies are often of uncertain etiology and various functional image findings comparing with anatomical image findings have been reported. However, only a few have mentioned its clinical implications. The purpose of our report is to compare clinical severity and functional SPECT abnormalities of thalami and cerebellum in CP patients with normal MRI. Thirty six CP patients with bilateral spastic palsy who had normal MRI and brain SPECT were studied from July 1996 to September 1997. The patients' age at the time of SPECT was 22.84{+-}17.69 months. The patients were divided into two groups according to motor quotient(MQ); moderate defect (>50MQ : n=27 MQ=22.78{+-}10.36), mild defect (<50MQ : n=9, MQ=66.11{+-}13.87). The degree of rCBF decrease between the two groups was evaluated by {chi}{sup 2} test. Brain SPECT was performed following IV administration of 0.05-0.1 mCi/kg (minimum 2.0 mCi) of Tc-99m ECD and chloral hydrate sedation (50-80 mg/kg p.o) using a triple head system (MS 3, Siemens). Interpretation of brain SPECT was visual analysis: severe decrease is defined when the defect is moderate to marked and mild decrease in rCBF as mild. Seven of 36 (19.4%) showed unilateral or bilateral moderate decrease in rCBF in thalami, 20(55.6%) showed mild decrease, and 9(25.0%) showed no decreased rCBF. All 7 who had moderate thalamic defect reveled moderate motor defect clinically. Ten of 36(27.9%) revealed unilateral or bilateral moderate rCBF defect, 23 (63.9%) depicted mild defect, and 3(8.3%) showed no defect. Sixteen with moderate thalamic rCBF defect showed moderate motor defect in 15 patients. There was statistically significant (p=0.02605) relationship between rCBF defect and motor defect in our CP patients. In conclusion, brain SPECT appears sensitive, non-invasive tool in the evaluation as well as in the prognostication of bilateral spastic cerebral palsy patients and deserves further study using larger number of patients.

  18. Clinical significance of brain SPECT abnormalities of thalami and cerebellum in cerebral palsy with normal MRI

    The cerebral palsy(CP) encephalopathies are often of uncertain etiology and various functional image findings comparing with anatomical image findings have been reported. However, only a few have mentioned its clinical implications. The purpose of our report is to compare clinical severity and functional SPECT abnormalities of thalami and cerebellum in CP patients with normal MRI. Thirty six CP patients with bilateral spastic palsy who had normal MRI and brain SPECT were studied from July 1996 to September 1997. The patients' age at the time of SPECT was 22.84±17.69 months. The patients were divided into two groups according to motor quotient(MQ); moderate defect (>50MQ : n=27 MQ=22.78±10.36), mild defect (2 test. Brain SPECT was performed following IV administration of 0.05-0.1 mCi/kg (minimum 2.0 mCi) of Tc-99m ECD and chloral hydrate sedation (50-80 mg/kg p.o) using a triple head system (MS 3, Siemens). Interpretation of brain SPECT was visual analysis: severe decrease is defined when the defect is moderate to marked and mild decrease in rCBF as mild. Seven of 36 (19.4%) showed unilateral or bilateral moderate decrease in rCBF in thalami, 20(55.6%) showed mild decrease, and 9(25.0%) showed no decreased rCBF. All 7 who had moderate thalamic defect reveled moderate motor defect clinically. Ten of 36(27.9%) revealed unilateral or bilateral moderate rCBF defect, 23 (63.9%) depicted mild defect, and 3(8.3%) showed no defect. Sixteen with moderate thalamic rCBF defect showed moderate motor defect in 15 patients. There was statistically significant (p=0.02605) relationship between rCBF defect and motor defect in our CP patients. In conclusion, brain SPECT appears sensitive, non-invasive tool in the evaluation as well as in the prognostication of bilateral spastic cerebral palsy patients and deserves further study using larger number of patients

  19. Investigation of olfactory function in normal volunteers and patients with anosmia : analysis of brain perfusion SPECTs using statistical parametric mapping

    The purpose of this study was to investigate olfactory function with Tc-99m ECD brain perfusion SPECT using statistical parametric mapping (SPM) analysis in normal volunteers and patients with anosmia. The study populations were 8 subjects matched healthy volunteers and 16 subjects matched patients with anosmia. We obtaibed baseline and post-stimulation (3% butanol) brain perfusion SPECTs in the silent dark room. We analyzed the all SPECTs using SPM. The difference between two sets of brain perfusion SPECTs were compared with t-test. The voxels with p-value of less than 0.01 were considered to be significantly different. We demonstrated increased perfusion in the both cingulated gyri, right middle temporal gyrus, right superior and inferior frontal gyri, right lingual gyrus and right fusiform gyrus on post-stimulation brain SPECT in normal volunteers, and demonstrated decreased perfusion in the both cingulate gyri, right middle temporal gyrus, right rectal gyrus and both superior and inferior frontal gyri in the 10 patients with anosmia. No significant hypoperfusion area was observed in the other 6 patients with anosmia. The baseline and post-stimulation brain perfusion SPECTs can helpful in the evaluation of olfactory function and be useful in the diagnosis of anosmia

  20. Comparison of normal adult and children brain SPECT imaging using statistical parametric mapping(SPM)

    This study compared rCBF pattern in normal adult and normal children using statistical parametric mapping (SPM). The purpose of this study was to determine distribution pattern not seen visual analysis in both groups. Tc-99m ECD brain SPECT was performed in 12 normal adults (M:F=11:1, average age 35 year old) and 6 normal control children (M:F=4:2, 10.5±3.1y) who visited psychiatry clinic to evaluate ADHD. Their brain SPECT revealed normal rCBF pattern in visual analysis and they were diagnosed clinically normal. Using SPM method, we compared normal adult group's SPECT images with those of 6 normal children subjects and measured the extent of the area with significant hypoperfusion and hyperperfusion (p<0.001, extent threshold=16). The areas of both angnlar gyrus, both postcentral gyrus, both superior frontal gyrus, and both superior parietal lobe showed significant hyperperfusion in normal adult group compared with normal children group. The areas of left amygdala gyrus, brain stem, both cerebellum, left globus pallidus, both hippocampal formations, both parahippocampal gyrus, both thalamus, both uncus, both lateral and medial occipitotemporal gyrus revealed significantly hyperperfusion in the children. These results demonstrated that SPM can say more precise anatomical area difference not seen visual analysis

  1. Comparison of normal adult and children brain SPECT imaging using statistical parametric mapping(SPM)

    Lee, Myoung Hoon; Yoon, Seok Nam; Joh, Chul Woo; Lee, Dong Soo [Ajou University School of Medicine, Suwon (Korea, Republic of); Lee, Jae Sung [Seoul national University College of Medicine, Seoul (Korea, Republic of)

    2002-07-01

    This study compared rCBF pattern in normal adult and normal children using statistical parametric mapping (SPM). The purpose of this study was to determine distribution pattern not seen visual analysis in both groups. Tc-99m ECD brain SPECT was performed in 12 normal adults (M:F=11:1, average age 35 year old) and 6 normal control children (M:F=4:2, 10.5{+-}3.1y) who visited psychiatry clinic to evaluate ADHD. Their brain SPECT revealed normal rCBF pattern in visual analysis and they were diagnosed clinically normal. Using SPM method, we compared normal adult group's SPECT images with those of 6 normal children subjects and measured the extent of the area with significant hypoperfusion and hyperperfusion (p<0.001, extent threshold=16). The areas of both angnlar gyrus, both postcentral gyrus, both superior frontal gyrus, and both superior parietal lobe showed significant hyperperfusion in normal adult group compared with normal children group. The areas of left amygdala gyrus, brain stem, both cerebellum, left globus pallidus, both hippocampal formations, both parahippocampal gyrus, both thalamus, both uncus, both lateral and medial occipitotemporal gyrus revealed significantly hyperperfusion in the children. These results demonstrated that SPM can say more precise anatomical area difference not seen visual analysis.

  2. Ophthalmoplegic migraine with reversible thalamic ischemia by Tc-99m ethylcysteinate dimer brain SPECT

    Kim, Jong Ho; Shin, Dong Jin; Kang, Sung Soo [Gachon Medical School, Gil Medical Center, Inchon (Korea, Republic of)

    1999-07-01

    Two patients presented with ophthalmoplegic migraine (OM) underwent EEG, Brain-MRI, cerebral angiography, and Tc-99m ECD SPECT during an attack. Follow-up SPECT was performed after neurologic symptoms resolved. In both cases, SPECT during an attack of ophthalmoplegia and headache demonstrated a significantly decreased regional cerebral blood flow in the thalamus to the side of ophthalmoplegia, which was normalized on the follow-up SPECT during a symptom free recovery phase (Lesion to Non-lesion thalamic ratio=1.19 to 0.96 and 1.16 to 0.98, respectively). The other roentgenographic and laboratory findings were normal. These findings are suggestive the ischemia in the perforators of PCA results in third nerve palsy because the portion of oculomotor nerve behind the cavernous sinus derives its blood supply from small perforating branches of the basilar and PCA. Matched ictal hypoperfusion of the thalamus to the site of ophthalmoplegic migraine is suggestive of the ischemic neuropathy as an etiology of OM.

  3. A new method for brain functional study using Tc-99m HMPAO SPECT

    The distribution of 99mTc-HMPAO in brain is in proportion to regional cerebral blood flow (rCBF) and can be interpreted as functional mapping. To evaluate local changes in CBF during neuropsychological testing, we developed a new subtraction method using HMPAO and SPECT. With patients resting, 15 mCi of HMPAO was injected and the first acquisition was performed, lasting a total of 10 minutes. Soon after the end of the first scan, patients were requested to undergo Buschke's memory test or to repeat words or numbers (repetition test). During the task, an additional 15 mCi of HMPAO was injected using the same position as in the first scan, and a second acquisition was started. A functional image was made by subtracting the image in the first scan from that in the second. In two patients with transient global amnesia and two normal controls, Buschke's memory test was performed in combination with SPECT. A relative increase in activity was seen in the thalamus, subthalamic area, hippocampus, and some cortial areas, apparently reflecting local functional change induced by the memory task. In two patients with moderate Alzheimer's disease with severe memory loss, no increase was detected in these areas. In one patient with aphasia, the repetition test with SPECT was correlated with the WADA test and dichotic listening test, and good agreement was obtained. In conclusion, our new SPECT technique is useful in detecting alterations in rCBF during mental activity and can be applied to neurophysiological studies. (author)

  4. Ophthalmoplegic migraine with reversible thalamic ischemia by Tc-99m ethylcysteinate dimer brain SPECT

    Two patients presented with ophthalmoplegic migraine (OM) underwent EEG, Brain-MRI, cerebral angiography, and Tc-99m ECD SPECT during an attack. Follow-up SPECT was performed after neurologic symptoms resolved. In both cases, SPECT during an attack of ophthalmoplegia and headache demonstrated a significantly decreased regional cerebral blood flow in the thalamus to the side of ophthalmoplegia, which was normalized on the follow-up SPECT during a symptom free recovery phase (Lesion to Non-lesion thalamic ratio=1.19 to 0.96 and 1.16 to 0.98, respectively). The other roentgenographic and laboratory findings were normal. These findings are suggestive the ischemia in the perforators of PCA results in third nerve palsy because the portion of oculomotor nerve behind the cavernous sinus derives its blood supply from small perforating branches of the basilar and PCA. Matched ictal hypoperfusion of the thalamus to the site of ophthalmoplegic migraine is suggestive of the ischemic neuropathy as an etiology of OM

  5. Brain perfusion SPECT and FDG PET findings in a patient with ballism associated with hyperthyroidism

    Bae, Sang Kyun; Kim, Sang Jin [Pusan Paik Hospital, Pusan (Korea, Republic of)

    2007-07-01

    Ballism is a very rare presentation in association with hyperthyroidism. We describe a 22-year-old lady with episodes of recurrent ballism and hyperthyroidism. A 22-year-old lady was admitted to Neurology department because of sudden development of vigorous involuntary movement and dysarthria. She was diagnosed as hyperthyroidism at the age 12 and treated irregularly. She arrived at the emergency room because of sudden onset of involuntary movement. Computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) of brain was normal. Serum levels of thyroid hormone were increased (Free T4 3.15 ng/dl; normal range 0.93-1.71 ng/dl), whereas thyroid-stimulating hormone (TSH) was undetectable. The thyroid gland was diffusely enlarged and exophthalmos was found. She had been given antithyroid medication from local clinic but medicated irregularly. Technetium thyroid scan reveals diffusely enlarged thyroid with increased radioactivity. Radioiodine uptake in 24 hours was 71 %. Brain perfusion SPECT using Tc-99m ECD reveals asymmetrical perfusion pattern in basal ganglia. Brain PET using F-18 FDG reveals increased metabolism at both caudate nucleus and putamen. She was treated with radioiodine and involuntary movement was improved. There is only few report on ballism associated with hyperthyroidism and no report on functional brain imaging. Brain perfusion SPECT and FDG PET may give useful information about functional status of brain in patients with ballism associated with hyperthyroidism in case of normal anatomical finding on CT/MRI.

  6. Brain perfusion SPECT and FDG PET findings in a patient with ballism associated with hyperthyroidism

    Ballism is a very rare presentation in association with hyperthyroidism. We describe a 22-year-old lady with episodes of recurrent ballism and hyperthyroidism. A 22-year-old lady was admitted to Neurology department because of sudden development of vigorous involuntary movement and dysarthria. She was diagnosed as hyperthyroidism at the age 12 and treated irregularly. She arrived at the emergency room because of sudden onset of involuntary movement. Computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) of brain was normal. Serum levels of thyroid hormone were increased (Free T4 3.15 ng/dl; normal range 0.93-1.71 ng/dl), whereas thyroid-stimulating hormone (TSH) was undetectable. The thyroid gland was diffusely enlarged and exophthalmos was found. She had been given antithyroid medication from local clinic but medicated irregularly. Technetium thyroid scan reveals diffusely enlarged thyroid with increased radioactivity. Radioiodine uptake in 24 hours was 71 %. Brain perfusion SPECT using Tc-99m ECD reveals asymmetrical perfusion pattern in basal ganglia. Brain PET using F-18 FDG reveals increased metabolism at both caudate nucleus and putamen. She was treated with radioiodine and involuntary movement was improved. There is only few report on ballism associated with hyperthyroidism and no report on functional brain imaging. Brain perfusion SPECT and FDG PET may give useful information about functional status of brain in patients with ballism associated with hyperthyroidism in case of normal anatomical finding on CT/MRI

  7. Tl-201 and Tc-99m-Sestamibi SPECT for brain tumor detection: Comparison using MRI coregistration

    Darcourt, J.; Itti, L.; Chang, L. [UCLA Medical Center, Torrance, CA (United States)] [and others

    1994-05-01

    Tl-201 (Tl) brain SPECT has been validated for the differential diagnosis of high versus low grade gliomas and recurrence versus radiation necrosis. We compared this technique to Tc-99m-Sestamibi (MIBI) SPECT in 9 patients (pts) with brain tumors using MRI coregistration. Pts were injected with 4 mCi of Tl and brain SPECT was performed using a dedicated brain system. This was immediately following by an injection of 20 mCi of MIBI and a brain SPECT using the same camera and with the pt in the same position. Four pts were studied for the diagnosis of radiation necrosis vs. tumor recurrence (2 had biopsy proven recurrence); 5 pts were studied for primary tumor evaluation: 2 meningiomas, 1 oligodendroglioma, 1 low-grade astrocytoma, 1 cysticercosis. Coregistration was performed for every pt by 3D surface fitting of the inner skull MIBI contour to the MRI brain surface extracted automatically. ROIs were drawn on the MRI and applied to the coregistered MIBI and Tl images for tumor to non-tumor ratios T/NT calculations. There was a tight correlation between MIBI and Tl T/NT (r-0.96) and a 1.5 threshold separated radiation necrosis from recurrence and low from high grade primary tumors. Therefore, the data already available on Tl brain tumor imaging can be used with MIBI SPECT with the advantage of a better image quality (2.5 to 4 times more counts).

  8. Comparative study of cerebral blood perfusion SPECT imaging and CT scan in evaluation of the curative effect of hyperbaric oxygen in patients with post-traumatic brain syndrome

    Objective: To comparatively study the results of cerebral SPECT and cerebral CT before and after hyperbaric oxygen (HBO) treatment in post-traumatic brain syndrome. Methods: HBO was used to treat 288 patients with post-traumatic brain syndrome for two courses, and made therapeutic surveillance and comparative analysis with 99Tcm-ECD SPECT, CT before and after treatment. Results: Before treatment, the positive rate of cerebral SPECT was 80.6%, but the positive rate of CT was only 10.2%; after treatment, 90% of SPECT became negative, and the clinical symptoms of the patients disappeared as SPECT became negative. The results showed that HBO treatment could evidently improve rCBF, and showed that SPECT was superior to CT in surveillance of HBO treatment. Conclusions: 99Tcm-ECD SPECT could play an important role in the diagnosis of post-traumatic brain syndrome and the therapeutic surveillance of HBO

  9. Hypoperfusion in baseline and cognitively activated brain SPECT imaging of adult and elderly patients with depression

    Objective: To evaluate the rCBF abnormalities of the baseline and cognitively activated rCBF imaging in unmedicated adult and elderly patients with depression. Methods: The subjects were divided into four groups: depressed adults, normal adult controls, depressed elders and normal elderly controls. All depressed patients were unmedicated and the diagnoses (depression of moderate degree with accompanying somatization) were confirmed by the ICD-10 criteria. Age range of the 39 depressed adult patients was 17 - 55 years. 17 age-matched normal adult controls (age range 21 - 50 years) were studied under identical conditions. The age range of 18 depressed elderly patients was 62 - 76 years. 21 age-matched normal elderly controls (age range 60 - 72 years) were studied under identical conditions. Baseline and cognitively activated 99Tcm-ECD SPECT were performed on 25 of the 39 adult patients with depression and 17 normal adult controls. Baseline 99Tcm-ECD SPECT only was performed on the remaining 14 patients with depression. Baseline and cognitively activated 99Tcm-ECD SPECT were performed on 12 of the 18 elderly patients with depression and 18 of the 21 normal elderly controls. Baseline 99Tcm-ECD SPECT only was performed on the remaining elderly patients and 3 normal elderly controls. Results: 1) The characteristic abnormalities of baseline and cognitively activated brain SPECT imaging of depression in adults: the baseline rCBF values of frontal and temporal lobe decreased significantly and the activated rCBF values of frontal, temporal lobe decreased more evidently than that in the baseline imaging and additionally decreased activated rCBF values in parietal lobe were found. 2) The characteristic abnormalities of baseline and cognitively activated brain SPECT imaging of elderly patients with depression: the baseline rCBF values of frontal, temporal lobe and right basal ganglia decreased significantly and the activated rCBF values of frontal, temporal, right parietal lobe

  10. Importance of brain perfusion SPECT in the diagnosis and prognosis of migraine

    Aim: The objective of this investigation was to establish the usefulness of ECD-99mTc brain perfusion SPECT in the evaluation of the diagnosis of functional alterations of Vascular Headaches of migrainous origin and to determine the changes in regional cerebral blood flow (FSCr) during the headache phase. Material and Methods: A population of 21 female patients, 5 controls, of the same age and sex, aged between 20 and 76 years, with clinical evidence of headache with or without aura, with a duration of 8 to 72 hours, pulsating pain, associated to nausea, photophobia, phonophobia, that does not resolve with common analgesics and characterized by increase of the pain with physical activity. Brain perfusion SPECT was practiced on them at the moment of crisis, independent of the presence of aura or pain, and without crisis. ECD-99mTc was administered at a dose of 925 to 1110 MBq. Images were analyzed by the semi quantification method. Results: SPECT detected 13 hypo-captures on the 16 patients studied. With an 81% sensitivity and 100% specificity, with a precision value of 86%. Analysis through X Binomial Aleatory Variable showed a precision of 90% (p= < 0,023) for the isotopic test, with a significance level of 5%. Conclusions: The results of this study confirm that brain SPECT is a neuroimaging technique capable of identifying migrainous patients, being able to reevaluate the type of hypo perfusion that each patient has, during crisis or out of crisis, and correlate the cortical perfusion deficits and the deterioration of neuropsychological functions

  11. Evaluation of both perfusion and atrophy in multiple system atrophy of the cerebellar type using brain SPECT alone

    Partial volume effects in atrophied areas should be taken into account when interpreting brain perfusion single photon emission computed tomography (SPECT) images of neurodegenerative diseases. To evaluate both perfusion and atrophy using brain SPECT alone, we developed a new technique applying tensor-based morphometry (TBM) to SPECT. After linear spatial normalization of brain perfusion SPECT using 99mTc-ethyl cysteinate dimer (99mTc-ECD) to a Talairach space, high-dimension-warping was done using an original 99mTc-ECD template. Contraction map images calculated from Jacobian determinants and spatially normalized SPECT images using this high-dimension-warping were compared using statistical parametric mapping (SPM2) between two groups of 16 multiple system atrophy of the cerebellar type (MSA-C) patients and 73 age-matched normal controls. This comparison was also performed in conventionally warped SPECT images. SPM2 demonstrated statistically significant contraction indicating local atrophy and decreased perfusion in the whole cerebellum and pons of MSA-C patients as compared to normal controls. Higher significance for decreased perfusion in these areas was obtained in high-dimension-warping than in conventional warping, possibly due to sufficient spatial normalization to a 99mTc-ECD template in high-dimensional warping of severely atrophied cerebellum and pons. In the present high-dimension-warping, modification of tracer activity remained within 3% of the original tracer distribution. The present new technique applying TBM to brain SPECT provides information on both perfusion and atrophy at the same time thereby enhancing the role of brain perfusion SPECT

  12. Three modality image registration of brain SPECT/CT and MR images for quantitative analysis of dopamine transporter imaging

    Yamaguchi, Yuzuho; Takeda, Yuta; Hara, Takeshi; Zhou, Xiangrong; Matsusako, Masaki; Tanaka, Yuki; Hosoya, Kazuhiko; Nihei, Tsutomu; Katafuchi, Tetsuro; Fujita, Hiroshi

    2016-03-01

    Important features in Parkinson's disease (PD) are degenerations and losses of dopamine neurons in corpus striatum. 123I-FP-CIT can visualize activities of the dopamine neurons. The activity radio of background to corpus striatum is used for diagnosis of PD and Dementia with Lewy Bodies (DLB). The specific activity can be observed in the corpus striatum on SPECT images, but the location and the shape of the corpus striatum on SPECT images only are often lost because of the low uptake. In contrast, MR images can visualize the locations of the corpus striatum. The purpose of this study was to realize a quantitative image analysis for the SPECT images by using image registration technique with brain MR images that can determine the region of corpus striatum. In this study, the image fusion technique was used to fuse SPECT and MR images by intervening CT image taken by SPECT/CT. The mutual information (MI) for image registration between CT and MR images was used for the registration. Six SPECT/CT and four MR scans of phantom materials are taken by changing the direction. As the results of the image registrations, 16 of 24 combinations were registered within 1.3mm. By applying the approach to 32 clinical SPECT/CT and MR cases, all of the cases were registered within 0.86mm. In conclusions, our registration method has a potential in superimposing MR images on SPECT images.

  13. Clinical correlative evaluation of an iterative method for reconstruction of brain SPECT images

    Background: Brain SPECT and PET investigations have showed discrepancies in Alzheimer's disease (AD) when considering data deriving from deeply located structures, such as the mesial temporal lobe. These discrepancies could be due to a variety of factors, including substantial differences in gamma-cameras and underlying technology. Mesial temporal structures are deeply located within the brain and the commonly used Filtered Back-Projection (FBP) technique does not fully take into account either the physical parameters of gamma-cameras or geometry of collimators. In order to overcome these limitations, alternative reconstruction methods have been proposed, such as the iterative method of the Conjugate Gradients with modified matrix (CG). However, the clinical applications of these methods have so far been only anecdotal. The present study was planned to compare perfusional SPECT data as derived from the conventional FBP method and from the iterative CG method, which takes into account the geometrical and physical characteristics of the gamma-camera, by a correlative approach with neuropsychology. Methods: Correlations were compared between perfusion of the hippocampal region, as achieved by both the FBP and the CG reconstruction methods, and a short-memory test (Selective Reminding Test, SRT), specifically addressing one of its function. A brain-dedicated camera (CERASPECT) was used for SPECT studies with 99mTc-hexamethylpropylene-amine-oxime in 23 consecutive patients (mean age: 74.2±6.5) with mild (Mini-Mental Status Examination score ≥15, mean 20.3±3), probable AD. Counts from a hippocampal region in each hemisphere were referred to the average thalamic counts. Results: Hippocampal perfusion significantly correlated with the MMSE score with similar statistical significance (p<0.01) between the two reconstruction methods. Correlation between hippocampal perfusion and the SRT score was better with the CG method (r=0.50 for both hemispheres, p<0.01) than with

  14. Clinical correlative evaluation of an iterative method for reconstruction of brain SPECT images

    Nobili, Flavio E-mail: fnobili@smartino.ge.it; Vitali, Paolo; Calvini, Piero; Bollati, Francesca; Girtler, Nicola; Delmonte, Marta; Mariani, Giuliano; Rodriguez, Guido

    2001-08-01

    Background: Brain SPECT and PET investigations have showed discrepancies in Alzheimer's disease (AD) when considering data deriving from deeply located structures, such as the mesial temporal lobe. These discrepancies could be due to a variety of factors, including substantial differences in gamma-cameras and underlying technology. Mesial temporal structures are deeply located within the brain and the commonly used Filtered Back-Projection (FBP) technique does not fully take into account either the physical parameters of gamma-cameras or geometry of collimators. In order to overcome these limitations, alternative reconstruction methods have been proposed, such as the iterative method of the Conjugate Gradients with modified matrix (CG). However, the clinical applications of these methods have so far been only anecdotal. The present study was planned to compare perfusional SPECT data as derived from the conventional FBP method and from the iterative CG method, which takes into account the geometrical and physical characteristics of the gamma-camera, by a correlative approach with neuropsychology. Methods: Correlations were compared between perfusion of the hippocampal region, as achieved by both the FBP and the CG reconstruction methods, and a short-memory test (Selective Reminding Test, SRT), specifically addressing one of its function. A brain-dedicated camera (CERASPECT) was used for SPECT studies with {sup 99m}Tc-hexamethylpropylene-amine-oxime in 23 consecutive patients (mean age: 74.2{+-}6.5) with mild (Mini-Mental Status Examination score {>=}15, mean 20.3{+-}3), probable AD. Counts from a hippocampal region in each hemisphere were referred to the average thalamic counts. Results: Hippocampal perfusion significantly correlated with the MMSE score with similar statistical significance (p<0.01) between the two reconstruction methods. Correlation between hippocampal perfusion and the SRT score was better with the CG method (r=0.50 for both hemispheres, p<0

  15. Towards adapting a normal patient database for SPECT brain perfusion imaging

    Single-photon emission computerized tomography (SPECT) is a tool which can be used to image perfusion in the brain. Clinicians can use such images to help diagnose dementias such as Alzheimer's disease. Due to the intrinsic stochasticity in the photon imaging system, some form of statistical comparison of an individual image with a 'normal' patient database gives a clinician additional confidence in interpreting the image. Due to the variations between SPECT camera systems, ideally a normal patient database is required for each individual system. However, cost or ethical considerations often prohibit the collection of such a database for each new camera system. Some method of adapting existing normal patient databases to new camera systems would be beneficial. This paper introduces a method which may be regarded as a 'first-pass' attempt based on 2-norm regularization and a codebook of discrete spatially stationary convolutional kernels. Some preliminary illustrative results are presented, together with discussion on limitations and possible improvements

  16. Brain MRI and SPECT in the diagnosis of early neurological involvement in Wilson's disease

    Piga, Mario; Satta, Loredana; Serra, Alessandra; Loi, Gianluigi [Policlinico Universitario, University of Cagliari, Nuclear Medicine, Department of Medical Science, Monserrato, Cagliari (Italy); Murru, Alessandra; Demelia, Luigi [Policlinico Universitario, University of Cagliari, Gastroenterology, Department of Medical Science, Monserrato, Cagliari (Italy); Sias, Alessandro [Policlinico Universitario, University of Cagliari, Radiology, Department of Medical Science, Monserrato, Cagliari (Italy); Marrosu, Francesco [Policlinico Universitario, University of Cagliari, Neurology, Department of Medical Science, Monserrato, Cagliari (Italy)

    2008-04-15

    To evaluate the impact of brain MRI and single-photon emission computed tomography (SPECT) in early detection of central nervous system abnormalities in patients affected by Wilson's disease (WD) with or without neurological involvement. Out of 25 consecutive WD patients, 13 showed hepatic involvement, ten hepatic and neurological manifestations, and twp hepatic, neurological, and psychiatric symptoms, including mainly movement disorders, major depression, and psychosis. Twenty-four healthy, age-gender matched subjects served as controls. All patients underwent brain MRI and {sup 99m}Tc-ethyl-cysteinate dimer (ECD) SPECT before starting specific therapy. Voxel-by-voxel analyses were performed using statistical parametric mapping to compare differences in {sup 99m}Tc-ECD brain uptake between the two groups. Brain MRI showed T2-weighted hyperintensities in seven patients (28%), six of whom were affected by hepatic and neurological forms. Brain perfusion SPECT showed pathological data in 19 patients (76%), revealing diffuse or focal hypoperfusion in superior frontal (Brodmann area (BA) 6), prefrontal (BA 9), parietal (BA 40), and occipital (BA 18, BA 39) cortices in temporal gyri (BA 37, BA 21) and in caudatus and putamen. Moreover, hepatic involvement was detected in nine subjects; eight presented both hepatic and neurological signs, while two exhibited WD-correlated hepatic, neurological, and psychiatric alterations. All but one patient with abnormal MRI matched with abnormal ECD SPECT. Pathologic MRI findings were obtained in six out of ten patients with hepatic and neurological involvement while abnormal ECD SPECT was revealed in eight patients. Both patients with hepatic, neurological, and psychiatric involvement displayed abnormal ECD SPECT and one displayed an altered MRI. These findings suggest that ECD SPECT might be useful in detecting early brain damage in WD, not only in the perspective of assessing and treating motor impairment but also in evaluating

  17. Value of 99mTc-MIBI brain SPECT in differentiating recurrence and radiotherapy effects in tumors brain patients

    Full text: Accurate neuroimaging can assist in the diagnosis, management, prognosis, and follow-up of central nervous system (CNS) malignancies. Differentiation between tumor progression and radiation necrosis is one of the most difficult tasks in oncologic neuroradiology. The main role of functional imaging in oncological practice is to determine whether a lesion observed in an anatomical study such as CT scan or MRI consists of tumor cells or is formed by fibrotic tissue only. 99mTc-MIBI brain SPECT is considered a useful tool in the management of brain tumors. The demonstration of increased tracer extraction and subsequent accumulation in the lesion indicates viability of the suspected tumor mass. Aim: Gliomas, arising from glial cells, account for approximately the 45-55% of all brain tumors. 99mTc-MIBI tumor uptake is related to histological grading, cellular proliferation index and prognosis. Our aim was to evaluate 99mTc-MIBI brain SPECT and MRI studies efficacy in the differential diagnosis between recurrence of malignant gliomas and glioblastomas and the local modification after radiotherapy. Material and methods: Eight patients with suspected recurrence after surgical removal of a supratentorial glioma (2 low grade and 6 high grade), 6-12 months before study and treated with radiotherapy were investigated. For brain SPECT - 740MBq of 99mTc-MIBI were i.v. injected to each patient 15 minutes before image acquisition by a dual-head gamma camera, using a fan-beam collimator. Transverse, coronal and sagittal views were reconstructed. Gd-DTPA enhanced TI and T2 weighted MRI studies were carried out in every patient within 3 days before 99mTc-MIBI SPECT. The brain SPECT images were analyzed by calculating lesion-to-normal ratios (I/n). Areas of abnormal tracer uptake were defined as focally increased uptake or as asymmetric uptake, compared with the contralateral side. Uptake ratios were calculated using reference regions in the contralateral hemisphere, because

  18. Brain SPECT guided repetitive transcranial magnetic stimulation (rTMS) in treatment resistant major depressive disorder.

    Jha, Shailesh; Chadda, Rakesh K; Kumar, Nand; Bal, C S

    2016-06-01

    Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential treatment in treatment resistant major depressive disorder (MDD). However, there is no consensus about the exact site of stimulation for rTMS. Single-photon emission computed tomography (SPECT) offers a potential technique in deciding the site of stimulation. The present study was conducted to assess the difference in outcome of brain SPECT assisted rTMS versus standard protocol of twenty sessions of high frequency rTMS as add on treatment in 20 patients with treatment resistant MDD, given over a period of 4 weeks. Thirteen subjects (group I) received high frequency rTMS over an area of hypoperfusion in the prefrontal cortex, as identified on SPECT, whereas 7 subjects (group II) were administered rTMS in the left dorsoslateral prefrontal cortex (DLPFC) area. Improvement was monitored using standardized instruments. Patients in the group I showed a significantly better response compared to those in the group II. In group I, 46% of the subjects were responders on MADRS, 38% on BDI and 77% on CGI. The parallel figures of responders in Group II were 0% on MADRS, 14% on BDI and 43% on CGI. There were no remitters in the study. No significant untoward side effects were noticed. The study had limitations of a small sample size and non-controlled design, and all the subjects were also receiving the standard antidepressant therapy. Administration of rTMS over brain SPECT specified area of hypoperfusion may have a better clinical outcome compared to the standard protocol. PMID:27208445

  19. Brain perfusion SPECT correlates with CSF biomarkers in Alzheimer's disease

    Habert, Marie-Odile [UMR-S 678, Universite Pierre et Marie Curie-Paris 6, INSERM, Paris (France); CHU Pitie-Salpetriere, AP-HP, Department of Nuclear Medicine, Paris (France); Hopital Pitie-Salpetriere, Department of Nuclear Medicine, Paris (France); Souza, Leonardo Cruz de; Dubois, Bruno; Sarazin, Marie [CHU Pitie-Salpetriere, AP-HP, Research and Resource Memory Centre and INSERM U610, Paris (France); Lamari, Foudil; Jardel, Claude [CHU Pitie-Salpetriere, AP-HP, Department of Metabolic Biochemistry, Paris (France); Daragon, Nelle; Desarnaud, Serge [CHU Pitie-Salpetriere, AP-HP, Department of Nuclear Medicine, Paris (France)

    2010-03-15

    Our aim was to study the correlations between cerebrospinal fluid (CSF) biomarker levels such as {beta}-amyloid 42 (A{beta}{sub 42}), total and phosphorylated tau protein (T-tau and P-tau) and brain perfusion SPECT in Alzheimer's disease (AD) using a voxel-based methodology. Patients (n = 31) with clinical features of AD (n = 25) or amnestic mild cognitive impairment (aMCI) (n = 6) were retrospectively included. All subjects underwent the same clinical, neuropsychological and neuroimaging tests. They had a lumbar puncture and a brain perfusion ({sup 99m}Tc-ECD) SPECT within a time interval of 10 ({+-}26) days. Correlations between CSF biomarker concentrations and perfusion were studied using SPM2 software. Individual normalised regional activity values were extracted from the eligible clusters for calculation of correlation coefficients. No significant correlation was found between A{beta}{sub 42} concentrations and brain perfusion. A significant correlation (p < 0.01, corrected) was found between T-tau or P-tau concentrations and perfusion in the left parietal cortex. Our results suggest a strong correlation between T-tau and P-tau levels and decreased brain perfusion in regions typically affected by neuropathological changes in AD. (orig.)

  20. Brain SPECT in mesial temporal lobe epilepsy: comparison between visual analysis and SPM (Statistical Parametric Mapping)

    Amorim, Barbara Juarez; Ramos, Celso Dario; Santos, Allan Oliveira dos; Lima, Mariana da Cunha Lopes de; Camargo, Edwaldo Eduardo; Etchebehere, Elba Cristina Sa de Camargo, E-mail: juarezbarbara@hotmail.co [State University of Campinas (UNICAMP), SP (Brazil). School of Medical Sciences. Dept. of Radiology; Min, Li Li; Cendes, Fernando [State University of Campinas (UNICAMP), SP (Brazil). School of Medical Sciences. Dept. of Neurology

    2010-04-15

    Objective: to compare the accuracy of SPM and visual analysis of brain SPECT in patients with mesial temporal lobe epilepsy (MTLE). Method: interictal and ictal SPECTs of 22 patients with MTLE were performed. Visual analysis were performed in interictal (VISUAL(inter)) and ictal (VISUAL(ictal/inter)) studies. SPM analysis consisted of comparing interictal (SPM(inter)) and ictal SPECTs (SPM(ictal)) of each patient to control group and by comparing perfusion of temporal lobes in ictal and interictal studies among themselves (SPM(ictal/inter)). Results: for detection of the epileptogenic focus, the sensitivities were as follows: VISUAL(inter)=68%; VISUAL(ictal/inter)=100%; SPM(inter)=45%; SPM(ictal)=64% and SPM(ictal/inter)=77%. SPM was able to detect more areas of hyperperfusion and hypoperfusion. Conclusion: SPM did not improve the sensitivity to detect epileptogenic focus. However, SPM detected different regions of hypoperfusion and hyperperfusion and is therefore a helpful tool for better understand pathophysiology of seizures in MTLE. (author)

  1. In vivo mapping of cholinergic neurons in the human brain using SPECT and IBVM

    In the search for an in vivo marker of cholinergic neuronal integrity, the authors extended to human use the tracer (-)-5-[123I]iodobenzovesamicol (IBVM)). IBVM, an analog of vesamicol that binds to the acetylcholine transporter on presynaptic vesicles, was prepared with specific activity greater than 1.11 x 109 MBq mmole-1. After intravenous injection of [123I]IBVM, body distribution studies (n = 5) and brain SPECT studies (n = 5) were performed on normal human subjects (n = 10). SPECT images of the brain were collected sequentially over the first 4.5 hr following injection, and again 18 hr later. Data were realigned and transformed to stereotaxic coordinates, and localized activities were extracted for tracer kinetic analysis. The cerebral tracer input function was determined from metabolite-corrected radial arterial blood samples. The best data fit was obtained using a three-compartment model, including terms reflecting cerebral blood volume, exchange of free tracer between plasma and brain and specific binding. Dissociation of bound tracer was negligible for up to 4 hr. For the fitted parameters reflecting transport (K1) and binding site density index (k3, co-efficients of variation were approximately 8% in cortical regions of interest. Relative distributions corresponded well with post-mortem immunohistochemical values reported for the acetylcholine-synthesizing enzyme choline acetyltransferase, k3 (IBVM binding site density index), and tracer activity distribution at 22 hr, but not at 4 hr after injection. SPECT imaging of [123I]IBVM succeeds as an in vivo measure of cholinergic neuronal integrity and should be useful for the study of cerebral degenerative processes such as Alzheimer's disease. 24 refs., 4 figs., 3 tabs

  2. Simulation of realistic abnormal SPECT brain perfusion images: application in semi-quantitative analysis

    Simulation is useful in the validation of functional image analysis methods, particularly when considering the number of analysis techniques currently available lacking thorough validation. Problems exist with current simulation methods due to long run times or unrealistic results making it problematic to generate complete datasets. A method is presented for simulating known abnormalities within normal brain SPECT images using a measured point spread function (PSF), and incorporating a stereotactic atlas of the brain for anatomical positioning. This allows for the simulation of realistic images through the use of prior information regarding disease progression. SPECT images of cerebral perfusion have been generated consisting of a control database and a group of simulated abnormal subjects that are to be used in a UK audit of analysis methods. The abnormality is defined in the stereotactic space, then transformed to the individual subject space, convolved with a measured PSF and removed from the normal subject image. The dataset was analysed using SPM99 (Wellcome Department of Imaging Neuroscience, University College, London) and the MarsBaR volume of interest (VOI) analysis toolbox. The results were evaluated by comparison with the known ground truth. The analysis showed improvement when using a smoothing kernel equal to system resolution over the slightly larger kernel used routinely. Significant correlation was found between effective volume of a simulated abnormality and the detected size using SPM99. Improvements in VOI analysis sensitivity were found when using the region median over the region mean. The method and dataset provide an efficient methodology for use in the comparison and cross validation of semi-quantitative analysis methods in brain SPECT, and allow the optimization of analysis parameters

  3. A new method for brain functional study using Tc-99m HMPAO SPECT

    Momose, Toshimitsu; Kosaka, Noboru; Nishikawa, Junichi; Ohtake, Tohru; Watanabe, Toshiaki; Iio, Masahiro (Tokyo Univ. (Japan). Faculty of Medicine)

    1989-04-01

    The distribution of {sup 99m}Tc-HMPAO in brain is in proportion to regional cerebral blood flow (rCBF) and can be interpreted as functional mapping. To evaluate local changes in CBF during neuropsychological testing, we developed a new subtraction method using HMPAO and SPECT. With patients resting, 15 mCi of HMPAO was injected and the first acquisition was performed, lasting a total of 10 minutes. Soon after the end of the first scan, patients were requested to undergo Buschke's memory test or to repeat words or numbers (repetition test). During the task, an additional 15 mCi of HMPAO was injected using the same position as in the first scan, and a second acquisition was started. A functional image was made by subtracting the image in the first scan from that in the second. In two patients with transient global amnesia and two normal controls, Buschke's memory test was performed in combination with SPECT. A relative increase in activity was seen in the thalamus, subthalamic area, hippocampus, and some cortial areas, apparently reflecting local functional change induced by the memory task. In two patients with moderate Alzheimer's disease with severe memory loss, no increase was detected in these areas. In one patient with aphasia, the repetition test with SPECT was correlated with the WADA test and dichotic listening test, and good agreement was obtained. In conclusion, our new SPECT technique is useful in detecting alterations in rCBF during mental activity and can be applied to neurophysiological studies. (author).

  4. Dynamic SPECT of the brain using a lipophilic technetium-99m complex, PnAO

    Holm, S; Andersen, A R; Vorstrup, S;

    1985-01-01

    The lipophilic 99mTc-labeled oxime propylene amine oxime (PnAO) should, according to recent reports behave like 133Xe in the human brain. This study compares SPECT images of the two tracers in six subjects: four stroke cases, one transitory ischemic attack case and one normal subject. Technetium-99...... cerebral blood flow followed by rapid washout. In the stroke cases, low flow areas were equally well visualized by both tracers. Two dissimilarities were seen in the initial pictures: PnAO visualized the cerebral veins and showed a lesser contrast of gray:white matter uptake. The results suggest that Pn...

  5. A quantitative study of brain perfusion patterns of 99mTc-ECD SPECT in children with developmental disabilities

    The aim of this study was to investigate the relationship between developmental disabilities and brain perfusion patterns. We performed technetium-99m-ethylcysteinate dimer (99mTc-ECD) single photon emission computed tomography (SPECT) in 30 children with neurological disorders using the Patlak plot method. In children without developmental disabilities, the distribution of regional cortical perfusion evolved in relation to brain maturation. At one month of age, there was a predominant uptake in the perirolandic cortex. Radionuclide uptake in both the parietal and occipital cortices became evident by three months. Uptake in the temporal and frontal cortex increased by 6 and 11 months, respectively. Brain perfusion showed a pattern similar to that of adults by two years of age at the latest. In children with developmental disabilities, developmental changes of brain perfusion were delayed compared to normally developing children. Brain SPECT is a useful tool to assess the brain maturation in children with developmental disabilities. (author)

  6. Diagnosis of Alzheimer's disease using brain perfusion SPECT and MR imaging: which modality achieves better diagnostic accuracy?

    The purpose of this study was to compare the accuracy of MR imaging and brain perfusion single-photon emission tomography (SPECT) in diagnosing Alzheimer's disease (AD). The transaxial section display of brain perfusion SPECT, three-dimensional stereotactic surface projection (3D-SSP) SPECT image sets, thin-section MR imaging of the hippocampus and perfusion MR imaging were evaluated in 66 subjects comprising 35 AD patients and 31 subjects without AD. SPECT and MR imaging were visually interpreted by two experts and two novices, and the diagnostic ability of each modality was evaluated by receiver operating characteristic (ROC) analysis. In the experts' interpretations, there was no significant difference in the area under the ROC curve (Az) between 3D-SSP and thin-section MR imaging, whereas the Az of transaxial SPECT display was significantly lower than that of 3D-SSP (3D-SSP: 0.97, thin-section MR imaging: 0.96, transaxial SPECT: 0.91), and the Az of perfusion MR imaging was lowest (0.63). The sensitivity and specificity of each modality were, respectively, 80.0% and 96.8% for 3D-SSP, 77.1% and 96.8% for thin-section MR imaging, 60.0% and 93.5% for transaxial SPECT display and 34.3% and 100% for perfusion MR imaging. In the novices' interpretations, the Az, sensitivity and specificity of 3D-SSP were superior to those of thin-section MR imaging. Thin-section hippocampal MR imaging and 3D-SSP image sets had potentially equivalent value for the diagnosis of AD, and they were superior to transaxial SPECT display and perfusion MR imaging. For avoidance of the effect of interpreters' experience on image evaluation, 3D-SSP appears to be optimal. (orig.)

  7. Brain SPECT analysis by 3D-SSP and clinical features of Parkinson's disease

    The aim of the present study is to investigate the association of symptoms in Parkinson's disease (PD) with cerebral perfusion on single photon emission computed tomography (SPECT). The clinical features of PD were compared with SPECT images of the brain obtained by three-dimensional stereotactic surface projection (3D-SSP) analysis. Thirty-eight patients who had PD without dementia (17 men and 21 women with a mean age of 68.6±4.7 years) were enrolled in this study. Their symptoms were rated using the unified parkinson's disease rating scale (UPDRS). Within a week, all patients were examined by SPECT with I-123, and reconstructed images were analyzed with 3D-SSP using an image-analysis software, iSSP ver. 3.5. Data on brain surface perfusion extracted by 3D-SSP analysis were compared between the PD patients and the normal control group. The same comparisons were made for subgroups of PD patients with severe symptoms, such as tremor, gait disturbance, bradykinesia, and the UPDRS motor score. Cerebral perfusion was decreased at the anterior cingulate cortex and occipital lobe of the PD patients compared with the normal controls. In the subgroups with severe gait disturbance and severe bradykinesia, additional hypoperfusion was seen at the lateral frontal association and lateral temporal association and the medial frontal gyrus, and by the pixel-by-pixel comparison, perfusion was significantly decreased (p<0.05) at the medial frontal gyrus and anterior cingulate cortex compared with the normal control group. In PD patients, severe gait disturbance and bradykinesia may be correlated with hypoperfusion of the medial aspect of the frontal lobe. This suggests that functional disturbance of the supplementary motor area and other parts of the frontal lobe are involved in the development of gait disturbance and bradykinesia in PD. (author)

  8. A CLINICAL STUDY FOR EVALUATING EARLY RADIOTHERAPY EFFECT IN PATIENTS WITH BRAIN TUMOR USING 99Tcm-HL91 SPECT

    ZHAO Ming; ZHANG Yong-xue; ZHANG Cheng-gang; LAN Sheng-min; WANG Zhong-min; ZHANG Xiu-fu

    2006-01-01

    Objective: The purpose of this study was to evaluate the early radiotherapy effect using 99Tcm-HL91 SPECT in patients with brain tumors. Methods: Twenty-one patients with brain tumors who were treated by radiotherapy were studied. KPS grade, tumor size on 99Tcm-HL91 SPECT , tumor size on MRI, and ratio of T/N (tumor counts/sec over normal brain tissue counts/sec) were investigated before ,during and after radiotherapy. Results: The average tumor size on 99Tcm-HL91 SPECT and MRI was 11.34(5.88 cm2, 9.46(5.66 cm2, respectively before radiotherapy. The tumor size on 99Tcm-HL91 SPECT was not in accordance with to that on MRI (P<0.05). KPS grade, tumor size on 99Tcm-HL91 SPECT and ratio of T/N had significance differences before, during and after radiotherapy (P<0.05), but the tumor size on MRI imaging had no significance differences before, during and after radiotherapy (P>0.05). The rate of symptom improvement was 80% during radiotherapy and 100% after radiotherapy. The rates of imaging remission based on the brain tumor size on 99Tcm-HL91 SPECT, MRI and T/N were 75%, 15%, and 80%, respectively during radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptom improvement were 70%, 40%, and 60% respectively during radiotherapy. The rates of imaging remission based on the brain tumor sizes on 99Tcm-HL91 SPECT, MRI and T/N were 100%, 25%, and 95% respectively after radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptoms improvement were 100%, 20%, and 95% respectively after radiotherapy. Conclusion: The tumor size on 99Tcm-HL91 SPECT is a valuable tool for evaluating early radiotherapy effect of brain tumor in process of radiotherapy. T/N is not a feasible method in evaluating radiotherapy effect of brain tumor because it may show elevation unrelated to the curative effect during radiotherapy.

  9. The development of ASPECT, an annular single crystal brain camera for high efficiency spect

    ASPECT is a new totally-digital annular SPECT camera system designed specifically for 3-dimensional brain imaging. Its detector consists of a ''single-crystal'' NaI(TI) ring (31 cm i.d. by 8 mm thick by 13 cm wide) coupled through an annular light pipe to a 21 by 3 array of 51 mm square photomultipliers. A unique multifield collimator system, consisting of set of six parallel hole collimators oriented in an annular array, is designed to view the patient's head from six angles simultaneously. This ring is rotated with high precision, concentric to the detector, through 2π radians to sample gamma ray emissions for 3-D reconstruction over a 23 cm by 9 cm field of view. Preliminary results indicate that central regions of the brain will be detected with an efficiency of about six times that of a conventional rotating parallel-hole camera SPECT system and an effective inherent transverse resolution of within 3.5 mm. The system is designed to achieve a reconstructed resolution FWHM within 7.5 mm at the center of the image field. It also features unique means for digital position analysis, calibration and user quality control. With ASPECT's precision rotating collimator, artifacts normally associated with detector motion, nonuniform sensitivity, and spatial nonlinearities are expected to be insignificant

  10. A survey of head movement during clinical brain SPECT using an optical tracking system

    Full text: The aim of this study was to survey patient motion during clinical brain SPECT using a commercial motion detection system called Polaris. Polaris is an optical tracker that remotely tracks head position and orientation via a small target attached to the patient. Its accuracy for position measurement is 1mm or 1 degree (deg), 33% moved > 2mm or 2deg and 10% moved > 4mm or 4deg. 65% of subjects moved 3 or more times. Motion in the D and P groups was equally likely to be small (<3mm or <3deg) or large and equally likely to occur early or late during acquisition. Motion in the N, F and C groups was less likely to be large and for N and F more likely to occur late in the acquisition suggesting fatigue was the main cause. The most common large movements were anterior-posterior translations and axial (Z) rotations. Significant head movement is common in brain SPECT, particularly in dementia and psychiatric subjects, and accurate motion correction is desirable to maintain image quality. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  11. Improving the quality of small animal brain pinhole SPECT imaging by Bayesian reconstruction

    Sohlberg, Antti [Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio (Finland); Lensu, Sanna [Department of Pharmacology and Toxicology, University of Kuopio, Kuopio (Finland); Department of Environmental Health, National Public Health Institute, Kuopio (Finland); Jolkkonen, Jukka [Department of Neuroscience and Neurology, University of Kuopio, Kuopio (Finland); Tuomisto, Leena [Department of Pharmacology and Toxicology, University of Kuopio, Kuopio (Finland); Ruotsalainen, Ulla [Institute of Signal Processing, DMI, Tampere University of Technology, Tampere (Finland); Kuikka, Jyrki T. [Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio (Finland); Niuvanniemi Hospital, Kuopio (Finland)

    2004-07-01

    The possibility of using existing hardware makes pinhole single-photon emission computed tomography (SPECT) attractive when pursuing the ultra-high resolution required for small animal brain imaging. Unfortunately, the poor sensitivity and the heavy weight of the collimator hamper the use of pinhole SPECT in animal studies by generating noisy and misaligned projections. To improve the image quality we have developed a new Bayesian reconstruction method, pinhole median root prior (PH-MRP), which prevents the excessive noise accumulation from the projections to the reconstructed image. The PH-MRP algorithm was used to reconstruct data acquired with our small animal rotating device, which was designed to reduce the rotation orbit misalignments. Phantom experiments were performed to test the device and compare the PH-MRP with the conventional Feldkamp-Davis-Kress (FDK) and pinhole ordered subsets maximum likelihood expectation maximisation (PH-OSEM) reconstruction algorithms. The feasibility of the system for small animal brain imaging was studied with Han-Wistar rats injected with {sup 123}I-epidepride and {sup 99m}Tc-hydroxy methylene diphosphonate. Considering all the experiments, no shape distortions due to orbit misalignments were encountered and remarkable improvements in noise characteristics and also in overall image quality were observed when the PH-MRP was applied instead of the FDK or PH-OSEM. In addition, the proposed methods utilise existing hardware and require only a certain amount of construction and programming work, making them easy to implement. (orig.)

  12. Improving the quality of small animal brain pinhole SPECT imaging by Bayesian reconstruction

    The possibility of using existing hardware makes pinhole single-photon emission computed tomography (SPECT) attractive when pursuing the ultra-high resolution required for small animal brain imaging. Unfortunately, the poor sensitivity and the heavy weight of the collimator hamper the use of pinhole SPECT in animal studies by generating noisy and misaligned projections. To improve the image quality we have developed a new Bayesian reconstruction method, pinhole median root prior (PH-MRP), which prevents the excessive noise accumulation from the projections to the reconstructed image. The PH-MRP algorithm was used to reconstruct data acquired with our small animal rotating device, which was designed to reduce the rotation orbit misalignments. Phantom experiments were performed to test the device and compare the PH-MRP with the conventional Feldkamp-Davis-Kress (FDK) and pinhole ordered subsets maximum likelihood expectation maximisation (PH-OSEM) reconstruction algorithms. The feasibility of the system for small animal brain imaging was studied with Han-Wistar rats injected with 123I-epidepride and 99mTc-hydroxy methylene diphosphonate. Considering all the experiments, no shape distortions due to orbit misalignments were encountered and remarkable improvements in noise characteristics and also in overall image quality were observed when the PH-MRP was applied instead of the FDK or PH-OSEM. In addition, the proposed methods utilise existing hardware and require only a certain amount of construction and programming work, making them easy to implement. (orig.)

  13. Improving the quality of small animal brain pinhole SPECT imaging by Bayesian reconstruction.

    Sohlberg, Antti; Lensu, Sanna; Jolkkonen, Jukka; Tuomisto, Leena; Ruotsalainen, Ulla; Kuikka, Jyrki T

    2004-07-01

    The possibility of using existing hardware makes pinhole single-photon emission computed tomography (SPECT) attractive when pursuing the ultra-high resolution required for small animal brain imaging. Unfortunately, the poor sensitivity and the heavy weight of the collimator hamper the use of pinhole SPECT in animal studies by generating noisy and misaligned projections. To improve the image quality we have developed a new Bayesian reconstruction method, pinhole median root prior (PH-MRP), which prevents the excessive noise accumulation from the projections to the reconstructed image. The PH-MRP algorithm was used to reconstruct data acquired with our small animal rotating device, which was designed to reduce the rotation orbit misalignments. Phantom experiments were performed to test the device and compare the PH-MRP with the conventional Feldkamp-Davis-Kress (FDK) and pinhole ordered subsets maximum likelihood expectation maximisation (PH-OSEM) reconstruction algorithms. The feasibility of the system for small animal brain imaging was studied with Han-Wistar rats injected with (123)I-epidepride and (99m)Tc-hydroxy methylene diphosphonate. Considering all the experiments, no shape distortions due to orbit misalignments were encountered and remarkable improvements in noise characteristics and also in overall image quality were observed when the PH-MRP was applied instead of the FDK or PH-OSEM. In addition, the proposed methods utilise existing hardware and require only a certain amount of construction and programming work, making them easy to implement. PMID:14991246

  14. Predictive value of brain perfusion SPECT for rTMS response in pharmacoresistant depression

    The aim of this study was to determine the predictive value of whole-brain voxel-based regional cerebral blood flow (rCBF) for repetitive transcranial magnetic stimulation (rTMS) response in patients with pharmacoresistant depression. Thirty-three right-handed patients who met DSM-IV criteria for major depressive disorder (unipolar or bipolar depression) were included before rTMS. rTMS response was defined as at least 50% reduction in the baseline Beck Depression Inventory scores. The predictive value of 99mTc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) for rTMS response was studied before treatment by comparing rTMS responders to non-responders at voxel level using Statistical Parametric Mapping (SPM) (p 0.10). In comparison to responders, non-responders showed significant hypoperfusions (p < 0.001, uncorrected) in the left medial and bilateral superior frontal cortices (BA10), the left uncus/parahippocampal cortex (BA20/BA35) and the right thalamus. The area under the curve for the combination of SPECT clusters to predict rTMS response was 0.89 (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value for the combination of clusters were: 94, 73, 81 and 92%, respectively. This study shows that, in pharmacoresistant depression, pretreatment rCBF of specific brain regions is a strong predictor for response to rTMS in patients with homogeneous demographic/clinical features. (orig.)

  15. In-111-labeled leukocyte brain SPECT imaging. Clinical significance in evaluating acute ischemic stroke

    Many experimental studies have demonstrated that leukocyte infiltration plays an important role in the progression of ischemic cellular damage or post perfusion brain injury. However, only a few clinical studies have been reported. The purpose of this study is to evaluate the clinical significance of leukocyte accumulation in the ischemic brain tissue. Seventy six patients (49 men, 27 women; mean age: 65.5±13.9 years) with acute ischemic stroke were studied by leukocyte brain SPECT imaging. A diagnosis included cardioembolism (n=46), atherothrombotic infarction (n=24), TIA (n=3) and lacuna (n=3). Immediately after the CBF study using Tc-99m-ECD (600 MBq), indium-111-labeled autologous leukocytes were injected. A brain scan for leukocytes was performed 48 hours later. The leukocyte-SPECT study was made 11.1±7.7 days after the onset of stroke. Regional accumulation of leukocytes in the ischemic tissue was evaluated both by visual assessment and by measuring the hemispheric asymmetry index for leukocyte (AI-leuko), and was evaluated by comparison with variable factors including age, gender, infarction size, hemorrhagic transformation, timing of study after the onset, type of stroke and functional outcome. Of the 61 patients with acute ischemic stroke within 2 weeks of onset, 28 patients showed the accumulation of leukocytes in the central zone of ischemia. Six of 7 patients with repeated studies showed a reduction in leukocyte accumulation with time after the onset. Factors significantly associated with the higher accumulation of leukocyte included cardioembolic stroke, larger size of infarct, presence of hemorrhagic transformation and significant reduction in flow. In the 61 patients within 2 weeks of onset, the functional outcome was significantly correlated with the accumulation of leukocyte (p<0.001). The accumulation of leukocytes was seen more in patients with embolic stroke, larger infarction, and hemorrhagic transformation. The higher accumulation correlated

  16. In-111-labeled leukocyte brain SPECT imaging. Clinical significance in evaluating acute ischemic stroke

    Fujinuma, Kunihiko [Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine

    2002-02-01

    Many experimental studies have demonstrated that leukocyte infiltration plays an important role in the progression of ischemic cellular damage or post perfusion brain injury. However, only a few clinical studies have been reported. The purpose of this study is to evaluate the clinical significance of leukocyte accumulation in the ischemic brain tissue. Seventy six patients (49 men, 27 women; mean age: 65.5{+-}13.9 years) with acute ischemic stroke were studied by leukocyte brain SPECT imaging. A diagnosis included cardioembolism (n=46), atherothrombotic infarction (n=24), TIA (n=3) and lacuna (n=3). Immediately after the CBF study using Tc-99m-ECD (600 MBq), indium-111-labeled autologous leukocytes were injected. A brain scan for leukocytes was performed 48 hours later. The leukocyte-SPECT study was made 11.1{+-}7.7 days after the onset of stroke. Regional accumulation of leukocytes in the ischemic tissue was evaluated both by visual assessment and by measuring the hemispheric asymmetry index for leukocyte (AI-leuko), and was evaluated by comparison with variable factors including age, gender, infarction size, hemorrhagic transformation, timing of study after the onset, type of stroke and functional outcome. Of the 61 patients with acute ischemic stroke within 2 weeks of onset, 28 patients showed the accumulation of leukocytes in the central zone of ischemia. Six of 7 patients with repeated studies showed a reduction in leukocyte accumulation with time after the onset. Factors significantly associated with the higher accumulation of leukocyte included cardioembolic stroke, larger size of infarct, presence of hemorrhagic transformation and significant reduction in flow. In the 61 patients within 2 weeks of onset, the functional outcome was significantly correlated with the accumulation of leukocyte (p<0.001). The accumulation of leukocytes was seen more in patients with embolic stroke, larger infarction, and hemorrhagic transformation. The higher accumulation

  17. Brain imaging with 123I-IMP-SPECT in migraine between attacks

    123I-IMP-SPECT brain imaging was performed in patients with classic migraine (n = 5) and migraine accompagnee (n = 18) during the headache-free interval. A regional reduction of tracer uptake into brain was observed in all patients with migraine accompagnee, while in patients with classic migraine only one case showed an area of decreased activity. The most marked alteration was found in a patient with persisting neurological symptoms (complicated migraine). In most cases the areas of decreased tracer uptake corresponded to headache localization as well as to topography of neurologic symptoms during migraine attacks. It may be concluded that migraine attacks occur in connection with exacerbations of preexisting changes of cerebral autoregulation due to endogenous or exogenous factors

  18. Diagnosis of ictal hyperperfusion using subtraction image of ictal and interictal brain perfusion SPECT

    A robust algorithm to disclose and display the difference of ictal and interictal perfusion may facilitate the detection of ictal hyperfusion foci. Diagnostic performance of localizing epileptogenic zones with subtracted SPECT images was compared with the visual diagnosis using ictal and interictal SPECT, MR, or PET. Ictal and interictal Tc-99m-HMPAO cerebral perfusion SPECT images of 48 patients(pts) were processed to get parametric subtracted images. Epileptogenic foci of all pts were diagnosed by seizure free state after resection of epileptogenic zones. In subtraction SPECT, we used normalized difference ratio of pixel counts(ictal-interictal)/interictal X 100%) after correcting coordinates of ictal and interictal SPECT in semi-automatized 3-dimensional fashion. We found epileptogenic zones in subtraction SPECT and compared the performance with visual diagnosis of ictal and interictal SPECT, MR and PET using post-surgical diagnosis as gold standard. The concordance of subtraction SPECT and ictal-interictal SPECT was moderately good(kappa=0.49). The sensitivity of ictal-interictal SPECT was 73% and that of subtraction SPECT 58%. Positive predictive value of ictal-interictal SPECT was 76% and that of subtraction SPECT was 64%. There was no statistical difference between sensitivity or positive predictive values of subtraction SPECT and ictal-interictal SPECT, MR or PET. Such was also the case when we divided patients into temporal lobe epilepsy and neocortical epilepsy. We conclude that subtraction SPECT we produced had equivalent diagnostic performance compared with ictal-interictal SPECT in localizing epileptogenic zones. Additional value of these subtraction SPECT in clinical interpretation of ictal and interictal SPECT should be further evaluated

  19. Large cerebral perfusion defects observed in brain perfusion SPECT may herald psychiatric or neurodegenerative diseases of transient global amnesia patients

    So, Young; Kim, Hahn Young; Roh, Hong Gee; Han, Seol Heui [Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2007-07-01

    Transient global amnesia (TGA) is a memory disorder characterized by an episode of antegrade amnesia and bewilderment which persists for several hours. We analyzed brain perfusion SPECT findings and clinical outcome of patients who suffered from TGA. From September 2005 to August 2007, 12 patients underwent Tc-99m ECD brain perfusion SPECT for neuroimaging of TGA. All patients also underwent MRI and MRA including DWI (MRI). Among them, 10 patients who could be chased more than 6 months were included in this study. Their average age was 60.74.0 yrs (M: F = 2: 8) and the average duration of amnesia was 4.42.2 hrs (1 hr {approx} 7 hrs). Duration from episode of amnesia to SPECT was 4.32.4 days (1{approx}9 days). Precipitating factors could be identified in 6 patients: emotional stress 3, hair dyeing 1, taking a nap 1 and angioplasty 1. SPECT and MRI was visually assessed, No cerebral perfusion defect was observed on SPECT in 3 patients and their clinical outcome was all good. Among 7 patients who had cerebral perfusion defects on SPECT, 3 patients had good clinical outcome, while others did not: one had hypercholesterolemia, another had depression, and 2 patients with cerebral perfusion defects at both temporoparetal cortex was later diagnosed as early Alzheimer's disease (AD) and mild cognitive impairment (MCI). MRI was negative in 6 patients and 3 of them had excellent clinical outcome while other 3 were diagnosed as hypercholesterolemia, early AD and MCI. Among 4 patients with positive MRI, 3 showed good clinical outcome and their MRI showed lesions at medial temporal cortex and/or vertebral artery. One patient with microcalcification at left putamen was diagnosed to have depression. Large cerebral perfusion defects on SPECT may herald psychiatric or neurodegenerative diseases of transient global amnesia patients which usually shows negative MRI.

  20. Large cerebral perfusion defects observed in brain perfusion SPECT may herald psychiatric or neurodegenerative diseases of transient global amnesia patients

    Transient global amnesia (TGA) is a memory disorder characterized by an episode of antegrade amnesia and bewilderment which persists for several hours. We analyzed brain perfusion SPECT findings and clinical outcome of patients who suffered from TGA. From September 2005 to August 2007, 12 patients underwent Tc-99m ECD brain perfusion SPECT for neuroimaging of TGA. All patients also underwent MRI and MRA including DWI (MRI). Among them, 10 patients who could be chased more than 6 months were included in this study. Their average age was 60.74.0 yrs (M: F = 2: 8) and the average duration of amnesia was 4.42.2 hrs (1 hr ∼ 7 hrs). Duration from episode of amnesia to SPECT was 4.32.4 days (1∼9 days). Precipitating factors could be identified in 6 patients: emotional stress 3, hair dyeing 1, taking a nap 1 and angioplasty 1. SPECT and MRI was visually assessed, No cerebral perfusion defect was observed on SPECT in 3 patients and their clinical outcome was all good. Among 7 patients who had cerebral perfusion defects on SPECT, 3 patients had good clinical outcome, while others did not: one had hypercholesterolemia, another had depression, and 2 patients with cerebral perfusion defects at both temporoparetal cortex was later diagnosed as early Alzheimer's disease (AD) and mild cognitive impairment (MCI). MRI was negative in 6 patients and 3 of them had excellent clinical outcome while other 3 were diagnosed as hypercholesterolemia, early AD and MCI. Among 4 patients with positive MRI, 3 showed good clinical outcome and their MRI showed lesions at medial temporal cortex and/or vertebral artery. One patient with microcalcification at left putamen was diagnosed to have depression. Large cerebral perfusion defects on SPECT may herald psychiatric or neurodegenerative diseases of transient global amnesia patients which usually shows negative MRI

  1. In-111-labeled leukocyte brain SPECT imaging in acute ischemic stroke in man

    This study was performed to investigate the role of leukocyte accumulation in human cerebral infarction and its association with neurological functional outcome. A total of 42 patients diagnosed as acute ischemic stroke (22 embolism, 17 thrombosis, 3 TIA) were examined. Leukocyte accumulation was studied using indium-111-labeled leukocyte brain SPECT. Volume of brain infarction was evaluated by CT and/or MRI. The data were compared with the cerebral blood flow (CBF) imaging. Immediately after CBF study by SPECT using either Tc-99m-HMPAO or Tc-99m-ECD, In-111-labeled autologous leukocytes were injected intravenously. Brain scan for leukocytes was performed after 48 hours. The European Stroke Scale was used for neurological assessment. Thirteen patients with cerebral embolism and three patients with cerebral thrombosis showed intensive accumulation of leukocytes in the region of low flow Leukocyte's accumulation was not seen in patients with TIA. The accumulation of leukocytes was more noticeable in the central zone of the ischemia. Patients who showed negative leukocyte accumulation revealed clinically mild functional outcome and the size of infarction on CT and/or MRI was small. The regional accumulation of leukocytes was seen in all the patients with hemorrhagic infarction, but the degree of hemorrhage on CT did not have significant influence on the amount of leukocyte accumulation. Abnormal accumulation of leukocytes was associated with reduced CBF during the acute embolic stroke. The present clinical study revealed that leukocyte accumulation correlated with the poor neurological functional outcome in patients with acute embolic stroke. (K.H.)

  2. In-111-labeled leukocyte brain SPECT imaging in acute ischemic stroke in man

    Fujinuma, Kunihiko; Sakai, Fumihiko; Iizuka, Takahiro; Kitai, Norio [Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine

    1997-01-01

    This study was performed to investigate the role of leukocyte accumulation in human cerebral infarction and its association with neurological functional outcome. A total of 42 patients diagnosed as acute ischemic stroke (22 embolism, 17 thrombosis, 3 TIA) were examined. Leukocyte accumulation was studied using indium-111-labeled leukocyte brain SPECT. Volume of brain infarction was evaluated by CT and/or MRI. The data were compared with the cerebral blood flow (CBF) imaging. Immediately after CBF study by SPECT using either Tc-99m-HMPAO or Tc-99m-ECD, In-111-labeled autologous leukocytes were injected intravenously. Brain scan for leukocytes was performed after 48 hours. The European Stroke Scale was used for neurological assessment. Thirteen patients with cerebral embolism and three patients with cerebral thrombosis showed intensive accumulation of leukocytes in the region of low flow Leukocyte`s accumulation was not seen in patients with TIA. The accumulation of leukocytes was more noticeable in the central zone of the ischemia. Patients who showed negative leukocyte accumulation revealed clinically mild functional outcome and the size of infarction on CT and/or MRI was small. The regional accumulation of leukocytes was seen in all the patients with hemorrhagic infarction, but the degree of hemorrhage on CT did not have significant influence on the amount of leukocyte accumulation. Abnormal accumulation of leukocytes was associated with reduced CBF during the acute embolic stroke. The present clinical study revealed that leukocyte accumulation correlated with the poor neurological functional outcome in patients with acute embolic stroke. (K.H.)

  3. SPECT quantitation of cobalt-57 bleomycin delivery to human brain tumors

    A newly developed and validated noninvasive quantitative SPECT method was used to measure the in vivo uptake of [57Co]bleomycin (Co-bleo) in 13 human brain tumors and the uptake of [/sup 99m/Tc]glucoheptonate (GH) in 23 brain tumors. Significant differences in tumor uptake were found. The tumor concentration over time, the tumor to blood radioactivity at 30 min and the tumor cumulative concentration of radioactivity showed marked differences even between tumors with the same histology. Only a weak correlation was found between tumor concentration of Co-bleo and of GH. Therefore, a simple imaging agent such as GH cannot, at the present time, serve as an indicator of individual tumor uptake and further experience with other agents is still necessary. Contrary to the generally held view, no correlation was found between the concentration of drug in the blood and its tumor concentration. It is suggested, therefore, that the level of a drug in the blood cannot be used as a criterion of the amount that will penetrate the tumor. Direct SPECT measurement of the concentration of the drug in the tumor itself should be performed. The bioavailability of a drug is critical in order for it to exert it tumoricidal effect. The results, showing marked differences in uptake between brain tumors, suggest that before chemotherapy is administered, uptake of the chemotherapeutic drug in the individual tumor to be treated should be assessed and comparisons should be made between the uptake of a series of drugs to determine which drug would be most efficacious on the basis of its uptake as well as its tumor cell killing potential

  4. A study on evaluation of frontal lobe epilepsy using statistical parametric mapping of brain perfusion SPECT

    This study investigates alteration of regional cerebral blood flow (rCBF) and identification of epileptic foci in interictal frontal lobe epilepsy (FLE) using statistical parametric mapping (SPM). Noninvasive rCBF measurements using 99mTc-ECD SPECT were performed on 23 patients with frontal lobe epilepsy and 49 age-matched normal subjects. The FLE patients were divided into three groups, 3 patients with dorsolateral and frontocentral seizures, 2 patients with supplementary motor seizures, and 18 patients with frontobasal-cingulate seizures by Mihara's classification determined by clinical and EEG findings. The SPM analysis revealed rCBF abnormality in frontal lobes in 12 patients when compared rCBF data for each patient with those for normal subjects in accordance with Mihara's classification in 8. On the contrary, rCBF abnormality in frontal lobes was detected in 4 patients by visual inspection in accordance with the classification in only one. The rCBF significantly decreased in orbito-frontal regions, frontopolar regions, and anterior cingulate gyrus in the group with frontobasal-cingulate seizures as compared with age-matched normal subjects with confounding covariates of plasma concentrations of antiepileptic drugs. These results suggest that SPM analysis of brain perfusion SPECT gives us useful information about frontal lobe epilepsy even in the interictal phase. (author)

  5. Ligands for SPECT and PET imaging of muscarinic-cholinergic receptors of the heart and brain

    Knapp, F.F. Jr.; McPherson, D.W.; Luo, H. [and others

    1995-06-01

    Interest in the potential use of cerebral SPECT and PET imaging for determination of the density and activity of muscarinic-cholinergic receptors (mAChR) has been stimulated by the changes in these receptors which occur in many neurological diseases. In addition, the important involvement of mAChR in modulating negative inotropic cardiac activity suggests that such receptor ligands may have important applications in evaluation of changes which may occur in cardiac disease. In this paper, the properties of several key muscarinic receptor ligands being developed or which have been used for clinical SPECT and PET are discussed. In addition, the ORNL development of the new iodinated IQNP ligand based on QNB and the results of in vivo biodistribution studies in rats, in vitro competitive binding studies and ex vivo autoradiographic experiments are described. The use of radioiodinated IQNP may offer several advantages in comparison to IQNB because of its easy and high yield preparation and high brain uptake and the potential usefulness of the {open_quotes}partial{close_quotes} subtype selective IONP isomers. We also describe the development of new IQNP-type analogues which offer the opportunity for radiolabeling with positron-emitting radioisotopes (carbon-11, fluorine-18 and bromine-76) for potential use with PET.

  6. Brain SPECT analysis using statistical parametric mapping in patients with transient global amnesia

    Kim, E. N.; Sohn, H. S.; Kim, S. H; Chung, S. K.; Yang, D. W. [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2001-07-01

    This study investigated alterations in regional cerebral blood flow (rCBF) in patients with transient global amnesia (TGA) using statistical parametric mapping 99 (SPM99). Noninvasive rCBF measurements using 99mTc-ethyl cysteinate dimer (ECD) SPECT were performed on 8 patients with TGA and 17 age matched controls. The relative rCBF maps in patients with TGA and controls were compared. In patients with TGA, significantly decreased rCBF was found along the left superior temporal extending to left parietal region of the brain and left thalamus. There were areas of increased rCBF in the right temporal, right frontal region and right thalamus. We could demonstrate decreased perfusion in left cerebral hemisphere and increased perfusion in right cerebral hemisphere in patients with TGA using SPM99. The reciprocal change of rCBF between right and left cerebral hemisphere in patients with TGA might suggest that imbalanced neuronal activity between the bilateral hemispheres may be important role in the pathogenesis of the TGA. For quantitative SPECT analysis in TGA patients, we recommend SPM99 rather than the ROI method because of its definitive advantages.

  7. Brain SPECT analysis using statistical parametric mapping in patients with transient global amnesia

    This study investigated alterations in regional cerebral blood flow (rCBF) in patients with transient global amnesia (TGA) using statistical parametric mapping 99 (SPM99). Noninvasive rCBF measurements using 99mTc-ethyl cysteinate dimer (ECD) SPECT were performed on 8 patients with TGA and 17 age matched controls. The relative rCBF maps in patients with TGA and controls were compared. In patients with TGA, significantly decreased rCBF was found along the left superior temporal extending to left parietal region of the brain and left thalamus. There were areas of increased rCBF in the right temporal, right frontal region and right thalamus. We could demonstrate decreased perfusion in left cerebral hemisphere and increased perfusion in right cerebral hemisphere in patients with TGA using SPM99. The reciprocal change of rCBF between right and left cerebral hemisphere in patients with TGA might suggest that imbalanced neuronal activity between the bilateral hemispheres may be important role in the pathogenesis of the TGA. For quantitative SPECT analysis in TGA patients, we recommend SPM99 rather than the ROI method because of its definitive advantages

  8. Evaluation of linear registration algorithms for brain SPECT and the errors due to hypoperfusion lesions

    The semiquantitative analysis of perfusion single-photon emission computed tomography (SPECT) images requires a reproducible, objective method. Automated spatial standardization (registration) of images is a prerequisite to this goal. A source of registration error is the presence of hypoperfusion defects, which was evaluated in this study with simulated lesions. The brain perfusion images measured by 99mTc-HMPAO SPECT from 21 patients with probable Alzheimer's disease and 35 control subjects were retrospectively analyzed. An automatic segmentation method was developed to remove external activity. Three registration methods, robust least squares, normalized mutual information (NMI), and count difference were implemented and the effects of simulated defects were compared. The tested registration methods required segmentation of the cerebrum from external activity, and the automatic and manual methods differed by a three-dimensional displacement of 1.4±1.1 mm. NMI registration proved to be least adversely effected by simulated defects with 3 mm average displacement caused by severe defects. The error in quantifying the patient-template parietal ratio due to misregistration was 2.0% for large defects (70% hypoperfusion) and 0.5% for smaller defects (85% hypoperfusion)

  9. The value of brain blood perfusion SPECT imaging in evaluation of the curative effect of hyperbaric oxygen in patients with ischemic brain injury

    Objective: Brain blood flow SPECT perfusion can detect changes in brain blood flow. The obiective of this study was to explore the clinical value of SPECT perfusion imaging in brain ischemic injury due to traumatic at before and after hyperbaric oxygen (HBO)treatment.Methods: Sixty-five cases of secondary ischemic brain injury patients were randomly divided into two groups. One was with HBO treatment group and the other was with conventional treatment. All had brain perfusion SPECT at before and after treatment. Computer region of interest (ROI)technology was applied in the cross-sectional images using lo-cat mirror ratio (Ra) method to determine cerebral ischemic lesions. The t-test was used to analyze the quantitative data. It would be considered as abnormal if the brain perfusion SPECT reduce Ra ≤ 0.9 aftertreatment. Results: In HBO treatment group.regional cerebral blood flow (rCBF) before and after treatment to reduce the district Ra values were 0.58 ± 0.1l and 0.82 ± 0.12 (t=7.327, P<0.01). In con-ventional treatment group. Rcbf before and after treatment to reduce the district Ra values were 0.6l ± 0.13 and 0.73 ± 0.12 (t=2.153. P=0.038). IncreaSed Rcbf at ischemic lesions in HBO treatment group was 0.24 ± 0.08 and was 0.12 ± 0.06 for conventional treatment group (t=2.571. P=0.015). Conclusions: Brain SPECT imaging could sensitively reflect the rCBF before and after treatment and was considered to be useful for therapeutic monitoring of HBO treatment efficacy. (authors)

  10. 99mTc-bicisate (neurolite) SPECT brain imaging and cognitive impairment in dementia of the Alzheimer type

    Waldemar, G; Walovitch, R C; Andersen, A R;

    1994-01-01

    A blinded read of images obtained with 99mTc-bicisate and single photon emission computed tomography (SPECT) was conducted to determine if a relationship exists between the severity of abnormalities on SPECT brain images and the severity of cognitive impairment in patients with dementia of the...... DAT patients and 13 normal volunteers) from 10 SPECT centers were selected for further analyses. The severity of abnormality was rated as mild, moderate, or severe by three readers. In DAT patients, a significant negative correlation (p <0.05) of Mini-Mental State Examination (MMSE) score with global......Tc-bicisate provides functional information about the severity of cognitive impairment in DAT patients.(ABSTRACT TRUNCATED AT 250 WORDS)...

  11. 99mTc-ECD brain SPECT imaging in patients with acquired immunodeficiency syndromes

    In order to investigate the changes of regional cerebral blood flow (rCBF) in patients with acquired immunodeficiency syndromes (AIDS), 99mTc-ECD brain SPECT imaging was performed in 5 patients with AIDS and 16 sex and age matched normal controls, and the rCBF percentages compared to the cerebellum were calculated using a semi-quantitative processing software. Hypo-perfusions in the right and left frontal, temporal, parietal lobe, basal ganglia and left thalamus were seen in 1 patient with dementia. Hypo-perfusions in the right and left frontal and temporal lobe were seen in 4 asymptomatic patients. The rCBF in the right and left frontal, temporal, parietal lobe, basal ganglia and thalamus, front and pons were decreased significantly in patients with AIDS than those of the control subjects (p < 0.005). It is concluded that there exists reduced cortico-subcortical rCBF in AIDS patients

  12. Sequential and simultaneous dual-isotope brain SPECT: Comparison with PET for estimation and discrimination tasks in early Parkinson disease

    Trott, Cathryn M.; El Fakhri, Georges

    2008-01-01

    Parkinson disease (PD) is the second most frequently occurring cerebral degenerative disease, after Alzheimer disease. Treatments are available, but their efficacy is diminished unless they are administered in the early stages. Therefore, early identification of PD is crucial. In addition to providing perfectly registered studies, simultaneous 99mTc∕123I imaging makes possible the assessment of pre- and postsynaptic neurotransmission functions under identical physiological conditions, while doubling the number of counts for the same total imaging time. These advantages are limited, however, by cross talk between the two radionuclides due to the close emission energies of 99mTc (140 keV) and 123I (159 keV). PET, on the other hand, provides good temporal and spatial resolution and sensitivity but usually requires the use of a single radionuclide. In the present work, the authors compared brain PET with sequential and simultaneous dual-isotope SPECT for the task of estimating striatal activity concentration and striatal size for a normal brain and two stages of early PD. Realistic Monte Carlo simulations of a time-of-flight PET scanner and gamma cameras were performed while modeling all interactions in the brain, collimator (gamma camera) and crystal (detector block in PET), as well as population biological variability of pre- and postsynaptic uptake. For SPECT imaging, we considered two values of system energy resolution and scanners with two and three camera heads. The authors used the Cramer–Rao bound, as a surrogate for the best theoretical performance, to optimize the SPECT acquisition energy windows and objectively compare PET and SPECT. The authors determined the discrimination performance between 500 simulated subjects in every disease stage as measured by the area under the ROC curve (AUC). The discrimination accuracy between a normal subject and a subject in the prodromal disease stage was AUC=0.924 with PET, compared to 0.863 and 0.831 with simultaneous

  13. Segmentation of the Striatum from MR Brain Images to Calculate the -TRODAT-1 Binding Ratio in SPECT Images

    Ching-Fen Jiang

    2013-01-01

    Full Text Available Quantification of regional -TRODAT-1 binding ratio in the striatum regions in SPECT images is essential for differential diagnosis between Alzheimer's and Parkinson's diseases. Defining the region of the striatum in the SPECT image is the first step toward success in the quantification of the TRODAT-1 binding ratio. However, because SPECT images reveal insufficient information regarding the anatomical structure of the brain, correct delineation of the striatum directly from the SPECT image is almost impossible. We present a method integrating the active contour model and the hybrid registration technique to extract regions from MR T1-weighted images and map them into the corresponding SPECT images. Results from three normal subjects suggest that the segmentation accuracy using the proposed method was compatible with the expert decision but has a higher efficiency and reproducibility than manual delineation. The binding ratio derived by this method correlated well (R2 = 0.76 with those values calculated by commercial software, suggesting the feasibility of the proposed method.

  14. SPECT imaging with the serotonin transporter radiotracer [123I]p ZIENT in nonhuman primate brain

    Introduction: Serotonin dysfunction has been linked to a variety of psychiatric diseases; however, an adequate SPECT radioligand to probe the serotonin transporter system has not been successfully developed. The purpose of this study was to characterize and determine the in vivo selectivity of iodine-123-labeled 2β-carbomethoxy-3β-(4'-((Z)-2-iodoethenyl)phenyl)nortropane, [123I]p ZIENT, in nonhuman primate brain. Methods: Two ovariohysterectomized female baboons participated in nine studies (one bolus and eight bolus to constant infusion at a ratio of 9.0 h) to evaluate [123I]p ZIENT. To evaluate the selectivity of [123I]p ZIENT, the serotonin transporter blockers fenfluramine (1.5, 2.5 mg/kg) and citalopram (5 mg/kg), the dopamine transporter blocker methylphenidate (0.5 mg/kg) and the norepinephrine transporter blocker nisoxetine (1 mg/kg) were given at 8 h post-radiotracer injection. Results: In the bolus to constant infusion studies, equilibrium was established by 4-8 h. [123I]p ZIENT was 93% and 90% protein bound in the two baboons and there was no detection of lipophilic radiolabeled metabolites entering the brain. In the high-density serotonin transporter regions (diencephalon and brainstem), fenfluramine and citalopram resulted in 35-71% and 129-151% displacement, respectively, whereas methylphenidate and nisoxetine did not produce significant changes (123I]p ZIENT is a favorable compound for in vivo SPECT imaging of serotonin transporters with negligible binding to norepinephrine and dopamine transporters.

  15. Brain 99Tcm-ECD SPECT imaging in patients with obsessive-compulsive disorder

    Purpose Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder of unknown aetiology. The purpose of the study is to evaluate the changes of brain function in patients with OCD. Methods: Regional cerebral perfusion was investigated using SPECT in 25 patients with OCD. The mean ages of the patients were 29.04 (1 8-46) years old. The clinical symptom consists of repeating thinking (suspect, worry, nervous) and repeating action (checking, washing, counting, making telephone calls) principally. After administration of 740-925 MBq (20-25 mCi) 99mTc-ECD a single photon emission tomography study was performed and then transaxial, sagittal and coronal slices were obtained. For the semiquantitative analysis of the data Results: 92 per cent of patients (23125) had relative hypoperfusions in some cerebral regions. The patients had a significant decrease of rCBF in the frontal lobes, temporal lobes, basal ganglia, thalamus, and cingulate gyrus. There were no correlation between the change of rCBF and age of age or course of disease. But there were some correlation with clinical symptom. Conclusion: Obsessive-compulsive disorder (OCD) has been linked to a dysfunction of brain orbitofrontal-striatum-pallidum-thalamus networks that were confirmed by PET SPECT functional imaging studies. These study indicated hypoperfusion in frontal lobes, basal ganglion, thalamus in OCD patients, and suggests a reduced serotonergic input into the fronto-subcortical circuits in OCD, thereby diminishing the inhibitory regulation of serotonin on these circuits. According to our results, patients with OCD had profound dysfunction of the frontal and temporal cortices, and basal ganglia. These may reflect a fundamental feature of clinical neuropathophysiology in OCD, and support previous findings about dysfunction of frontal-subcortical circuits in this disorder. (authors)

  16. Comparison of different references for brain perfusion SPECT quantification in clinical routine

    Full text: We used 40 brain perfusion SPECT studies from the INM, UCL database to investigate the performance of several references (denominators) in the calculation of perfusion ratios with single photon emission tomography (S PET) within a routine clinical service. According to clinical diagnosis and previous SPECT findings 4 groups were identified composed of: 10 controls (C, 23 to 84 y old); 10 myalgic-encephalomyelitis / chronic fatigue syndrome (ME/CFS, 22 to 61 y old); 10 major depression (MD, 24 to 68 y old); and 10 temporal lobe epilepsy (TLE, 19 to 39 y old). Routine protocols for processing were used and the analysis was blind to group classification. Brain perfusion ratios were calculated using 7 different references: hemi cerebellum with higher counts (Cer), total counts in a 4 pixel slice through the basal ganglia slice (BG), average counts per pixel in the visual cortex (VC), average counts per pixel in the white matter (WM), total acquired counts (TAC), total reconstructed counts (TRC) and maximum counts per pixel in the entire study (MAXX). Unpaired test to compare different diagnostic groups, coefficient of variation (CV) to assess the reliability to each references followed by ANOVA were the statistical test used. The lowest mean CV's were found with VC (4.8%) and TRC (5.1%), with all the others significantly higher (p<0.0001). The range of CV's for Cer was the lowest (3.7% to 5.9%). Consistent differentiation between diagnostic groups and controls was only obtained with Cer. In conclusion, it appears that for clinical routine services Cer is the most reliable reference, exception made for all diseases affecting the cerebellum. In these cases TRC or VC should be preferred. (authors)

  17. Predictive value of brain perfusion SPECT for rTMS response in pharmacoresistant depression

    Richieri, Raphaelle; Lancon, Christophe [Sainte-Marguerite University Hospital, Department of Psychiatry, Marseille (France); La Timone University, EA 3279 - Self-perceived Health Assessment Research Unit, School of Medicine, Marseille (France); Boyer, Laurent [La Timone University, EA 3279 - Self-perceived Health Assessment Research Unit, School of Medicine, Marseille (France); La Timone University Hospital, Assistance Publique - Hopitaux de Marseille, Department of Public Health, Marseille (France); Farisse, Jean [Sainte-Marguerite University Hospital, Department of Psychiatry, Marseille (France); Colavolpe, Cecile; Mundler, Olivier [La Timone University Hospital, Assistance Publique - Hopitaux de Marseille, Service Central de Biophysique et Medecine Nucleaire, Marseille (France); Universite de la Mediterranee, Centre Europeen de Recherche en Imagerie Medicale (CERIMED), Marseille (France); Guedj, Eric [La Timone University Hospital, Assistance Publique - Hopitaux de Marseille, Service Central de Biophysique et Medecine Nucleaire, Marseille (France); Universite de la Mediterranee, Centre Europeen de Recherche en Imagerie Medicale (CERIMED), Marseille (France); Hopital de la Timone, Service Central de Biophysique et de Medecine Nucleaire, Marseille Cedex 5 (France)

    2011-09-15

    The aim of this study was to determine the predictive value of whole-brain voxel-based regional cerebral blood flow (rCBF) for repetitive transcranial magnetic stimulation (rTMS) response in patients with pharmacoresistant depression. Thirty-three right-handed patients who met DSM-IV criteria for major depressive disorder (unipolar or bipolar depression) were included before rTMS. rTMS response was defined as at least 50% reduction in the baseline Beck Depression Inventory scores. The predictive value of {sup 99m}Tc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) for rTMS response was studied before treatment by comparing rTMS responders to non-responders at voxel level using Statistical Parametric Mapping (SPM) (p < 0.001, uncorrected). Of the patients, 18 (54.5%) were responders to rTMS and 15 were non-responders (45.5%). There were no statistically significant differences in demographic and clinical characteristics (p > 0.10). In comparison to responders, non-responders showed significant hypoperfusions (p < 0.001, uncorrected) in the left medial and bilateral superior frontal cortices (BA10), the left uncus/parahippocampal cortex (BA20/BA35) and the right thalamus. The area under the curve for the combination of SPECT clusters to predict rTMS response was 0.89 (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value for the combination of clusters were: 94, 73, 81 and 92%, respectively. This study shows that, in pharmacoresistant depression, pretreatment rCBF of specific brain regions is a strong predictor for response to rTMS in patients with homogeneous demographic/clinical features. (orig.)

  18. Transient hyperperfusion after extracranial-intracranial bypass surgery on brain perfusion SPECT

    We designed this study to investigate the transient relative hyperperfusion and its clinical implication after STA (superficial temporal artery) to MCA (middle cerebral artery) bypass surgery in patients with ischemic cerebral stroke. In 25 patients, comprising of 11 moyamoya disease (MMD) and 14 atherosclerotic disease (ASD), STA-MCA anastomosis was performed to distal cortical branches of middle cerebral artery for revascularization. 99mTc-ECD brain perfusion SPECT was performed before, 3 days and then 10 days after bypass surgery. Each image was spatially normalized into the standard space and changes of brain perfusion in the entire internal carotid artery (ICA) territory were evaluated using standardized ROIs. In the overall analysis including all patients, the surgery effectively increased ICA territory perfusion on the 3rd and 10th day after bypass surgery in comparison with the preoperative one (p<0.01 and p=0.03). The 3rd day perfusion was significantly higher than the 10th day one (p<0.01), demonstrating transient relative hyperperfusion on the 3rd day compared with the 10th day. In MMD group, such transient increase of perfusion was most severe in the vicinity of the anastomosis site, and more definite than the ASD group. Three patients, 2 ASD and one MMD, showed temporary neurological deterioration (dysphasia or dysarthria) beginning within 3 days after surgery and resolving completely within 2 weeks after onset, without hemorrhage, infarction or other serious defects on CT scan. Their neurological changes correlated well with the focal perfusion changes confirmed by SPECT images on the 3rd and 10th postoperative day. Transient relative hyperperfusion was observed on postoperative 3rd day compared with the 10th day following STA-MCA bypass surgery. In some patients, such transient increase of focal perfusion seems to provoke temporary neurological deterioration

  19. Transient hyperperfusion after extracranial-intracranial bypass surgery on brain perfusion SPECT

    Kim, Yu Kyeong; Oh, Chang Wan; Cho, Sang Soo; Lee, Eun Ju; Eo, Jae Seon; Lee, Won Woo; Kim, Sang Eun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2005-07-01

    We designed this study to investigate the transient relative hyperperfusion and its clinical implication after STA (superficial temporal artery) to MCA (middle cerebral artery) bypass surgery in patients with ischemic cerebral stroke. In 25 patients, comprising of 11 moyamoya disease (MMD) and 14 atherosclerotic disease (ASD), STA-MCA anastomosis was performed to distal cortical branches of middle cerebral artery for revascularization. 99mTc-ECD brain perfusion SPECT was performed before, 3 days and then 10 days after bypass surgery. Each image was spatially normalized into the standard space and changes of brain perfusion in the entire internal carotid artery (ICA) territory were evaluated using standardized ROIs. In the overall analysis including all patients, the surgery effectively increased ICA territory perfusion on the 3rd and 10th day after bypass surgery in comparison with the preoperative one (p<0.01 and p=0.03). The 3rd day perfusion was significantly higher than the 10th day one (p<0.01), demonstrating transient relative hyperperfusion on the 3rd day compared with the 10th day. In MMD group, such transient increase of perfusion was most severe in the vicinity of the anastomosis site, and more definite than the ASD group. Three patients, 2 ASD and one MMD, showed temporary neurological deterioration (dysphasia or dysarthria) beginning within 3 days after surgery and resolving completely within 2 weeks after onset, without hemorrhage, infarction or other serious defects on CT scan. Their neurological changes correlated well with the focal perfusion changes confirmed by SPECT images on the 3rd and 10th postoperative day. Transient relative hyperperfusion was observed on postoperative 3rd day compared with the 10th day following STA-MCA bypass surgery. In some patients, such transient increase of focal perfusion seems to provoke temporary neurological deterioration.

  20. The relative contributions of scatter and attenuation corrections toward improved brain SPECT quantification

    Mounting evidence indicates that scatter and attenuation are major confounds to objective diagnosis of brain disease by quantitative SPECT. There is considerable debate, however, as to the relative importance of scatter correction (SC) and attenuation correction (AC), and how they should be implemented. The efficacy of SC and AC for 99mTc brain SPECT was evaluated using a two-compartment fully tissue-equivalent anthropomorphic head phantom. Four correction schemes were implemented: uniform broad-beam AC, non-uniform broad-beam AC, uniform SC+AC, and non-uniform SC+AC. SC was based on non-stationary deconvolution scatter subtraction, modified to incorporate a priori knowledge of either the head contour (uniform SC) or transmission map (non-uniform SC). The quantitative accuracy of the correction schemes was evaluated in terms of contrast recovery, relative quantification (cortical:cerebellar activity), uniformity ((coefficient of variation of 230 macro-voxels) x100%), and bias (relative to a calibration scan). Our results were: uniform broad-beam (μ=0.12cm-1) AC (the most popular correction): 71% contrast recovery, 112% relative quantification, 7.0% uniformity, +23% bias. Non-uniform broad-beam (soft tissue μ=0.12cm-1) AC: 73%, 114%, 6.0%, +21%, respectively. Uniform SC+AC: 90%, 99%, 4.9%, +12%, respectively. Non-uniform SC+AC: 93%, 101%, 4.0%, +10%, respectively. SC and AC achieved the best quantification; however, non-uniform corrections produce only small improvements over their uniform counterparts. SC+AC was found to be superior to AC; this advantage is distinct and consistent across all four quantification indices. (author)

  1. Impact of extraneous mispositioned events on motion-corrected brain SPECT images of freely moving animals

    Angelis, Georgios I., E-mail: georgios.angelis@sydney.edu.au; Ryder, William J.; Bashar, Rezaul; Meikle, Steven R. [Faculty of Health Sciences and Brain and Mind Research Institute, The University of Sydney, Sydney, NSW 2006 (Australia); Fulton, Roger R. [Faculty of Health Sciences and Brain and Mind Research Institute, The University of Sydney, Sydney, NSW 2006 (Australia); School of Physics, University of Sydney, Sydney, NSW 2006 (Australia); Department of Medical Physics, Westmead Hospital, Sydney, NSW 2145 (Australia)

    2014-09-15

    Purpose: Single photon emission computed tomography (SPECT) brain imaging of freely moving small animals would allow a wide range of important neurological processes and behaviors to be studied, which are normally inhibited by anesthetic drugs or precluded due to the animal being restrained. While rigid body motion of the head can be tracked and accounted for in the reconstruction, activity in the torso may confound brain measurements, especially since motion of the torso is more complex (i.e., nonrigid) and not well correlated with that of the head. The authors investigated the impact of mispositioned events and attenuation due to the torso on the accuracy of motion corrected brain images of freely moving mice. Methods: Monte Carlo simulations of a realistic voxelized mouse phantom and a dual compartment phantom were performed. Each phantom comprised a target and an extraneous compartment which were able to move independently of each other. Motion correction was performed based on the known motion of the target compartment only. Two SPECT camera geometries were investigated: a rotating single head detector and a stationary full ring detector. The effects of motion, detector geometry, and energy of the emitted photons (hence, attenuation) on bias and noise in reconstructed brain regions were evaluated. Results: The authors observed two main sources of bias: (a) motion-related inconsistencies in the projection data and (b) the mismatch between attenuation and emission. Both effects are caused by the assumption that the orientation of the torso is difficult to track and model, and therefore cannot be conveniently corrected for. The motion induced bias in some regions was up to 12% when no attenuation effects were considered, while it reached 40% when also combined with attenuation related inconsistencies. The detector geometry (i.e., rotating vs full ring) has a big impact on the accuracy of the reconstructed images, with the full ring detector being more

  2. Impact of extraneous mispositioned events on motion-corrected brain SPECT images of freely moving animals

    Purpose: Single photon emission computed tomography (SPECT) brain imaging of freely moving small animals would allow a wide range of important neurological processes and behaviors to be studied, which are normally inhibited by anesthetic drugs or precluded due to the animal being restrained. While rigid body motion of the head can be tracked and accounted for in the reconstruction, activity in the torso may confound brain measurements, especially since motion of the torso is more complex (i.e., nonrigid) and not well correlated with that of the head. The authors investigated the impact of mispositioned events and attenuation due to the torso on the accuracy of motion corrected brain images of freely moving mice. Methods: Monte Carlo simulations of a realistic voxelized mouse phantom and a dual compartment phantom were performed. Each phantom comprised a target and an extraneous compartment which were able to move independently of each other. Motion correction was performed based on the known motion of the target compartment only. Two SPECT camera geometries were investigated: a rotating single head detector and a stationary full ring detector. The effects of motion, detector geometry, and energy of the emitted photons (hence, attenuation) on bias and noise in reconstructed brain regions were evaluated. Results: The authors observed two main sources of bias: (a) motion-related inconsistencies in the projection data and (b) the mismatch between attenuation and emission. Both effects are caused by the assumption that the orientation of the torso is difficult to track and model, and therefore cannot be conveniently corrected for. The motion induced bias in some regions was up to 12% when no attenuation effects were considered, while it reached 40% when also combined with attenuation related inconsistencies. The detector geometry (i.e., rotating vs full ring) has a big impact on the accuracy of the reconstructed images, with the full ring detector being more

  3. Technetium-99m-ECD SPECT in antiphospholipid antibody syndrome: a drastic improvement in brain perfusion by antiplatelet therapy

    Tokumaru, Sunao; Yoshikai, Tomonori; Uchino, Akira; Kudo, Sho [Dept. of Radiology, Saga Medical School (Japan); Matsui, Makoto; Kuroda, Yasuo [Dept. of Neurology, Saga Medical School (Japan)

    2001-12-01

    We present a case of antiphospholipid antibody syndrome (APS) with repeated transient ischemic attacks (TIAs). Magnetic resonance imaging showed multiple cerebral infarcts and ischemic changes in the cerebral white matter. Cerebral angiographies showed no abnormalities. Technetium-99m-ethyl cysteinate dimer (Tc-99m-ECD) brain SPECT showed multiple decreased perfusion areas, which were more extensive than the lesions demonstrated on MRI. After treatment with an antiplatelet agent, the patient subsequently recovered from the TIAs. Although no interval changes were observed by MRI after therapy, follow-up Tc-99m-ECD SPECT revealed a marked improvement in brain perfusion. This is the first imaging report of remarkable post-therapy improvement in brain perfusion in APS cases. (orig.)

  4. Technetium-99m-ECD SPECT in antiphospholipid antibody syndrome: a drastic improvement in brain perfusion by antiplatelet therapy

    We present a case of antiphospholipid antibody syndrome (APS) with repeated transient ischemic attacks (TIAs). Magnetic resonance imaging showed multiple cerebral infarcts and ischemic changes in the cerebral white matter. Cerebral angiographies showed no abnormalities. Technetium-99m-ethyl cysteinate dimer (Tc-99m-ECD) brain SPECT showed multiple decreased perfusion areas, which were more extensive than the lesions demonstrated on MRI. After treatment with an antiplatelet agent, the patient subsequently recovered from the TIAs. Although no interval changes were observed by MRI after therapy, follow-up Tc-99m-ECD SPECT revealed a marked improvement in brain perfusion. This is the first imaging report of remarkable post-therapy improvement in brain perfusion in APS cases. (orig.)

  5. The relationship between BMI and striatal dopamine transporter with 99Tcm-TRODAT-1 brain SPECT

    Objective: To assess the relationship between the BMI and the brain DAT, and the influence of BMI on the brain SPECT imaging with 99Tcm-TRODAT-1. Methods: MRI and 99Tcm-TRODAT-1SPECT imaging were performed in 31 healthy volunteers (16 males and 15 females), and then the three-dimensional reconstruction of SPECT images were completed. Based on the MRI images, right striatum (RST) and the left striatum (LST) were drawn as ROI on the 4 most clearly consecutive transverse slices.The cerebellum (CB) was taken as the background reference area and the corresponding uptake ratios of ST/CB, LST/CB and RST/CB were calculated. The Pearson correlation tests for radio-uptake ratios (ST/CB, LST/CB, RST/CB), BMI and age were performed, Then multiple linear regression analysis using ST/CB as dependent variable and BMI and age as independent variables was performed. SPSS 15.0 was used in data analysis. Results: The ST imaging was symmetrical. The radioactivity was higher in the ST front area than that of the back area. The average uptake ratios of ST/CB, LST/CB, RST/CB were 1.71±0.16,1.70±0.16 and 1.72±0.17 respectively, in which the three ratios of the female were 1.74±0.18, 1.71±0.19 and 1.76±0.19 respectively and those of the male were 1.68±0.14, 1.68±0.13 and 1.69±0.15 respectively. ST/CB, LST/CB and RST/CB were negatively correlated with patients' BMI (r = -0.53, -0.57, -0.47, all P<0.05). The ST/CB was negatively correlated with patients' age (r=-0.39, P=0.03). The multiple linear regression analysis showed that the BMI was significant independent variable (β=-0.53, t= -3.36, P=0.002). Conclusions: The ST DAT level may decrease as patients' BMI and age increase. Females' DAT level is slightly higher than males'. For ST DAT imaging, age, gender and BMI should be all taken into consideration. (authors)

  6. Evaluation of glioma with thallium-201 brain SPECT: the correlation with 1H MR spectroscopy and pathology

    Thallim-201 (201TI) brain SPECT and proton (1H) magnetic resonance spectroscopy (MRS) have been used to evaluate tumor grade and viability of glioma. We assessed the correlations between 201TI brain index or spectrum of metabolites of 1H MRS and grade of glioma or histopathologic findings. We studied 17 patients (4 astrocytoma, 7 anaplastic astrocytoma and 6 glioblastoma). On 201TI Brain SPECT, 201TI index was measured as the ratio of average counts for region interest to those for the contralateral normal brain. On 1H MRS, we calculated choline (Cho)/ creatine (Cr) ratio and N-acetylaspartate (NAA)/Cr ratio in ROI defined as tumor center. Histopathologic findings were graded by Ki-67 index, cellularity, mitosis, pleomorphism, necrosis and endothelial proliferation. An unpaired t test and statistical correlations were performed to evaluate these data. TI-index showed the best correlation with Ki-67 index (p201TI brain SPECT did not correlate directly with grade of malignancy, it may still be useful in determining biological aggressiveness of tumor and prognosis of patients because it correlated well with Ki-67 index, a growth fraction of glioma, cellularity, mitosis and endothelial proliferation

  7. Types of traumatic brain injury and regional cerebral blood flow assessed by 99mTc-HMPAO SPECT

    To investigate the relationship between focal and diffuse traumatic brain injury (TBI) and regional cerebral blood flow (rCBF), rCBF changes in the first 24 hours post-trauma were studied in 12 severe head trauma patients using single photon emission computed tomography (SPECT) with 99mtechnetium-hexamethyl propyleneamine oxime (HMPAO). Patients were classified as focal or diffuse TBI based on x-ray computed tomographic (X-CT) findings and neurological signs. In six patients with focal damage, SPECT demonstrated: 1) perfusion defect (focal severe ischemia) in the brain region larger than the brain contusion by X-CT, 2) hypoperfusion (focal CBF reduction) in the brain region without abnormality by X-CT, and 3) localized hyperperfusion (focal CBF increase) in the surgically decompressed brain after decompressive craniectomy. Focal damage may be associated with a heterogeneous CBF change by causing various focal CBF derangements. In six patients with diffuse damage, SPECT revealed hypoperfusion in only one patient. Diffuse damage may be associated with a homogeneous CBF change by rarely causing focal CBF derangements. The type of TBI, focal or diffuse, determines the type of CBF change, heterogeneous or homogeneous, in the acute severe head trauma patient. (author)

  8. Compartment analysis of 123I-iomazenil brain SPECT in patients with moyamoya disease

    We investigated 11 patients with moyamoya disease about 123I-Iomazenil kinetics in the brain using three-compartment, two-parameter model. The transition rate constant (K1) from the blood to the brain and the binding potential (BP) of the benzodiazepine to the receptors were calculated for every ROI (right and left side of cerebellum, frontal lobe, parietal lobe, occipital lobe and temporal lobe; 10 ROIs a case). The K1 value correlated with BP value significantly, but not so closely (r=0.639). And there is no significant difference in BP valued among low-K1 group (mean (of K1)-S.D.≤K1≤mean) and high-K1 group (mean< K1≤mean+S.D.). This means that CBF and BP do not correlate closely in the average moyamoya disease patients. And we showed a case with IMP/IMZ discrepancy. The nerve cell in the hypoperfused area which has almost normal BP value is ischemic but viable. IMZ-SPECT presents an important information about the viability of the hypoperfused area in moyamoya disease patients' brain. (author)

  9. Advance prediction of mild cognitive impairment (MCI) using 99mTc-ECD SPECT brain blood flow imaging

    Mild Cognitive Impairment (MCI) is considered as a precursor state of Alzheimer disease (AD). Single photon emission computed tomography (SPECT) brain blood flow imaging was investigated in MCI and it's relevance to the prognosis of MCI was evaluated in an attempt define the characteristics of brain blood flow imaging of MCI (amnestic MCI; aMCI) converting to AD. Ninety-two patients over 60 years old with amnesia were studied. 99mTc-ethyl cysteinate dimer (ECD) SPECT brain blood flow examinations of the subject under drug-free conditions were conducted and imaging was analyzed according to the first clinical diagnosis. Patients given a diagnosis of MCI on the first clinical diagnosis, were examined again after 2 years and the SPECT imaging before 2 years previously was classified and analyzed. Of them, there were 35 MCI patients, converting of 13 AD patients (37.1%; aMCI), 10 MCI patients (28.6%; non-converter), 4 depression patients (11.4%; Depression type MCI (dMCI)), 1 Geriatric psychosis patient, but 7 patients dropped out. In the aMCI group, relative hypoperfusion was recognized in the posterior cingulate and the precuneus. In the dMCI group, relative hypoperfusion was recognized in the dorsolateral prefrontal cortex (DLPFC) and the anterior cingulate. In the non-converter group, relative hypoperfusion was recognized in the basal forebrain. The hypoperfusion of the precuneus in aMCI, and the hypoperfusion of the right frontal lobe (DLPFC, dorsal-anterior cingulate) in dMCI were characteristic brain blood-flow abnormalities. We believe 99mTc-ECD SPECT brain blood flow imaging to be useful in the diagnosis of aMCI and in the early detection of depression. (author)

  10. Reduced brain perfusion in basal forebrain associated with cognitive decline in Alzheimer's diseases: a Tc-99m HMPAO SPECT study

    Aim: Reduction of regional cerebral blood flow (rCBF) in various cerebral regions and decline of cognitive function have been reported in Alzheimer's disease (AD) patients. The aim of this study was to identify the brain areas showing correlation between longitudinal changes of rCBFs and decline of general mental function, measured by Mini-Mental State Examination (MMSE) in probable Alzheimer's disease patients. Materials and Methods: Nine probable AD patients according to NINCDS-ADRDA criteria and DSM-IV were studied with Tc-99m HMPAO SPECT at an initial point and at the follow-up after a period of average 1.8 year. MMSE score was obtained in both occasions (average MMSE 16.4 at initial study; average MMSE = 8.1 at follow-up). Single SPECT was performed in 30 age-matched normal controls. Each SPECT image was normalized to the cerebellar activity. Using statistical parametric mapping (SPM99), correlation was analyzed between individual changes in rCBF of two SPECT scans and the MMSE scores at the time of each study in AD patients. In addition, the SPECT images of the initial study and the follow-up study were compared with SPECT images of the age-matched normal group respectively. Results: Significant correlation between longitudinal changes of rCBFs and MMSE scores was found in left basal forebrain region including substantia innominata (x, y, z = -24, 16, -23; P < .05, corrected). Within a short follow-up period of 1.8 years, cerebral hypoperfusion extended to various cortical regions from bilateral temporo-parietal to bilateral frontal regions and cingulate cortex, compared to normal controls. Conclusion: The decline of cognitive function in individual AD patients was correlated with rCBF reduction in left basal forebrain. This finding supports the cholinergic hypothesis of AD since hypoperfusion in basal forebrain region might indicate deterioration of cholinergic neurons in nucleus basalis of Meynert or substantia innominata

  11. 201Tl and 99Tcm-HMPAO SPECT imaging in brain lesions

    Eighty-five patients with three different types of brain lesions were included in the study. Twenty-five patients with malignant astrocytoma, either post-operatively (15 cases) or with recurrent tumour versus gliosis (10 cases), were studied using 201Tl SPECT (single photon emission computed tomography). Calculation of early delayed uptake and the retention index showed high early late uptake with low retention index in high grade astrocytoma versus a low mean value of early and delayed uptake with a high retention index in low grade glioma. Also, recurrent cases showed remarkable differences in early and delayed 201Tl uptake (P 201Tl SPECT (100%) versus 80% using computed tomography (CT) scanning. Furthermore, 30 patients with interictal epileptic fits were evaluated with 99Tcm-HMPAO (hexamethylpropylene amine oxime), electroencephalogram (EEG) and CT, with sensitivities of 80, 73.3 and 20%, respectively. The third group of 30 patients with different onset of cerebrovascular stroke was evaluated with 99Tcm-HMPAO. They showed larger lesions in both the acute phase (8 patients) and the subacute phase (12 patients) compared with CT scanning. Also, crossed cerebellar diaschiasis was seen in 50% of each group and 'luxury' perfusion in 30% of the subacute phase. Additional lesions with signs of cerebral atrophy in 75% of acute 50% of subacute phases were noted. A similar finding was noted for 99Tcm-HMPAO and CT scanning in ten patients in a chronic phase with no evidence of other lesions, cerebellar diaschiasis, or signs of cerebral atrophy. (author). 13 refs, 3 figs

  12. Brain SPECT of chronic fatigue syndrome (CFS): SPM analysis of two age groups

    Full text: Chronic fatigue syndrome (CFS) is a complex disorder characterised by profound fatigue and neuropsychiatric dysfunction. Previous studies with cerebral perfusion SPECT (rCBF) scans were performed with inhomogeneous patient populations and were not analysed with Statistical Parametric Mapping (SPM). We have used SPM to study subjects with moderate CFS based on the Fukuda criteria, who were not on medication and not depressed, compared to age matched control subjects. An apparent bimodal age distribution has been observed in CFS. Subjects were therefore divided into two age groups: 16-35 or under 35 (17 CFS, 11 control) and 36-61 or over 35 (15 CFS, 15 control). HMPAO brain SPECT was acquired on a 3-head camera. After lower window scatter subtraction, reconstruction with attenuation correction (mu=0.15/cm) and editing of facial activity, scans were spatially normalised (affine + 2x3x2 nonlinear) to SPM's anatomical space. SPM statistical analysis yielded the location, amplitude and corrected p-value of significant focal rCBF deficits. They were: for under 35, left lateral temporal lobe (13%, 0.004), the left insular region (15%, 0.006) and the right lentiform nucleus (15%, 0.01); and for over 35 the left lentiform nucleus (18%, 0.01). Counts at the most significant voxel in the under 35 age group permitted separation of the CFS and control groups with sensitivity 94% and specificity 100%. We are acquiring more controls to better define the age and sex dependence of rCBF in CFS. Analysis of associated clinical variables will be used to investigate the observed differences between the two age groups. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  13. Brain SPECT analysis using statistical parametric mapping in patients with posttraumatic stress disorder

    Kim, Euy Neyng; Sohn, Hyung Sun; Kim, Sung Hoon; Chung, Soo Kyo; Yang, Dong Won [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2001-07-01

    This study investigated alterations in regional cerebral blood flow (rCBF) in patients with posttraumatic stress disorder (PTSD) using statistical parametric mapping (SPM99). Noninvasive rCBF measurements using {sup 99m}Tc-ethyl cysteinate dimer (ECD) SPECT were performed on 23 patients with PTSD and 21 age matched normal controls without re-exposure to accident-related stimuli. The relative rCBF maps in patients with PTSD and controls were compared. In patients with PTSD, significant increased rCBF was found along the limbic system in the brain. There were a few foci of decreased rCBF in the superior frontal gyrus, parietal and temporal region. PTSD is associated with increased rCBF in limbic areas compared with age-matched normal controls. These findings implicate regions of the limbic brain, which may mediate the response to aversive stimuli in healthy individuals, play on important role in patients suffering from PTSD and suggest that ongoing hyperfunction of 'overlearned survival response' or flashbacks response in these regions after painful, life threatening, or horrifying events without re-exposure to same traumatic stimulus.

  14. Statistics that learn: can logistic discriminant analysis improve diagnosis in brain SPECT?

    Full text: Logistic discriminant analysis (LDA) is a statistical technique capable of discriminating individuals within a diseased group against normals. It also enables classification of various diseases within a group of patients. This technique provides a quantitative, automated and non-subjective clinical diagnostic tool. Based on a population known to have the disease and a normal control group, an algorithm was developed and trained to identify regions in the human brain responsible for the disease in question. The algorithm outputs a statistical map representing diseased or normal probability on a voxel or cluster basis from which an index is generated for each subject. The algorithm also generates a set of coefficients which is used to generate an index for the purpose of classification of new subjects. The results are comparable and complement those of Statistical Parametric Mapping (SPM) which employs a more common linear discriminant technique. The results are presented for brain SPECT studies of two diseases: chronic fatigue syndrome (CFS) and fibromyalgia (FM). A 100% specificity and 94% sensitivity is achieved for the CFS study (similar to SPM results) and for the FM study 82% specificity and 94% sensitivity is achieved with corresponding SPM results showing 90% specificity and 82% sensitivity. The results encourages application of LDA for discrimination of new single subjects as well as of diseased and normal groups. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  15. Brain SPECT analysis using statistical parametric mapping in patients with posttraumatic stress disorder

    This study investigated alterations in regional cerebral blood flow (rCBF) in patients with posttraumatic stress disorder (PTSD) using statistical parametric mapping (SPM99). Noninvasive rCBF measurements using 99mTc-ethyl cysteinate dimer (ECD) SPECT were performed on 23 patients with PTSD and 21 age matched normal controls without re-exposure to accident-related stimuli. The relative rCBF maps in patients with PTSD and controls were compared. In patients with PTSD, significant increased rCBF was found along the limbic system in the brain. There were a few foci of decreased rCBF in the superior frontal gyrus, parietal and temporal region. PTSD is associated with increased rCBF in limbic areas compared with age-matched normal controls. These findings implicate regions of the limbic brain, which may mediate the response to aversive stimuli in healthy individuals, play on important role in patients suffering from PTSD and suggest that ongoing hyperfunction of 'overlearned survival response' or flashbacks response in these regions after painful, life threatening, or horrifying events without re-exposure to same traumatic stimulus

  16. Clinical value of scatter correction for interictal brain 99m Tc-HMPAO SPECT in mesial temporal lobe epilepsy

    Aim: It is well known that some patients with temporal lobe epilepsy (TLE) show normal perfusion during interictal SPECT study. The aim of this research was to evaluate if the scatter radiation has some influence on this kind of result. Materials and Methods: We studied 15 patients with TLE by clinical diagnosis and by video-EEG monitoring with surface electrodes (11 left TLE, 4 right TLE), which showed normal perfusion during interictal brain 99mTc-HMPAO SPECT. The SPECT data were reconstructed by filtered backprojection without scatter correction (A). The same SPECT data were reconstructed after the projections were corrected by dual energy window method of scatter correction (B). Attenuation was corrected in all cases using first order Chang Method. For A and B images groups, cerebellum perfusion ratios were calculated on irregular regions of interest (ROI) drawn on anterior (ATL), lateral (LTL), mesial (MTL) and whole temporal lobe (WTL). To evaluate the influence of scatter radiation, the cerebellum perfusion ratios of each subject were compared with a normal database of 10 normal subjects, with and without scatter correction, using z-score analysis. Results: In group A, the z-score was less than 2 in all cases. In group B, the z-score was more than 2 in 6 cases, 4 in MTL (3 left, 1 right) and 2 in left LTL, which were coincident with the EEG localization. All images of group B showed better contrast than images of group A. Conclusions: These results suggest that scatter correction could improve the sensitivity of interictal brain SPECT to identify epileptic focus in patients with TLE

  17. Effects of partial volume correction on discrimination between very early Alzheimer's dementia and controls using brain perfusion SPECT

    We assessed the accuracy of brain perfusion single-photon emission computed tomography (SPECT) in discriminating between patients with probable Alzheimer's disease (AD) at the very early stage and age-matched controls before and after partial volume correction (PVC). Three-dimensional MRI was used for PVC. We randomly divided the subjects into two groups. The first group, comprising 30 patients and 30 healthy volunteers, was used to identify the brain area with the most significant decrease in regional cerebral blood flow (rCBF) in patients compared with normal controls based on the voxel-based analysis of a group comparison. The second group, comprising 31 patients and 31 healthy volunteers, was used to study the improvement in diagnostic accuracy provided by PVC. A Z score map for a SPECT image of a subject was obtained by comparison with mean and standard deviation SPECT images of the healthy volunteers for each voxel after anatomical standardization and voxel normalization to global mean or cerebellar values using the following equation: Z score = ([control mean]-[individual value])/(control SD). Analysis of receiver operating characteristics curves for a Z score discriminating AD and controls in the posterior cingulate gyrus, where a significant decrease in rCBF was identified in the first group, showed that the PVC significantly enhanced the accuracy of the SPECT diagnosis of very early AD from 73.9% to 83.7% with global mean normalization. The PVC mildly enhanced the accuracy from 73.1% to 76.3% with cerebellar normalization. This result suggests that early diagnosis of AD requires PVC in a SPECT study. (orig.)

  18. Comparison of brain perfusion SPECT and MRI findings in children with neuronal ceroid-lipofuscinosis and in their families

    Neuronal ceroid-lipofuscinoses (NCL) are among the progressive encephalopathies of childhood that are inherited in an autosomal recessive manner. In this study we specifically aimed to investigate any white-matter changes in the carriers (parents) and the healthy siblings of individuals with neuronal ceroid lipofuscinosis disease and whether we may be able to predict the occurrence of any neurological symptoms in healthy children in the future thus enabling early management. Since the NCLs are genetically determined diseases, we investigated fifteen individuals in three families that had diseased children of the juvenile type, with brain perfusion SPECT and MRI. Brain perfusion SPECT was performed after administering 222-555 MBq (6-15 mCi) Tc-99m hexamethyl-propylene amine oxime (HMPAO) intravenously in a dimmed and quiet room. Imaging was performed at least one hour after injection, with a three headed gamma camera equipped with high resolution collimators. A Metz filter (FWHM: 11 mm) was used for processing. Cranial MRI was performed with an imager operating at 1.5 Tesla. Spin-echo T1- and T2-weighted and FLAIR slices were obtained for each individual. In all of the five diseased children we observed pathologic findings both on MRI and Tc-99m HMPAO SPECT. The findings on MRI were mainly features of cerebral and cerebellar atrophy and the observations on Tc-99m HMPAO SPECT were regional perfusion abnormalities. We observed some structural abnormalities on MRI in four of the parents and two of the four healthy siblings. We also noted perfusion abnormalities on Tc-99m HMPAO SPECT in two of the parents and two of the healthy siblings. Because the disease is inherited in an autosomal recessive manner, the parents and the healthy siblings were not supposed to exhibit any demonstrable brain lesions, but the brain perfusion SPECT and MRI examinations clearly revealed multiple lesions in some of the parents and healthy siblings. Detailed neurological examinations of these

  19. Evaluating acute effects of Electro Convulsive Therapy (ECT) on brain perfusion with Tc-99m HMPAO brain SPECT

    Regional cerebral blood flow (rCBF) was measured by Tc-99m HMPAO brain perfusion SPECT in 10 schizophrenes (8 male, 2 female) undergoing electro convulsive therapy (ECT) and the results were compared to those of baseline studies performed 3 days prior to the ECT application to evaluate its acute effect on brain perfusion. ECT caused a redistribution in the tracers uptake. There was a global increase in the rCBF and the uptake became more pronounced in the basal ganglia (left: 44.4+-1.9%, right: 43.1+-19%) and to a degree in the parietal (left: 26.5+-4.1%, right: 25+-3.4%) and temporal (left: 22.9+-4.3%, right: 22.3+-3.6%) cortices. When evaluating the effects of ECT on rCBF, factors like the used perfusion agent, the injection and rCBF measurement times, clinical status of the patient, duration of the illness, used therapeutic agents and variations in the ECT application should be taken into consideration because the obtained data may reflect either the ictal or post-ictal changes on rCBF and is specific to the group of patients undergoing the study

  20. Follow-up of pain processing recovery after ketamine in hyperalgesic fibromyalgia patients using brain perfusion ECD-SPECT

    Guedj, Eric; Cammilleri, Serge; Colavolpe, Cecile; Laforte, Catherine de; Mundler, Olivier [Assistance Publique des Hopitaux de Marseille, Centre Hospitalo-Universitaire de la Timone, Service Central de Biophysique et de Medecine Nucleaire, Marseille, Cedex 5 (France); Niboyet, Jean [Clinique La Phoceanne, Unite d' Etude et de Traitement de la Douleur, Marseille (France)

    2007-12-15

    The aim of this study was to determine whether the follow-up of pain processing recovery in hyperalgesic fibromyalgia (FM) could be objectively evaluated with brain perfusion ethyl cysteinate dimer single photon computerized tomography (ECD-SPECT) after administration of ketamine. We enrolled 17 hyperalgesic FM women patients (48.5 {+-} 11 years, range 25-63). After treatment with subcutaneous ketamine, 11 patients were considered as 'good responders', with a decrease in pain intensity, evaluated by visual analog scale (VAS), greater than 50%. On the other hand, six patients were considered as 'poor responders'. A voxel-based analysis of regional cerebral blood flow (rCBF) was conducted (p{sub voxel} < 0.001uc), in the two subgroups of patients, before and after treatment, in comparison to a group of ten healthy subjects, matched for age and gender. In comparison to baseline brain SPECT, midbrain rCBF showed a greater increase after ketamine in the responder group than in the nonresponder group (p{sub cluster} = 0.016c). In agreement with the clinical response, the change in midbrain rCBF after ketamine was highly correlated with the reduction of VAS pain score (r = 0.7182; p = 0.0041). This prospective study suggests that blockade of facilitatory descending modulation of pain with ketamine can be evaluated in the periaqueductal grey with brain perfusion SPECT. (orig.)

  1. Neuronal activation by electrical neuromuscular stimulation in hemiplegic patients demonstrated with 99m-Tc-ECD brain SPECT

    Electrical neuromuscular stimulation (ENS) has been shown to improve volitional movement of upper limbs and decrease muscle hypertonia in hemiplegic patients. Aim: The purpose of this study was to demonstrate regional cerebral perfusion changes secondary to neuronal activation after ENS using 99mTc-ECD SPECT and to correlate these findings with clinical improvement. Materials and Methods: Nine hemiplegic and 3 paraparetic patients, with 14 to 59 years of age, 10 males and 2 females, were studied. ENS was performed for 14 weeks in 45-minute sessions on the muscles involved in hand opening and closing. Each patient was submitted to neurological examination before and after treatment and underwent three 99mTc-ECD SPECT studies: a pre-treatment study; a study performed during the first ENS session; and the third study during the last ENS session (after 14 weeks of treatment). Visual analysis of brain SPECT images was performed by two experienced nuclear physicians. Region-to-pons ratio (R/PO) was obtained for 15 brain regions. An asymmetry index (AI) was also calculated for all regions using the equation: AI=2X(R-L)/(R+L), where R is right and L is left. The visual and semi-quantitative results were compared in the three studies. Results: Visual analysis revealed perfusion improvement mainly in areas adjacent to the brain lesion (penumbra) but also in the contra-lateral cerebral hemisphere. Perfusion improvement was found in the frontal lobe (5 patients), fronto-parietal (1), fronto-temporal (1), temporal (2), basal ganglia (5) and in the thalami (1). In the pre-treatment study, 8 patients showed cerebellar diaschisis, which decreased during treatment in 2 patients and increased in 2. The asymmetry index showed significant variability among the three studies in 8 regions. The R/PO ratio did not correlate with the visual analysis. Neurological examination showed significant improvement in 10 patients, 9 of which showed perilesional brain perfusion improvement

  2. Old wine in new bottles: validating the clinical utility of SPECT in predicting cognitive performance in mild traumatic brain injury.

    Romero, Kristoffer; Lobaugh, Nancy J; Black, Sandra E; Ehrlich, Lisa; Feinstein, Anthony

    2015-01-30

    The neural underpinnings of cognitive dysfunction in mild traumatic brain injury (TBI) are not fully understood. Consequently, patient prognosis using existing clinical imaging is somewhat imprecise. Single photon emission computed tomography (SPECT) is a frequently employed investigation in this population, notwithstanding uncertainty over the clinical utility of the data obtained. In this study, subjects with mild TBI underwent (99m)Tc-ECD SPECT scanning, and were administered a brief battery of cognitive tests and self-report symptom scales of concussion and emotional distress. Testing took place 2 weeks (n=84) and 1 year (n=49) post-injury. Multivariate analysis (i.e., partial least squares analysis) revealed that frontal perfusion in right superior frontal and middle frontal gyri predicted poorer performance on the Stroop test, an index of executive function, both at initial and follow-up testing. Conversely, SPECT scans categorized as normal or abnormal by radiologists did not differentiate cognitively impaired from intact subjects. These results demonstrate the clinical utility of SPECT in mild TBI, but only when data are subjected to blood flow quantification analysis. PMID:25466236

  3. Contrasted study on the opening degree of blood-brain barriier after radiation therapy with SPECT and MRI

    The blood-brain barrier(BBB) is the largest barrier responsible for preventing direct contact between chemotherapeutic drugs in blood and tumors in brain, the permeability of BBB incease at different degree after brain irradiation in clinical brain tumors radiotherapy. Methods: In our study, 26 patients with metastatic brain tumors(21 cases in pr/mary lung carcinoma, 5 cases in breast carcinoma) were accepted the full brain irradiation. The detructive effects of radiation on the BBB were determined by the 99mTc-DTPA SPECT and the concentration ratio of methotrexate(MTX) in cerebrospinal fluid(CSF) and blood, the brain MRI before and after radiotherapy were retrospective contrasted study with SPECT. Results: the degree of destructive effect on the BBB was directly proportional to radiation doses. After a dose of 20Gy radiation to brain, the permeability of BBB inceased markedly(P<0.01). But in cases the dexamethasone(DXM) was administrated to decease the brain edema during radiotherapy, the permeability inceased less than that in patients without DXM(P<0.05). Conclutions: After 20Gy irradiation, the BBB would gradually open. At this time, chemotherapy is the best choice to improving the therapeutic effect. Dexamethasone was found to cause the decease in BBB permeability but no significant remission of brain edema. So, if the combination of radiotherapy and chemotherapy in treatment of metastatic brain tumors will be plan, the dexamethasone may be not used in expecting to deceasing the side effect and that no affecting the therapeutic effect. (authors)

  4. 99Tcm-Neurolite brain SPECT imaging as an outcome predictor after brain trauma: initial experience

    Full text: The aim of this study was to use semi-quantitative 99Tcm-ethylene cysteine dimer (Neurolite) cerebral blood flow (CBF) SPET brain imaging to assess its role in predicting outcome after brain trauma. Twelve adult patients (9 males, 3 females) who sustained moderate to severe brain trauma were studied by CBF/SPET within 4 weeks of the injury (scan A) and again after 1 year (scan B). Clinical assessment was also performed at these times and included extensive neuropsychometric testing. Patients received 800-850 MBq 99Tcm-Neurolite intravenously, and were imaged using a triple-headed gamma camera with LEUHR fan beam collimators. Processing, filtering, reconstruction and data set selection were identical for scans A and B. Semi-quantitative analysis was performed using 25 regions of interest in the cerebral cortex and deep structures in 2 coronal, 2 sagittal and 3 oblique planes. Normalized mean counts per pixel for the whole brain, and regional brain ratios were calculated. Scans A and B were compared and correlated to the clinical outcome data. Two patients with minimal CBF abnormalities made full recoveries. The remaining 10 had moderate to severe focal CBF defects, which showed no significant improvement at 12 months. Of these patients, 2 had moderate disability, 3 had severe to moderate disability and 2 had severe disability at 12 months. Patients with persisting focal abnormal CBF showed persisting neurological deficits. Neurolite brain CBF imaging is a useful method of predicting outcome after moderate to severe head injury

  5. Improvement of image resolution of brain SPECT by use of the wide-angle offset acquisition method

    Cerebral single photon emission computed tomography (SPECT) images require high spatial and contrast resolution for precise evaluation of the abnormal tracer distribution in the brain. A shorter data acquisition time is preferable so that artifacts due to patient movement are avoided. We tried to shorten data acquisition time applying larger sampling angle and offset acquisition method, in which half degree of the step angle was shifted in the opposite gamma camera of the dual-detector SPECT system. A simulation study was performed with a 3-dimensional mathematical phantom. The phantom studies were performed with a hot-rod phantom and a brain phantom. A clinical study with 99mTc-ECD SPECT was also performed on a patient who had a cerebral infarction. Reconstruction of images was done for the normal 6 deg and 12 deg onset and 12 deg offset. Data for the 12 deg offset were acquired by shifting of sampling angles of the opposite detector by half (6 deg) of the sampling angles of 12 deg. The maximum likelihood-expectation maximization (MLEM) algorithm was used for image reconstruction. Image qualities in the simulation study, the phantom studies, and the clinical study were compared for the 6 deg and 12 deg onset, and for the 12 deg offset by quantitative analysis with use of profile curves. Analysis of the profile curves revealed that the image quality of the 12 deg offset was better than that of the 12 deg onset and compared to that of the 6 deg onset in the simulation study, the phantom studies, and the clinical study. The present study indicates that wide-angle offset data acquisition improves the image resolution of brain SPECT compared to onset data acquisition with the same sampling time. (author)

  6. Perfusion impairments on brain SPECT in patients with infantile autism and nonautistic pervasive developmental disorders: comparison with MR findings

    Ryu, Young Hoon; Lee, Jong Doo; Yoon, Pyeong Ho; Kim, Dong Ik; Jeon, Tae Joo; Shin, Yee Jin; Lee, Byung Hee; Shin, Hyung Cheol [College of Medecine, Soonchunhyang Univ., Chonan (Korea, Republic of)

    1998-07-01

    Neuroimaging findings of autism has been the subjects of continuing investigation. Because previous study had not demonstrated consistent and specific neuroimaging findings of autism and most studies comprised adults and school-aged children, we performed a retrospective review in search of common functional and structural abnormalities in pre-school aged autistic children using Tc-99m ECD brain SPECT and MRI and compared them with age-matched children with nonautistic pervasive developmental disorders (PDD). 58 children between 3 and 8 years of age infantile autism (n=37) and non-autistic PDD (n=21) were performed Tc-99m ECD brain SPECT and MRI. Diagnosis of autism and non-autistic PDD was based on the criteria of DSM-IV and Childhood Autism Rating Scale (CARS). Of the 37 autistic patients, 32 revealed decreased perfusion of cerebellar hemisphere, followed by hypoperfusion of thalami (n=30), parietal cortex (n=16), temporal cortex (n=12). Of those 21 PDD patients, 14 patients showed hypoperfusion of the thalami and 10 patients showed temporal hypoperfusion. However, cerebellar hemispheric (n=8) and parietal (n=1) hypoperfusion was infrequently seen. All autistic and nonautistic PDD patients had normal MRI scan. Cerebellar hemispheric and parietal hypoperfusion on brain SPECT showed statistically significant correlation with CARS. Cerebellar hemispheric and parietal hypoperfusion is significantly frequently noted in autistic patients although they had normal MRI and SPECT may be useful and more sensitive modality in reflecting pathophysiology of autism as evidenced by previous MRI and postmortem studies. Thalamic and temporal hypoperfusion can be seen in both autistic and nonautistic patients and further studies are necessary to determine the significance of the thalamic hypoperfusion.

  7. Perfusion impairments on brain SPECT in patients with infantile autism and nonautistic pervasive developmental disorders: comparison with MR findings

    Neuroimaging findings of autism has been the subjects of continuing investigation. Because previous study had not demonstrated consistent and specific neuroimaging findings of autism and most studies comprised adults and school-aged children, we performed a retrospective review in search of common functional and structural abnormalities in pre-school aged autistic children using Tc-99m ECD brain SPECT and MRI and compared them with age-matched children with nonautistic pervasive developmental disorders (PDD). 58 children between 3 and 8 years of age infantile autism (n=37) and non-autistic PDD (n=21) were performed Tc-99m ECD brain SPECT and MRI. Diagnosis of autism and non-autistic PDD was based on the criteria of DSM-IV and Childhood Autism Rating Scale (CARS). Of the 37 autistic patients, 32 revealed decreased perfusion of cerebellar hemisphere, followed by hypoperfusion of thalami (n=30), parietal cortex (n=16), temporal cortex (n=12). Of those 21 PDD patients, 14 patients showed hypoperfusion of the thalami and 10 patients showed temporal hypoperfusion. However, cerebellar hemispheric (n=8) and parietal (n=1) hypoperfusion was infrequently seen. All autistic and nonautistic PDD patients had normal MRI scan. Cerebellar hemispheric and parietal hypoperfusion on brain SPECT showed statistically significant correlation with CARS. Cerebellar hemispheric and parietal hypoperfusion is significantly frequently noted in autistic patients although they had normal MRI and SPECT may be useful and more sensitive modality in reflecting pathophysiology of autism as evidenced by previous MRI and postmortem studies. Thalamic and temporal hypoperfusion can be seen in both autistic and nonautistic patients and further studies are necessary to determine the significance of the thalamic hypoperfusion

  8. The study of ictal brain SPECT during seizures induced by clonidine and sleep-deprivation in patients with epilepsy

    Objective: To evaluate the feasibility and clinical value of combined clonidine and sleep-deprivation induced seizures for ictal brain SPECT imaging in patients with epilepsy. Methods: Fifty-two epilepsy patients were given oral clonidine plus sleep-deprivation to induce seizures with video-electroencephalogram (VEEG) monitoring. Forty-seven patients were selected as control group, whose seizures were induced by sleep-deprivation only. 99Tcm-ethylcysteinate dimer (ECD) was injected within 30 s since a clinical sign and/or a typical EEG discharge of epilepsy was recognized. Brain SPECT was performed 30 min after 99Tcm-ECD injection. χ2-test was performed by using software SPSS 10.0. Results: One to two hr after oral intake of clonidine plus sleep-deprivation, 75% (39/52) patients were induced seizures, including 92.3% (36/39) with subclinical seizures and 7.7% (3/39) with clinical seizures. Ictal brain SPECT localized the lesions with high uptake of 99Tcm-ECD in 37 (94.9%) patients. In control group, 38.3% (18/47) were induced epileptic seizures, including 77.8% (14/18) with subclinical seizures and 22.2% (4/18) with clinical seizures. The induction rate of epileptic seizures in clonidine plus sleep-deprivation group was significantly higher than that of control group (χ2 = 13.614, P2 = 1.253, P>0.05). Conclusions: The combination of oral intake of clonidine and sleep-deprivation could increase the induction rate of epileptic seizures and it is effective for epilepsy SPECT imaging. (authors)

  9. NeuroSPECT assessment of ischemic penumbra in acute brain infarct: control of intra-arterial thrombolysis

    Introduction: Brain infarct is the most common cause of incapacity in adults, the second cause of dementia and the 2nd or 3rd cause of death. Acute brain infarct is a medical emergency potentially reversible if treated with thrombolysis in the first hours of evolution. Thrombolysis is now an approved and efficacious method of treatment for acute ischemic stroke. During the first 3 hours of evolution, intravenous administration of plasminogen activator (tPA) can be performed. The window of time of treatment is expanded to 6 hours with the intra-arterial super selective route for thrombolysis. Aim: The aim of this study was to define levels of reversible ischemia (penumbra) demonstrated by statistically evaluated HMPAO Tc99m NeuroSPECT performed before and after intra-arterial thrombolysis in the treatment of acute infarct. Materials and Methods: 21 patients were treated during the first 6 hours of evolution of an acute ischemic stroke with the following protocol. 1) Admission, and complete neurological evaluation. 2) Brain CT scan to rule hemorrhage or established infarct. 3) I.V injection of 1100MBq Tc99m HMPAO (Ceretec tm) 4) Conventional cerebral angiography and intra-arterial thrombolysis and/or angioplasty/stenting if necessary. 5) NeuroSPECT assessment of ischemic penumbra. 6) Control at 24 hrs with NeuroSPECT. NeuroSPECT image acquisition is performed immediately following arterial thrombolysis with a dual Head Camera, SHR collimators and conventional protocol. Image processing was performed using the Segami Software, as previously reported in Alasbimn Journal2 (7): April 2000. http://www.alasbimnjournal.cl. The analysis consists of 1) Tallairach brain volume normalization. 2) Voxel by voxel comparison of the individual brain cortex uptake normalized to the maximum in the cortex with a normal database of 24 age-matched controls. Results: The results are expressed in standard deviations (S.D.) below the normal mean. Normal mean is 72% + 6. Only voxels between

  10. Technetium-99m HMPAO brain SPECT in children with attention deficit hyperactivity disorder

    Attention deficit hyperactivity disorder (ADHD) is a developmental, neurobehavioral syndrome with an onset in childhood. The aim of this study was to investigate the existence of regional perfusion changes in ADHD by means of Tc-99m HMPAO brain SPECT. Thirteen children with a diagnosis of ADHD and 7 healthy, age-matched controls were included in this study. Hypoperfusion was observed on the right temporal cortex in 9, and on the left temporal cortex in 3 children. The distribution of the lesions showed right lateral temporal cortex involvement in 3, right medial temporal cortex in 9 and left medial temporal cortex in 8 children. Asymmetric perfusion was seen on the caudate nucleus in 4, on the thalamus in 3 and on the frontal cortex in 6 children. There was a significant difference between children with ADHD and controls in right medial temporal cortex: cerebellum and right lateral temporal cortex: cerebellum ratios. Hypoperfusion in the right medial temporal cortex was significantly and inversely correlated with Du Paul teachers' questionnaire rating scale (r=-0.71, p=0.006). It has been postulated that difficulty in self regulating response to stimuli in ADHD is mediated by underfunctioning of the orbital frontal cortex and subsequent connection to the limbic system. Decreased temporal cortex perfusion may dysfunction of the limbic system or the orbito-frontal-limbic axis. (author)

  11. 1-123-lodo-{alpha}-methyl tyrosine SPECT in non-parenchymal brain tumours

    Matheja, P.; Weckesser, M.; Franzius, Ch.; Riemann, B.; Schober, O. [Dept. of Nuclear Medicine, Univ. Hospital Muenster (Germany); Rickert, Ch. [Inst. of Neuropathology, Univ. Hospital Muenster (Germany); Palkovic, St. [Dept. of Neurosurgery, Univ. Hospital Muenster (Germany)

    2002-08-01

    Purpose: Scintigraphy using 1-123-iodo-{alpha}-methyl tyrosine (IMT) is useful in the preoperative characterization of gliomas, in detecting recurrent glioma and in the biological re-evaluation of residual or recurrent tumours. A systematic evaluation of non-parenchymal brain tumours has not yet been performed. The aim of the present study was to evaluate IMT SPECT in the management of intracerebral metastases and lymphomas. Patients and methods: IMT uptake was analyzed in 31 patients with 28 metastases of extracerebral solid tumours and 7 cerebral lymphomas. Histology revealed high grade lymphomas, melanomas, and carcinomas of the following origin: lung, unknown primary, breast, colon, renal cell, ovary, vagina, frontal sinus. IMT uptake was quantified as ratio between maximal tumour accumulation and average uptake in the contralateral hemisphere. Results: All tumours except two renal cell and one small cell lung carcinoma metastases accumulated IMT (91%). The highest IMT uptake was found in metastasis of lung carcinoma. IMT uptake was highly variable and was similar in primary and in recurrent tumours. Conclusion: Significant accumulation of IMT is seen in the majority of tumours, so that this technique might be helpful for the management of cerebral metastases and lymphomas. (orig.)

  12. 1-123-lodo-α-methyl tyrosine SPECT in non-parenchymal brain tumours

    Purpose: Scintigraphy using 1-123-iodo-α-methyl tyrosine (IMT) is useful in the preoperative characterization of gliomas, in detecting recurrent glioma and in the biological re-evaluation of residual or recurrent tumours. A systematic evaluation of non-parenchymal brain tumours has not yet been performed. The aim of the present study was to evaluate IMT SPECT in the management of intracerebral metastases and lymphomas. Patients and methods: IMT uptake was analyzed in 31 patients with 28 metastases of extracerebral solid tumours and 7 cerebral lymphomas. Histology revealed high grade lymphomas, melanomas, and carcinomas of the following origin: lung, unknown primary, breast, colon, renal cell, ovary, vagina, frontal sinus. IMT uptake was quantified as ratio between maximal tumour accumulation and average uptake in the contralateral hemisphere. Results: All tumours except two renal cell and one small cell lung carcinoma metastases accumulated IMT (91%). The highest IMT uptake was found in metastasis of lung carcinoma. IMT uptake was highly variable and was similar in primary and in recurrent tumours. Conclusion: Significant accumulation of IMT is seen in the majority of tumours, so that this technique might be helpful for the management of cerebral metastases and lymphomas. (orig.)

  13. Technetium-99m HMPAO brain SPECT in children with attention deficit hyperactivity disorder

    Kaya, G.C.; Pekcanlar, A.; Bekis, R.; Ada, E.; Miral, S.; Emiroglu, N.; Durak, H. [Dokuz Eylul Univ., Izmir (Turkey). School of Medicine

    2002-12-01

    Attention deficit hyperactivity disorder (ADHD) is a developmental, neurobehavioral syndrome with an onset in childhood. The aim of this study was to investigate the existence of regional perfusion changes in ADHD by means of Tc-99m HMPAO brain SPECT. Thirteen children with a diagnosis of ADHD and 7 healthy, age-matched controls were included in this study. Hypoperfusion was observed on the right temporal cortex in 9, and on the left temporal cortex in 3 children. The distribution of the lesions showed right lateral temporal cortex involvement in 3, right medial temporal cortex in 9 and left medial temporal cortex in 8 children. Asymmetric perfusion was seen on the caudate nucleus in 4, on the thalamus in 3 and on the frontal cortex in 6 children. There was a significant difference between children with ADHD and controls in right medial temporal cortex: cerebellum and right lateral temporal cortex: cerebellum ratios. Hypoperfusion in the right medial temporal cortex was significantly and inversely correlated with Du Paul teachers' questionnaire rating scale (r=-0.71, p=0.006). It has been postulated that difficulty in self regulating response to stimuli in ADHD is mediated by underfunctioning of the orbital frontal cortex and subsequent connection to the limbic system. Decreased temporal cortex perfusion may dysfunction of the limbic system or the orbito-frontal-limbic axis. (author)

  14. High-resolution single photon planar and spect imaging of brain and neck employing a system of two co-registered opposed gamma imaging heads

    Majewski, Stanislaw; Proffitt, James

    2011-12-06

    A compact, mobile, dedicated SPECT brain imager that can be easily moved to the patient to provide in-situ imaging, especially when the patient cannot be moved to the Nuclear Medicine imaging center. As a result of the widespread availability of single photon labeled biomarkers, the SPECT brain imager can be used in many locations, including remote locations away from medical centers. The SPECT imager improves the detection of gamma emission from the patient's head and neck area with a large field of view. Two identical lightweight gamma imaging detector heads are mounted to a rotating gantry and precisely mechanically co-registered to each other at 180 degrees. A unique imaging algorithm combines the co-registered images from the detector heads and provides several SPECT tomographic reconstructions of the imaged object thereby improving the diagnostic quality especially in the case of imaging requiring higher spatial resolution and sensitivity at the same time.

  15. Clinical experience with Tc-99m HM-PAO high resolution SPECT of the brain in patients with cerebrovascular accidents

    In order to evaluate the diagnostic contribution of brain SPECT imaging with 99mTc-HMPAO in cerebrovascular disease, we examined 92 stroke cases (144 lesions), 2 hematoma cases and 30 cases with transient neurologic symptoms. Abnormal tracer distribution is visible as zones of either hypoactivity or hyperactivity (border zone hyperemia or luxury perfusion). Remote vascularization changes could also be found (crossed cerebellar diaschisis or ipsilateral cortical perfusion reduction in thalamic or capsula interna lesions). Both X-ray CT and blood flow SPECT have comparable sensitivity in the exploaration of cerebral infarction, with detection in, respectively, 89,5% and 87,5% of the lesions. False negative scintitomographic images are frequently recorded in small lacunar infarcts within the basal ganglia and white matter (capsula interna). Some early infarcts and asymmetry of brain perfusion in patients with transient neurologic symptoms are frequently not detected by CT. An additional advantage of blood flow SPECT is its ability to visualize remote blood flow changes and the changing pattern of vascularization of ischemic lesions and their surrounding areas including hyperemia. (orig.)

  16. Neuropsychological functions and rCBF SPECT in Parkinson's disease patients considered candidates for deep brain stimulation

    In the present study, we examined relationships between neuropsychological functions and brain single photon emission computed tomography (SPECT) regional cerebral blood flow (rCBF) observed at presurgical evaluation for deep brain stimulation (DBS) of the subthalamic nucleus (STN) in advanced Parkinson's disease (PD) patients. Twenty advanced non-demented PD patients, candidates for DBS surgery, underwent perfusion brain SPECT study and neuropsychological assessment prior to surgery (range: 30-50 days). Patients were further assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (H and Y) scale. During all assessments patients were ''on'' standard medication. NeuroGam software, which permits voxel by voxel analysis, was used to compare the brain perfusion of PD patients with a normal database adjusted for sex and age. Neuropsychological scores were compared to age, education and sex-adjusted normative databases. Our results indicated that the distribution of rCBF showed significant differences when compared to an age- and sex-adjusted normative database. We found impaired blood flow in 17 (85%) of our patients in the left prefrontal lobe, in 14 (70%) in the right prefrontal lobe and in 11 (55%) in the left frontal and right parietal lobes. Neuropsychological testing revealed that 18 (90%) of our patients had significant impairments in measures of executive functions (set-shifting) and 15 (75%) in response inhibition. Furthermore, we found significant correlations between measures of visual attention, executive functions and the right frontal lobe region. The presence of widespread blood flow reduction was observed mainly in the frontal lobes of dementia-free patients with advanced PD. Furthermore, performance on specific cognitive measures was highly related to perfusion brain SPECT findings. (orig.)

  17. Neuropsychological functions and rCBF SPECT in Parkinson's disease patients considered candidates for deep brain stimulation

    Paschali, Anna; Lakiotis, Velissarios; Vassilakos, Paulos [University of Patras Medical School, Department of Nuclear Medicine, Patras (Greece); Messinis, Lambros; Lyros, Epameinondas; Papathanasopoulos, Panagiotis [University of Patras Medical School, Department of Neurology, Neuropsychology Section, Patras (Greece); Constantoyannis, Costas; Kefalopoulou, Zinovia [University of Patras Medical School, Department of Neurosurgery, Patras (Greece)

    2009-11-15

    In the present study, we examined relationships between neuropsychological functions and brain single photon emission computed tomography (SPECT) regional cerebral blood flow (rCBF) observed at presurgical evaluation for deep brain stimulation (DBS) of the subthalamic nucleus (STN) in advanced Parkinson's disease (PD) patients. Twenty advanced non-demented PD patients, candidates for DBS surgery, underwent perfusion brain SPECT study and neuropsychological assessment prior to surgery (range: 30-50 days). Patients were further assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (H and Y) scale. During all assessments patients were ''on'' standard medication. NeuroGam software, which permits voxel by voxel analysis, was used to compare the brain perfusion of PD patients with a normal database adjusted for sex and age. Neuropsychological scores were compared to age, education and sex-adjusted normative databases. Our results indicated that the distribution of rCBF showed significant differences when compared to an age- and sex-adjusted normative database. We found impaired blood flow in 17 (85%) of our patients in the left prefrontal lobe, in 14 (70%) in the right prefrontal lobe and in 11 (55%) in the left frontal and right parietal lobes. Neuropsychological testing revealed that 18 (90%) of our patients had significant impairments in measures of executive functions (set-shifting) and 15 (75%) in response inhibition. Furthermore, we found significant correlations between measures of visual attention, executive functions and the right frontal lobe region. The presence of widespread blood flow reduction was observed mainly in the frontal lobes of dementia-free patients with advanced PD. Furthermore, performance on specific cognitive measures was highly related to perfusion brain SPECT findings. (orig.)

  18. Correlation between 99Tcm-HMPAO-SPECT brain image and a history of decompression illness or extent of diving experience in commercial divers.

    1997-01-01

    OBJECTIVES: To explore the use of 99technetiumm-hexamethyl propylene amine oxime single photon computed tomography (HMPAO-SPECT) of the brain as a means of detecting nervous tissue damage in divers and to determine if there is any correlation between brain image and a diver's history of diving or decompression illness (DCI). METHODS: 28 commercial divers with a history of DCI, 26 divers with no history of DCI, and 19 non-diving controls were examined with brain HMPAO-SPECT. Results were class...

  19. Usefulness of 99mTc-ECD brain SPECT in acute onset pediatric CNS diseases. In comparison with CT and MRI

    The purpose of this study was to assess the usefulness of regional cerebral blood flow (rCBF) measured by 99mTc-L, L-ethyl cysteinate dimer (ECD) brain SPECT in the acute onset type of pediatric central nervous system (CNS) diseases. Thirteen children (7 girls, 6 boys, 4 month-12 years of age) who were diagnosed with 9 cases of viral encephalitis, two cases of febrile convulsion and one each of migraine and metabolic disorder underwent 99mTc-ECD brain SPECT, CT and/or MRI within one week interval. The incidence of abnormal findings in the 13 patients was 96.4% (30/31) on 99mTc-ECD brain SPECT, 17.6% (3/17) on CT and 63.6% (14/22) on MRI. The positive detection rate of 99mTc-ECD brain SPECT was statistically (P2 and/or Fisher's exact probability test) higher than those of CT and MRI. And the changes in rCBF were demonstrated. 99mTc-ECD brain SPECT is a useful examination for the diagnosis and follow up management in patients with the acute onset type of pediatric CNS diseases. (author)

  20. Usefulness of {sup 99m}Tc-ECD brain SPECT in acute onset pediatric CNS diseases. In comparison with CT and MRI

    Hashimoto, Teisuke; Chikatsu, Hiroko; Nishiyama, Hiromune; Endo, Hiroko; Kono, Tatsuo; Iimura, Fumitoshi; Kuwashima, Shigeko; Saiki, Natoru; Fujioka, Mutsuhisa [Dokkyo Univ., Mibu, Tochigi (Japan). School of Medicine

    2001-07-01

    The purpose of this study was to assess the usefulness of regional cerebral blood flow (rCBF) measured by {sup 99m}Tc-L, L-ethyl cysteinate dimer (ECD) brain SPECT in the acute onset type of pediatric central nervous system (CNS) diseases. Thirteen children (7 girls, 6 boys, 4 month-12 years of age) who were diagnosed with 9 cases of viral encephalitis, two cases of febrile convulsion and one each of migraine and metabolic disorder underwent {sup 99m}Tc-ECD brain SPECT, CT and/or MRI within one week interval. The incidence of abnormal findings in the 13 patients was 96.4% (30/31) on {sup 99m}Tc-ECD brain SPECT, 17.6% (3/17) on CT and 63.6% (14/22) on MRI. The positive detection rate of {sup 99m}Tc-ECD brain SPECT was statistically (P<0.01 by a {chi}{sup 2} and/or Fisher's exact probability test) higher than those of CT and MRI. And the changes in rCBF were demonstrated. {sup 99m}Tc-ECD brain SPECT is a useful examination for the diagnosis and follow up management in patients with the acute onset type of pediatric CNS diseases. (author)

  1. Evaluation of the effects of rehabilitation exercise on cerebral infarction with 99Tcm-ECD SPECT brain imaging

    Objective: To investigate the therapeutic effects of motor therapy on hemiplegia with SPECT brain perfusion imaging. Methods: The study population consisted of 59 patients with cerebral infarction, and all patients were treated with motor therapy. Among them, 30 cases were assigned to undertake single bridging exercise and 29 cases passive exercise. SPECT brain perfusion imaging was performed before and after motor therapy under the same condition, and the regional cerebral blood flow (rCBF) changes were compared and analysed with visual and semi-quantitative methods; in addition, the relationship between rCBF changes and scores of Fugl-Meyer or Barthel index were also analysed. Results: After motor therapy, various degrees of radioactivity increase were compared with the pretreatment radioactivity hypoperfusion in patients with cerebral infarction, and showed that motor therapy could evidently improve rCBF of regional hypoperfusion. The posttreatment rCBF was higher than the pretreatment level (P<0.01), and the rCBF of group of single bridging was higher than that of passive exercise group. And the changes of rCBF were all significant after motor therapy. In addition, the variation of the rCBF after motor therapy was positively correlated with the variation of Fugl-Meyer and Barthel score. Conclusions: SPECT brain perfusion imaging can serve as a useful method for evaluating the effectiveness of motor therapy in cerebral infarction rehabilitation. The single bridging exercise and the passive exercise are both beneficial to brain rehabilitation, but the former improves the rCBF in lesions better than the later does

  2. Brain SPECT in the pre-surgical evaluation of epileptic patients

    Fifteen adult epileptic patients were studied pre-operatively using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99 m Tc-HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hypoperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: in 4, SPECT findings correlated well with the anatomical findings; in 5 instances, SPECT was able to disclose additional functional deficits; in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n=10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and heterogeneity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic who are candidates for epilepsy surgery. (author)

  3. N-isopropyl I-123 p-iodoamphetamine (IMP) brain SPECT in dementia

    Six patients of Alzheimer's disease (AD), two patients of Pick disease (PD) and two patients of Creutzfeldt-Jakob disease (CJD) were studied with N-Isopropyl I-123 p-Iodoamphetamine (IMP) with SPECT. The pattern of IMP uptake in these demented groups were compared with that in five agematched normal controls and correlated with MRI and XCT. In all AD cases, SPECT revealed focal reduction of IMP uptake in frontal (6/6), parietal (6/6) and temporal (6/6) cortex, although MRI and XCT were normal. In both PD case, SPECT showed focal reduction of IMP uptake in frontal (1/2) and temporal (2/2) cortex with moderate labor atrophy on MRI and XCT. In both CJD case, SPECT showed diffuse reduction of IMP uptake in cerebral cortex in spite of no abnormality on MRI and XCT. These findings suggest that SPECT can detect earlier diseased process of AD and CJD than MRI or XCT and that SPECT may be helpful for the differential diagnosis of non-vascular dementia. (author)

  4. Study on brain dopamine D2R 131I-epidepride SPECT imaging in patients with early stage Parkinson's disease

    Objective: To evaluate the clinical application of dopamine D2 receptor (D2R) 131I-epidepride SPECT imaging in early stage Parkinson' disease (PD). Methods: Ten healthy controls and forty-six untreated patients with early stage PD [Hoehn and Yahr (H-Y) stage I 22 cases, H-Y stage II 24 cases] were observed with dopamine D2R 131I-epidepride SPECT imaging. Striatal specific uptake of 131I-epidepride was calculated with region of interest analysis according to the ratios of striatum to occipital cortex [(ST-OC)/OC] and of striatum to frontal cortex [(ST-FC)/FC]. Results: No obvious side-to-side differences were observed in controls. (ST-OC)/OC and (ST-FC)/FC in the striatum contralateral to the clinical symptom were significantly upgraded compared to ipsilateral side in PD of H-Y stage I and H-Y stage II. (ST-OC)/OC and (ST-FC)/FC in the striatum significantly rose as the severity increasing and all the increments were significantly higher compared with that in the controls. Conclusion: Dopamine D2R 131I-epidepride SPECT imaging in human brain will conduce to the diagnosing of early stage PD

  5. CT-based attenuation and scatter correction compared with uniform attenuation correction in brain perfusion SPECT imaging for dementia

    Gillen, Rebecca; Firbank, Michael J.; Lloyd, Jim; O'Brien, John T.

    2015-09-01

    This study investigated if the appearance and diagnostic accuracy of HMPAO brain perfusion SPECT images could be improved by using CT-based attenuation and scatter correction compared with the uniform attenuation correction method. A cohort of subjects who were clinically categorized as Alzheimer’s Disease (n=38 ), Dementia with Lewy Bodies (n=29 ) or healthy normal controls (n=30 ), underwent SPECT imaging with Tc-99m HMPAO and a separate CT scan. The SPECT images were processed using: (a) correction map derived from the subject’s CT scan or (b) the Chang uniform approximation for correction or (c) no attenuation correction. Images were visually inspected. The ratios between key regions of interest known to be affected or spared in each condition were calculated for each correction method, and the differences between these ratios were evaluated. The images produced using the different corrections were noted to be visually different. However, ROI analysis found similar statistically significant differences between control and dementia groups and between AD and DLB groups regardless of the correction map used. We did not identify an improvement in diagnostic accuracy in images which were corrected using CT-based attenuation and scatter correction, compared with those corrected using a uniform correction map.

  6. Practical aspects of data-driven motion correction approach for brain SPECT

    Full text: Patient motion can cause image artifacts in SPECT despite restraining measures. Data-driven detection and correction of motion can be achieved by comparison of acquired data with the forward-projections. By optimising the orientation of a partial reconstruction, parameters can be obtained for each misaligned projection and applied to update this volume using a 3D reconstruction algorithm. Phantom validation was performed to explore practical aspects of this approach. Noisy projection datasets simulating a patient undergoing at least one fully 3D movement during acquisition were compiled from various projections of the digital Hoffman brain phantom. Motion correction was then applied to the reconstructed studies. Correction success was assessed visually and quantitatively. Resilience with respect to subset order and missing data in the reconstruction and updating stages, detector geometry considerations, and the need for implementing an iterated correction were assessed in the process. Effective correction of the corrupted studies was achieved. Visually, artifactual regions in the reconstructed slices were suppressed and/or removed. Typically the ratio of mean square difference between the corrected and reference studies compared to that between the corrupted and reference studies was > 2. Although components of the motions are missed using a single-head implementation, improvement was still evident in the correction. The need for multiple iterations in the approach was small due to the bulk of misalignment errors being corrected in the first pass. Dispersion of subsets for reconstructing and updating the partial reconstruction appears to give optimal correction. Further validation is underway using triple-head physical phantom data. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  7. Quantification of GABAA receptors in the rat brain with [123I]Iomazenil SPECT from factor analysis-denoised images

    Purpose: In vivo imaging of GABAA receptors is essential for the comprehension of psychiatric disorders in which the GABAergic system is implicated. Small animal SPECT provides a modality for in vivo imaging of the GABAergic system in rodents using [123I]Iomazenil, an antagonist of the GABAA receptor. The goal of this work is to describe and evaluate different quantitative reference tissue methods that enable reliable binding potential (BP) estimations in the rat brain to be obtained. Methods: Five male Sprague–Dawley rats were used for [123I]Iomazenil brain SPECT scans. Binding parameters were obtained with a one-tissue compartment model (1TC), a constrained two-tissue compartment model (2TCc), the two-step Simplified Reference Tissue Model (SRTM2), Logan graphical analysis and analysis of delayed-activity images. In addition, we employed factor analysis (FA) to deal with noise in data. Results: BPND obtained with SRTM2, Logan graphical analysis and delayed-activity analysis was highly correlated with BPF values obtained with 2TCc (r = 0.954 and 0.945 respectively, p c and SRTM2 in raw and FA-denoised images (r = 0.961 and 0.909 respectively, p ND values from raw images while scans of only 70 min are sufficient from FA-denoised images. These images are also associated with significantly lower standard errors of 2TCc and SRTM2 BP values. Conclusion: Reference tissue methods such as SRTM2 and Logan graphical analysis can provide equally reliable BPND values from rat brain [123I]Iomazenil SPECT. Acquisitions, however, can be much less time-consuming either with analysis of delayed activity obtained from a 20-minute scan 50 min after tracer injection or with FA-denoising of images

  8. Brain SPECT imaging and whole-body biodistribution with [{sup 123}I]ADAM - a serotonin transporter radiotracer in healthy human subjects

    Lin, K.-J. [Graduate Institute of Clinical Medical Sciences, Chang-Gung University, Tao-Yuan 333, Taiwan (China); Molecular Imaging Center, Chang-Gung Memorial Hospital, Tao-Yuan 333, Taiwan (China); Department of Nuclear Medicine, Chang-Gung Memorial Hospital, Tao-Yuan 333, Taiwan (China); Liu, C.-Y. [Neuroscience Research Center, Chang-Gung Memorial Hospital, Tao-Yuan 333, Taiwan (China); Department of Psychiatry, Chang-Gung Memorial Hospital, Tao-Yuan 333, Taiwan (China); Wey, S.-P. [Molecular Imaging Center, Chang-Gung Memorial Hospital, Tao-Yuan 333, Taiwan (China); Department of Medical Imaging and Radiological Sciences, Chang-Gung University, Tao-Yuan 333, Taiwan (China); Hsiao, I.-T. [Molecular Imaging Center, Chang-Gung Memorial Hospital, Tao-Yuan 333, Taiwan (China); Department of Medical Imaging and Radiological Sciences, Chang-Gung University, Tao-Yuan 333, Taiwan (China); Wu, Jay [Health Physics Divisions, Atomic Energy Council, Institute of Nuclear Energy Research, Tao-Yuan 325, Taiwan (China); Fu, Y.-K. [Atomic Energy Council, Institute of Nuclear Energy Research, Tao-Yuan 325, Taiwan (China); Yen, T.-C. [Molecular Imaging Center, Chang-Gung Memorial Hospital, Tao-Yuan 333, Taiwan (China) and Department of Nuclear Medicine, Chang-Gung Memorial Hospital, Tao-Yuan 333, Taiwan (China)]. E-mail: yen1110@adm.cgmh.org.tw

    2006-02-15

    Introduction: [{sup 123}I]-2-((2-((dimethylamino)methyl)phenyl)thio)-5-iodophenylamine ([{sup 123}I]ADAM), a novel radiotracer, has promising application in the imaging of the serotonin transporter (SERT) in the human brain. In this study, the optimal scanning time for acquiring brain single photon emission computed tomography (SPECT) images was determined by performing dynamic SPECT studies at intervals from 0 to 6 h postinjection of [{sup 123}I]ADAM. Additionally, radiation-absorbed doses were determined for three healthy human subjects using attenuation-corrected images. Methods: Twelve subjects were randomized into one of three study groups as follows: whole-body distribution imaging (n=3), dynamic SPECT imaging (n=3) and brain SPECT imaging (n=6). The radiation-absorbed dose was calculated using MIRDOSE 3.0 software with attenuation-corrected data. The specific binding (SB) ratio of the brain stem was measured from dynamic SPECT images to determine the optimal scanning time. Results: Dynamic SPECT images showed that the SB of the brain stem gradually increased to a maximum 4 h postinjection. Single photon emission computed tomography images at 4 h postinjection showed a high uptake of the radiotracer (SB) in the hypothalamus (1.40{+-}0.12), brain stem (1.44{+-}0.16), pons (1.13{+-}0.14) and medial temporal lobe (0.59{+-}0.10). The mean adult male value of effective dose was 3.37x10{sup -2} mSv/MBq with a 4.8-h urine-voiding interval. Initial high uptake in SERT-rich sites was demonstrated in the lung and brain. A prominent washout of the radiotracer from the lung further increased brain radioactivity that reached a peak value of 5.03% of injected dose 40 min postinjection. Conclusions: [{sup 123}I]ADAM is a promising radiotracer for SPECT imaging of SERT in humans with acceptable dosimetry and high uptake in SERT-rich regions. Brain SPECT images taken within 4 h following injection show optimal levels of radiotracer uptake in known SERT sites. However, dynamic

  9. Brain SPECT imaging and whole-body biodistribution with [123I]ADAM - a serotonin transporter radiotracer in healthy human subjects

    Introduction: [123I]-2-((2-((dimethylamino)methyl)phenyl)thio)-5-iodophenylamine ([123I]ADAM), a novel radiotracer, has promising application in the imaging of the serotonin transporter (SERT) in the human brain. In this study, the optimal scanning time for acquiring brain single photon emission computed tomography (SPECT) images was determined by performing dynamic SPECT studies at intervals from 0 to 6 h postinjection of [123I]ADAM. Additionally, radiation-absorbed doses were determined for three healthy human subjects using attenuation-corrected images. Methods: Twelve subjects were randomized into one of three study groups as follows: whole-body distribution imaging (n=3), dynamic SPECT imaging (n=3) and brain SPECT imaging (n=6). The radiation-absorbed dose was calculated using MIRDOSE 3.0 software with attenuation-corrected data. The specific binding (SB) ratio of the brain stem was measured from dynamic SPECT images to determine the optimal scanning time. Results: Dynamic SPECT images showed that the SB of the brain stem gradually increased to a maximum 4 h postinjection. Single photon emission computed tomography images at 4 h postinjection showed a high uptake of the radiotracer (SB) in the hypothalamus (1.40±0.12), brain stem (1.44±0.16), pons (1.13±0.14) and medial temporal lobe (0.59±0.10). The mean adult male value of effective dose was 3.37x10-2 mSv/MBq with a 4.8-h urine-voiding interval. Initial high uptake in SERT-rich sites was demonstrated in the lung and brain. A prominent washout of the radiotracer from the lung further increased brain radioactivity that reached a peak value of 5.03% of injected dose 40 min postinjection. Conclusions: [123I]ADAM is a promising radiotracer for SPECT imaging of SERT in humans with acceptable dosimetry and high uptake in SERT-rich regions. Brain SPECT images taken within 4 h following injection show optimal levels of radiotracer uptake in known SERT sites. However, dynamic changes in lung SERT distribution

  10. SPECT imaging of dopamine receptors with [123I]epidepride: characterization of uptake in the human brain

    Summary. [123I]Epidepride is a new ligand for single photon emission computerized tomography (SPECT) that specifically labels D2-like dopamine receptors with very high affinity. Here, we report on the regional kinetic uptake of [123I]epidepride in the brain of 4 normal volunteers and 3 patients with choreatic movement disorders. In healthy subjects striatal activity peaked at 2.5 hours after injection of the tracer and decreased slowly thereafter. There were no significant differences between left and right brain hemispheres. Activity above background was also measurable in areas corresponding to the thalamus, temporal cortex and frontal cortex. The striatal to cerebellar ratio was about 14 after 2.5 hours and this ratio steadily increased with time. The striatal to cerebellar ratio was clearly reduced in all 3 patients with choreatic movement disorders (from about 14 in control subjects after 2.5 hours to about 7 in choreatic patients). [123I]Epidepride may be a useful SPECT ligand for studying D2 receptors in the living human brain because of its high target to background ratio, its high affinity and the possibility to investigate extrastriatal D2 receptors. (author)

  11. Parieto-occipital hypoaccumulation of 123I-IMP in the brain SPECT associated with maternal inheritance of diabetes mellitus

    To determine the latent effect of diabetes inheritance on central nervous system, thirty diabetic patients were examined (14 male, 16 female). Seventeen patients had a mother with diabetes, and the other thirteen had non-diabetic mothers. They were previously determined to not have the 3243 mitochondrial tRNA mutation in peripheral leukocytes. Patients were tested for parieto-occipital hypoaccumulation of 123I-IMP of brain SPECT, a characteristic neurofinding of mitochondrial diabetes mellitus due to the 3243 tRNA mutation. Seven (41.2%) out of 17 subjects with material inheritance had the parieto-occipital abnormality, whereas one (7.7%) out of 13 subjects with non-maternal inheritance had the abnormality. Seventeen (94.4%) out of 18 patients diabetes due to mitochondrial tRNA mutation at position 3243 showed the abnormality. Our results suggest that the material inheritance of diabetes is associated with the hypoaccumulation of 123I-IMP of brain SPECT. We speculate that, because the patients with maternal inheritance might have subclinical mitochondrial dysfunction due to unknown mitochondrial DNA abnormalities, the mitochondrial DNA abnormality might cause their subclinical brain damage in the parieto-occipital area. (author)

  12. Correlation with neuropsychological assessment and SPM analysis of brain perfusion SPECT in patients with progressive supranuclear palsy

    Progressive supranuclear palsy (PSP) is a degenerative condition of unknown aetiology that produces an akinetic-rigid form of parkinsonism characterised by early falls, dementia and abnormalities of extraocular movements. The patterns of decreased regional cerebral blood flow and cognitive impairment in PSP compared with normal control have been insufficiently investigated and a limited number of studies have been performed. We evaluated clinical symptoms, functional neuroimaging study using Tc-99m HMPAO SPECT and neuropsychological profiles in patients with PSP. Eleven patients with PSP diagnosed by the clinical criteria of National Institute of Neurological Disorders and Stroke and the Society for PSP (NINDS-SPSP) (mean age: 70.5±5.6 years, educational period: 4.5±4.7 years) and age-matched 10 healthy control subjects (mean age: 68.1±4.5 years, educational period: 6.5±4.1 years) participated in this study were participated. All patients were given a neurologic examination, brain MRI and cerebral perfusion SPECT using Tc-99m HMPAO. We concomittently evaluated several cognitive profiles using the Seoul Neuropsychological Screening Battery. SPM analysis of the SPECT image showed significant perfusion deficits in the left inferior frontal gyrus, left caudate nucleus, left middle frontal gyrus and cingulate gyrus in the patients with PSP compared with age-matched healthy control (uncorrected p<0.01). On neuropsychological assessment, cognitive deficits on verbal and visual memory, word fluency and frontal executive functions were prominent in most patients with PSP compared with healthy control subjects. Our findings suggest that measurement of regional cerebral blood flow by perfusion SPECT and voxel-based SPM analysis with neuropsychological assessment are useful to understanding the correlation between perfusion deficits and abnormal cognitive profiles in patients with PSP

  13. Correlation with neuropsychological assessment and SPM analysis of brain perfusion SPECT in patients with progressive supranuclear palsy

    Jeong, Young Jin; Kang, Do Young; Park, Kyung Won; Kim, Jae Woo [School of Medicine, Dong-A University, Busan (Korea, Republic of)

    2004-07-01

    Progressive supranuclear palsy (PSP) is a degenerative condition of unknown aetiology that produces an akinetic-rigid form of parkinsonism characterised by early falls, dementia and abnormalities of extraocular movements. The patterns of decreased regional cerebral blood flow and cognitive impairment in PSP compared with normal control have been insufficiently investigated and a limited number of studies have been performed. We evaluated clinical symptoms, functional neuroimaging study using Tc-99m HMPAO SPECT and neuropsychological profiles in patients with PSP. Eleven patients with PSP diagnosed by the clinical criteria of National Institute of Neurological Disorders and Stroke and the Society for PSP (NINDS-SPSP) (mean age: 70.5{+-}5.6 years, educational period: 4.5{+-}4.7 years) and age-matched 10 healthy control subjects (mean age: 68.1{+-}4.5 years, educational period: 6.5{+-}4.1 years) participated in this study were participated. All patients were given a neurologic examination, brain MRI and cerebral perfusion SPECT using Tc-99m HMPAO. We concomittently evaluated several cognitive profiles using the Seoul Neuropsychological Screening Battery. SPM analysis of the SPECT image showed significant perfusion deficits in the left inferior frontal gyrus, left caudate nucleus, left middle frontal gyrus and cingulate gyrus in the patients with PSP compared with age-matched healthy control (uncorrected p<0.01). On neuropsychological assessment, cognitive deficits on verbal and visual memory, word fluency and frontal executive functions were prominent in most patients with PSP compared with healthy control subjects. Our findings suggest that measurement of regional cerebral blood flow by perfusion SPECT and voxel-based SPM analysis with neuropsychological assessment are useful to understanding the correlation between perfusion deficits and abnormal cognitive profiles in patients with PSP.

  14. The early diagnostic value of oral acetazolamide load combined with SPECT rCBF imaging in patients with transient ischemia attack in brain

    Objective: In order to assess the diagnostic value of acetazolamide (ACZ) combined with rCBF-SPECT imaging in patients with transient ischemia attack (TIA). Methods: SPECT imaging was performed before and after oral ACZ with visual and semiquantitative analysis of the images. Blood gas analysis was done before and after ACZ administration either. Results: After ACZ loading, in normal group, 99Tcm-ECD was distributed symmetrically on correspondent parts of the brain and rCBF was generally increased. The blood pH was decreased and blood PCO2 was increased, respectively in TIA group, the positive rate of hypoperfusion foci on SPECT images were increased from 5/6 to 6/6 in symptomatic patients and from 60% to 92% in asymptomatic patients. The total positive rate was 93%. Conclusion: Oral ACZ before SPECT imaging is a simple, reliable way for early diagnosis in patients with TIA

  15. Brain spect in the pre-surgical evaluation of epileptic patients preliminary results

    Carlos A. Buchpiguel

    1992-03-01

    Full Text Available Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG monitoring and anatomical studies (CT and MRI. Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc_HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas. In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions. Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a in 4, SPECT findings correlated well with the anatomical findings; (b in 5 instances, SPECT was able to disclose additional functional deficits; (c in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n=10 SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and hete-rogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.

  16. SPM analysis of brain perfusion SPECT and F-18 FDG PET in the Korean autosomal dominant nocturnal frontal lobe epilepsy family

    This study attempted to investigate the specific pattern of brain perfusion and glucose metabolism in the Korean autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) family. Using Tc-99m ECD brain perfusion SPECT. we assessed brain perfusion in 6 patients at interictal period and 5 patients at ictal period. Interictal F-18 FDG PET was performed on 6 affected family members. The scans were statistically analyzed by using statistical parametric mapping (SPM99). The data of the affected family members were compared to those of the control subjects. Interictal F-18 FDG PET SPM group analysis showed decreased glucose metabolism over the left middle and superior frontal gyri and the left central regions including the anterior parietal lobe. There was a less pronounced decrease in glucose uptake in the right anterior superior frontal gyrus. Interictal brain perfusion SPECT SPM group analysis showed similar pattern of decreased perfusion compared to those of interictal F-18 FDG PET. Ictal brain perfusion SPECT SPM group analysis revealed increased perfusion over the left pre-and postcentral gyri and less pronounced increased perfusion in the right postcentral gyrus. lnterictal F -18 PET and brain perfusion SPECT SPM group analysis suggest that major abnormalities of ADNFLE family are in the left frontal lobe. These findings may be helpful to elucidate the pathophysiological mechanism of this rare disease entity

  17. Influence of attenuation correction and reconstruction techniques on the detection of hypoperfused lesions in brain SPECT studies

    Full text: Aim: To study the influence of attenuation correction and the reconstruction technique on the detection of hypoperfused lesions in brain SPECT imaging, Material and Methods: A simulation experiment was used in which the effects of attenuation and reconstruction were decoupled, A high resolution SPECT phantom was constructed using the BrainWeb database, In this phantom, activity values were assigned to grey and white matter (ratio 4:1) and scaled to obtain counts of the same magnitude as in clinical practice, The true attenuation map was generated by assigning attenuation coefficients to each tissue class (grey and white matter, cerebral spinal fluid, skull, soft and fatty tissue and air) to create a non-uniform attenuation map, The uniform attenuation map was calculated using an attenuation coefficient of 0.15 cm-1, Hypoperfused lesions of varying intensities and sizes were added. The phantom was then projected as typical SPECT projection data, taking into account attenuation and collimator blurring with the addition of Poisson noise, The projection data was reconstructed using four different methods of reconstruction: (1) filtered backprojection (FBP) with the uniform attenuation map; (2) FBP using the true attenuation map; (3) ordered subset expectation maximization (OSEM) (equivalent to 423 iterations) with a uniform attenuation map; and (4) OSEM with a true attenuation map. Different Gaussian postsmooth kernels were applied to the reconstructed images. Results: The analysis of the reconstructed data was performed using figures of merit such as signal to noise ratio (SNR), bias and variance. The results illustrated that uniform attenuation correction offered slight deterioration (less than 2%) with regard to SNR when compared to the ideal attenuation map. which in reality is not known. The iterative techniques produced superior signal to noise ratios (increase of 5 - 20 % depending on the lesion and the postsmooth) in comparison to the FBP methods

  18. SPECT in psychiatry. SPECT in der Psychiatrie

    Barocka, A. (Psychiatrische Klinik und Poliklinik, Erlangen (Germany)); Feistel, H. (Nuklearmedizinische Klinik, Erlangen (Germany)); Ebert, D. (Psychiatrische Klinik und Poliklinik, Erlangen (Germany)); Lungershausen, E. (Psychiatrische Klinik und Poliklinik, Erlangen (Germany))

    1993-08-13

    This review presents Single Photon Emission Computed Tomography (SPECT) as a powerful tool for clinical use and research in psychiatry. Its focus is on regional cerebral blood flow, measured with technetium labelled HMPAO. In addition, first results with brain receptor imaging, concerning dopamin-D[sub 2] and benzodiazepine receptors, are covered. Due to major improvements in image quality, and impressive number of results has been accumulated in the past three years. The authors caution against using SPECT results as markers for disease entities. A finding like 'hypofrontality' is considered typical of a variety of mental disorders. Clearly both, more experience with SPECT and contributions from psychopathology, are needed. (orig.)

  19. Follow-up of pain processing recovery after ketamine in hyperalgesic fibromyalgia patients using brain perfusion ECD-SPECT

    The aim of this study was to determine whether the follow-up of pain processing recovery in hyperalgesic fibromyalgia (FM) could be objectively evaluated with brain perfusion ethyl cysteinate dimer single photon computerized tomography (ECD-SPECT) after administration of ketamine. We enrolled 17 hyperalgesic FM women patients (48.5 ± 11 years, range 25-63). After treatment with subcutaneous ketamine, 11 patients were considered as ''good responders'', with a decrease in pain intensity, evaluated by visual analog scale (VAS), greater than 50%. On the other hand, six patients were considered as ''poor responders''. A voxel-based analysis of regional cerebral blood flow (rCBF) was conducted (pvoxel cluster = 0.016c). In agreement with the clinical response, the change in midbrain rCBF after ketamine was highly correlated with the reduction of VAS pain score (r = 0.7182; p = 0.0041). This prospective study suggests that blockade of facilitatory descending modulation of pain with ketamine can be evaluated in the periaqueductal grey with brain perfusion SPECT. (orig.)

  20. Relationship between brain perfusion SPECT and MMSE score in dementia of Alzheimer's type: a statistical parametric mapping analysis

    The aim of this study was to identify the brain areas in which reductions of regional cerebral blood flow (rCBF) were correlated with decline of general mental function, measured by Mini-Mental State Examination (MMSE). Tc-99m HMPAO brain SPECT was performed in 9 probable AD patients at the initial and follow-up periods of 1.8 years (average) after the first study. MMSE scores were also measured in both occasions. The mean MMSE score of the initial study 16.4 (range: 5-24) and the mean MMSE score of the follow-up was 8.1 (range: 0-17). Each SPECT image was normalized to the cerebellar activity and a correlation analysis was performed between the level of rCBF in AD patients and the MMSE scores by voxel-based analysis using SPM99 software. Significant correlation was found between the blood-flow decrease in left inferior prefrontal region(BA 47) and left middle temporal region (BA 21) and the MMSE score changes. Additional areas such as anterior and posterior cingulate cortices, precuneus, and bilateral superior and middle prefrontal regions showed and similar trends. A relationship was found between reduction of regional cerebral blood flow in left prefrontal and temporal areas and decline of cognitive function in Alzheimer's diseases (AD) patients. This voxel-based analysis is useful in evaluating the progress of cognitive function in Alzheimer's disease

  1. The study on regional brain blood flow in the patients with Parkinson's disease using 99Tcm-ECD SPECT

    Purpose The aim of this study is to evaluate the changes of brain blood floe in patients with Parkinson's disease (PD) and to investigate the clinical characteristics of the patients with PD correlate with rCBF. Methods: Regional cerebral perfusion was investigated using SPECT in 34 patients with PD . The mean ages of the patients were 56.61±11.04 Years old. The course of disease in most patients was from 1 to over 20 years. Results: 94.1 per cent of patients (32/3) had a significant decrease of rCBF in the basal ganglia, frontal lobes, temporal lobes and thalamus. Parietal and occipital cortex were involved in some patients. The decrease of rCBF in the basal ganglia is unilateral in most patients with PD. There were over 3 brain regions that Conclusion: According to our results, patients with PD had decreased rCBF in the basal ganglia, frontal and temporal cortices. These may reflect a fundamental feature of clinical neuropathophysiology in PD. 99Tcm-ECD SPECT imaging is helpful to the diagnosis of PD and may help investigate the potential pathophysiology of PD. (authors)

  2. SPECT imaging of dopamine and serotonin transporters with [123I]β-CIT. Binding kinetics in the human brain

    Single photon emission computerized tomography (SPECT) studies in non-human primates have previously shown that the cocaine derivative [123I]-2-β-carbomethoxy-3-β-(4-iodophenyl)-tropane ([123I]β-CIT) labels dopamine transporters in the striatum and serotonin transporters in the hypothalamus-midbrain area. Here, we report on the regional kinetic uptake of [123I]β-CIT in the brain of 4 normal volunteers and 2 patients with Parkinson's disease. In healthy subjects striatal activity increased slowly to reach peak values at about 20 hours post injection. In the hypothalamus-midbrain area peak activities were observed at about 4 hours with a slow decrease thereafter. Low activity was observed in cortical and cerebellar areas. The striatal to cerebellar ratio was about 4 after 5 hours and 9 after 20 hours. In 2 patients with idiopathic Parkinson's disease striatal activity was markedly decreased while the activity in hypothalamus-midbrain areas was only diminished. Uptake into cortical and cerebellar areas appeared to be unchanged in Parkinson's disease. Consequently, in Parkinson's disease the striatal to cerebellar ratio was decreased to values around 2.5 after 20 hours. These preliminary methodological studies suggest that [123I]β-CIT is a useful SPECT ligand for studying dopamine and possibly also serotonin transporters in the living human brain

  3. A Silicon SPECT System for Molecular Imaging of the Mouse Brain

    Shokouhi, Sepideh; Fritz, Mark A; McDonald, Benjamin S.; Durko, Heather L.; Furenlid, Lars R.; Wilson, Donald W.; Peterson, Todd E

    2007-01-01

    We previously demonstrated the feasibility of using silicon double-sided strip detectors (DSSDs) for SPECT imaging of the activity distribution of iodine-125 using a 300-micrometer thick detector. Based on this experience, we now have developed fully customized silicon DSSDs and associated readout electronics with the intent of developing a multi-pinhole SPECT system. Each DSSD has a 60.4 mm × 60.4 mm active area and is 1 mm thick. The strip pitch is 59 micrometers, and the readout of the 102...

  4. Advanced brain dopamine transporter imaging in mice using small-animal SPECT/CT

    Pitkonen, Miia; Hippeläinen, Eero; Raki, Mari; Andressoo, Jaan-Olle; Urtti, Arto; Männistö, Pekka T.; Savolainen, Sauli; Saarma, Mart; Bergström, Kim

    2012-01-01

    Background Iodine-123-β-CIT, a single-photon emission computed tomography (SPECT) ligand for dopamine transporters (DATs), has been used for in vivo studies in humans, monkeys, and rats but has not yet been used extensively in mice. To validate the imaging and analysis methods for preclinical DAT imaging, wild-type healthy mice were scanned using 123I-β-CIT. Methods The pharmacokinetics and reliability of 123I-β-CIT in mice (n = 8) were studied with a multipinhole SPECT/CT camera after intrav...

  5. Tc-99m ECD brain SPECT in patients with traumatic brain injury: evaluating distribution of hypoperfusion and assessment of cognitive and behavioral impairment in relation to thalamic hypoperfusion

    We evaluated the distribution of hypoperfusion in patients with traumatic brain injury (TBI) and the relationship of thalamic hypoperfusion to severity of cognitive and behavioral sequelae. Tc-99m ECD SPECT and MRI were performed in 103 patients (M/F=81/22, mean age 34.7± 15.4 yrs) from 0.5 to 55 months (mean 10.3 months) after TBI. The patients were divided into three groups showing no abnormalities (G1), focal (G2) and diffuse injury (G3) on MRI. Psychometric tests assessed 11 cognitive or behavioral items. In all patients, we evaluated the distribution of hypoperfused areas in SPECT, and in 57/103 patients, neuropsychological (NP) abnormalities in patients with thalamic hypoperfusion were compared with those of patients without thalamic hypoperfusion. The perfusion dificits were most frequently located in the frontal lobe (G1, 42.3%: G2 34.5%: G3 33.3%), temporal lobe (24∼26%) thalami (21∼22.4%), parietal and occipital lobe (≤10%). Numbers of NP abnormalities in the cases of cortical hypoperfusion with or without concomitant thalamic hypoperfusion were following: the former 4.7±1.5 and the latter 3.2±1.4 in G1, 5.0±1.1 and 4.8±1.2 in G2, 6.8±1.8 and 6.3±1.1 in G3, respectively. This difference according to thalamic hypoperfusion was significant in G1 (p=0.002), but was not significant in G2 or G3. SPECT in patients with TBI had demonstrated hypoperfusion mostly involving the frontal, temporal and thalami. In normal group on MRI, frontal hypoperfusion was more prominent than that of any other group, Furthermore in this group, SPECT could predict severity of NP outcome by concomitant thalamic hypoperfusion with cerebral cortical abnormalities

  6. Does supplementation of contrast MR imaging with thallium-201 brain SPECT improve differentiation between benign and malignant ring-like contrast-enhanced cerebral lesions?

    The objective of this study was to determine whether thallium-201 (201Tl) brain single photon emission computed tomography (SPECT) could supplement magnetic resonance (MR) imaging diagnostic information by visual comparison of two separate data sets from patients with ring-like contrast-enhanced cerebral lesions. A combination of MR imaging and 201Tl brain SPECT sets obtained from 13 patients (10 men, 3 women) ranging in age from 26 years to 86 years (mean 61.0 years) were retrospectively reviewed. A total of 12 patients had a solitary lesion, and the others had multiple lesions. All but two intracranial foci were pathologically confirmed. The final diagnoses were six glioblastomas, two cerebral metastases from lung cancer, and one each of abscess, resolving hematoma, primary central nervous system lymphoma, toxoplasmosis, and radiation necrosis. The two separate image formats (MR images and SPECT) were shown to ten readers with practical experience. All of the MR images for each patient were shown to each reader first. After interpreting them, the readers were shown the SPECT images. Images were scored in terms of how benign or malignant the foci were on a 5-point scale from ''definitely benign'' to ''definitely malignant.'' The improvement in the performance of all ten readers was from 67.7% to 93.8% in mean accuracy (P=0.0028) and from 0.730 to 0.971 in mean Az value (P=0.0069) after they were shown the 201Tl brain SPECT images. 201Tl brain SPECT should substantially increase confidence in the diagnosis of intracranial lesions with ring-like contrast enhancement when MR imaging does not permit differentiation between benign and malignant disease. (author)

  7. Optimal number of pinholes in multi-pinhole SPECT for mouse brain imaging-a simulation study

    This study simulates a multi-pinhole single-photon emission computed tomography (SPECT) system using the Monte Carlo method, and investigates different multi-pinhole designs for quantitative mouse brain imaging. Prior approaches investigating multi-pinhole SPECT were not often optimal, as the number and geometrical arrangement of pinholes were usually chosen empirically. The present study seeks to optimize the number of pinholes for a given pinhole arrangement, and also for the specific application of quantitative neuroreceptor binding in the mouse brain. An analytical Monte Carlo simulation based method was used to generate the projection data for various count levels. A three-dimensional ordered-subsets expectation-maximization algorithm was developed and used to reconstruct the images, incorporating a realistic pinhole model for resolution recovery and noise reduction. Although artefacts arising from overlapping projections could be a major problem in multi-pinhole reconstruction, the cold-rod phantom study showed minimal loss of spatial resolution in multi-pinhole systems, compared to a single-pinhole system with the same pinhole diameter. A quantitative study of neuroreceptor binding sites using a mouse brain phantom and low activity (37 MBq) showed that the multi-pinhole system outperformed the single-pinhole system by maintaining the mean and lowering the variance in the measured uptake ratio. Multi-pinhole collimation can be used to reduce the injected dose and thereby reduce the radiation exposure to the animal. Results also suggest that the nine-pinhole configuration shown in this paper is a good choice for mouse brain imaging

  8. Comparative value of brain perfusion SPECT and [123I]MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and Alzheimer's disease

    Both decreased occipital perfusion on brain single-photon emission computed tomography (SPECT) and reduction in cardiac 123I-metaiodobenzylguanidine (MIBG) uptake are characteristic features of dementia with Lewy bodies (DLB), and potentially support the clinical diagnosis of DLB. The aim of this study was to compare the diagnostic value of these two methods for differentiation of DLB from Alzheimer's disease (AD). The study population comprised 19 patients with probable DLB and 39 patients with probable AD who underwent both SPECT with N-isopropyl-p-[123I]iodoamphetamine and MIBG myocardial scintigraphy. Objective and quantitative measurement of perfusion in the medial occipital lobe, including the cuneus and lingual gyrus, was performed by the use of three-dimensional stereotactic surface projections. Medial occipital perfusion was significantly decreased in the DLB group compared with the AD group. The mean heart/mediastinum ratios of MIBG uptake were significantly lower in the DLB group than in the AD group. Although SPECT failed to demonstrate significant hypoperfusion in the medial occipital lobe in five patients with DLB, marked reduction of MIBG uptake was found in all patients with DLB. Receiver operating characteristic analysis revealed that MIBG myocardial scintigraphy enabled more accurate discrimination between DLB and AD than was possible with perfusion SPECT. MIBG myocardial scintigraphy may improve the sensitivity in the detection of DLB. In particular, this method may provide a powerful differential diagnostic tool when it is difficult to distinguish cases of DLB from AD using brain perfusion SPECT. (orig.)

  9. Increased thalamic perfusion as a characteristic finding with brain SPECT in patients with obsessive-compulsive disorder

    Aim: Obsessive-compulsive disorder (OCD) is a relatively frequent psychiatric condition affecting most commonly young patients. Correct diagnosis and follow-up is essential in order to apply effective therapy. However, some common characteristics have been reported with brain SPECT for OCD and depression, with several brain structures belonging to the limbic system involved in both conditions: frontal cortex, cingulate gyrus, caudate nucleus, thalamus and hippocampus, among others. The aim of this study was to investigate quantitative findings of brain SPECT in OCD compared to other psychiatric conditions such as depression and dementia. Material and Methods: We studied 33 patients, 22 women, ages 39.3±10.9 years. Fifteen patients had clinical diagnosis of OCD (8 women, 21∫8 ys.), 13 of bipolar or unipolar depression (11 women, 28±15 ys.) and 5 of senile dementia (3 women, 69±10 ys). All were injected in the basal state with a standard dose of 925 MBq (25 mCi) of 99mTc-ECD. Brain SPECT was performed with a dual-head camera equipped with a high-resolution collimator using 3600 rotation, 120 angular steps and 15 sec/step in a 64x64 matrix with 1.5 x magnification. Reconstruction of transaxial tomograms was performed using filtered backprojection with a Metz filter. Attenuation correction was applied according to Chang's method. In order to calculate uptake ratios, regions of interest (ROIs) were placed on the right and left frontal cortex (RFron, LFron), anterior or posterior cingulate gyrus (Cing) according to the site of highest uptake recorded, both caudate nucleus (RCau, LCau), thalamus (Thal) and cerebellum (cer). Results: The findings are presented. Conclusion: Cingulate gyrus hyperactivity has been reported in patients with OCD and confirmed in our series, however not significantly different from that observed in depressed patients. The only distinct finding was higher thalamic activity in OCD patients compared to the other groups, suggesting that this

  10. Semiquantitative Analysis Using Thallium-201 SPECT for Differential Diagnosis Between Tumor Recurrence and Radiation Necrosis After Gamma Knife Surgery for Malignant Brain Tumors

    Purpose: Semiquantitative analysis of thallium-201 chloride single photon emission computed tomography (201Tl SPECT) was evaluated for the discrimination between recurrent brain tumor and delayed radiation necrosis after gamma knife surgery (GKS) for metastatic brain tumors and high-grade gliomas. Methods and Materials: The medical records were reviewed of 75 patients, including 48 patients with metastatic brain tumor and 27 patients with high-grade glioma who underwent GKS in our institution, and had suspected tumor recurrence or radiation necrosis on follow-up neuroimaging and deteriorating clinical status after GKS. Analysis of 201Tl SPECT data used the early ratio (ER) and the delayed ratio (DR) calculated as tumor/normal average counts on the early and delayed images, and the retention index (RI) as the ratio of DR to ER. Results: A total of 107 tumors were analyzed with 201Tl SPECT. Nineteen lesions were removed surgically and histological diagnoses established, and the other lesions were evaluated with follow-up clinical and neuroimaging examinations after GKS. The final diagnosis was considered to be recurrent tumor in 65 lesions and radiation necrosis in 42 lesions. Semiquantitative analysis demonstrated significant differences in DR (P=.002) and RI (P201Tl SPECT provides useful information for the differentiation between tumor recurrence and radiation necrosis in metastatic brain tumors and high-grade gliomas after GKS, and the RI may be the most valuable index for this purpose.