Comparative Study on Initial Symptoms Using Single Photon Emission Computer Tomography in Schizophrenia

OBJECTIVES: This study was conducted to compare between hallucination group and delusion group in patient with schizophrenia, using Brain (99m)Tc-ECD SPECT. METHODS: Among 16 patients with less than 3 schizophrenic episodes, 8 patients whose initial symptom was hallucination were assigned to the hallucination group, and other 8 patients with initial sumptom of delusion were assinged to the hallucination group. All of the patients clinically evaluated using the PANSS and BPRS. Both groups of patients and 8 healthy subjects underwent (99m)Tc-ECD SPECT. RESULTS: Score of thinking disturbance subscale of BPRS were significantly lower in the hallucination group than the delusion group. In SPECT analysis, the hallucination group showed significantly increased perfusion in some areas of the right temporal lobe, bilateral limbic lobes and left parietal lobe compared to delusion group. Both group had a reduced rCBF in some areas of the frontal lobe. CONCLUSION: The hallucniation group, compared with the delusion group, showed significantly increased regional cerebral blood flow in some regions. Therefore, this data suggests that different neural substrates may affect the process of auditory hallucination and delusion.

Ipsilateral Cerebral and Contralateral Cerebellar Hyperperfusion in Patients with Unilateral Cerebral Infarction; SPM Analysis / 핵의학분자영상

PURPOSE: Cortical reorganization has an important role in the recovery of stroke. We analyzed the compensatory cerebral and cerebellar perfusion change in patients with unilateral cerebral infarction using statistical parametric mapping (SPM). MATERIALS AND METHODS: Fifty seven (99m)Tc-Ethylene Cystein Diethylester (ECD) cerebral perfusion SPECT images of 57 patients (male/female=38/19, mean age=56+/-17 years) with unilateral cerebral infarction were evaluated retrospectively. Patients were divided into subgroups according to the location (left, right) and the onset (acute, chronic) of infarction. Each subgroup was compared with normal controls (male/female=11/1, mean age=36+/-10 years) in a voxel-by-voxel manner (two sample t-test, p<0.001) using SPM. RESULTS: All 4 subgroups showed hyperperfusion in the ipsilateral cerebral cortex, but not in the contralateral cerebral cortex. Chronic left and right infarction groups revealed hyperperfusion in the ipsilateral primary sensorimotor cortex, meanwhile, acute subgroups did not. Contralateral cerebellar hyperperfusion was also demonstrated in the chronic left infarction group. CONCLUSION: Using (99m)Tc-ECD SPECT, we observed ipsilateral cerebral and contralateral cerebeller hyperperfusion in patients with cerebral infarction. However, whether these findings are related to the recovery of cerebral functions should be further evaluated.

Assessment of Hyperperfusion by Brain Perfusion SPECT in Transient Neurological Deterioration after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis Surgery / 핵의학분자영상

PURPOSE: Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis surgery. Materials and METHODS: A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: 50+/-16 yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using (99m)Tc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. RESULTS: In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of the cerebral perfusion ratio on preoperative and tenth postoperative day between patients with TND and other patients. CONCLUSION: In patients with TND, relative and moderate hyperperfusion was observed in affected side after bypass surgery. These finding may help to understand the pathophysiology of TND.

Hemodynamic Outcome of Successful Bypass Surgery in Patients with Atherosclerotic Cerebrovascular Disease: A study with Acetazolamide and (99m)Tc-ECD SPECT / 핵의학분자영상

PURPOSE: The aim of the study was to evaluate the hemodynamic changes after successful bypass surgery in patients with atherosclerotic stenosis in ICA using (99m)Tc-ECD SPECT. MATERIALS AND METHODS: Fourteen patients (M:F=8:6, mean age; 60+/-9 years) who underwent STA-MCA anastomosis for unilateral atherosclerotic cerebrovascular disease were enrolled. (99m)Tc-ECD basal/acetazolamide perfusion SPECT studies were performed before, 10 days and 6 months after bypass surgery. Perfusion reserve was defined as the % changes after acetazolamide over rest image. Regional cerebral blood flow and perfusion reserve were compared preoperative, early-postoperative and late-postoperative scans. RESULTS: The mean resting perfusion and decrease in perfusion reserve in affected ICA territory on preoperative scan was 52.4+/-3.5 and -7.9+/-4.7%, respectively. The resting perfusion was significantly improved after surgery on early-postoperative scan (mean 53.7+/-2.7) and late-postoperative scan (mean 53.3+/-2.5) compared with preoperative images (p<0.05, respectively). Resting perfusion did not showed further improvement on late-postoperative scan compared with early-postoperative scan. The perfusion reserve was -3.7+/-2.6% on early-postoperative scan, and -1.6+/-2.3% on late-postoperative scan, which was significantly improved after surgery. Additionally, further improvement of perfusion reserved as observed on late-postoperative scan (p<0.05). While, in the unaffected ICA territory, no significant changes in the resting perfusion and perfusion reserve was observed. CONCLUSION: The improvement of resting perfusion and perfusion reserve in early-postoperative scan reflects the immediate restoration of the cerebral blood flow by bypass surgery. In contrasts, further improvement of perfusion reserve showing on late-postoperative scan may indicate a good collateral development after surgery, which may indicate good surgical outcome after surgery.

Evaluation of Therapeutic Effects of Cognitive-Behavioral Therapy in Patients with Panic Disorder using Serial (99m)Tc-ECD Brain Perfusion / 핵의학분자영상

PURPOSE: Although several neuroanatomical models of panic disorder have been proposed, little is known regarding the neurological mechanisms underlying cognitive-behavioral therapy (CBT) in patients with panic disorder. This study was performed to identify the brain structures that show changes of regnioal cerebral blood flow (rCBF) after CBT in patients with panic disorder. MATERIALS AND METHODS: Seven patients who were diagnosed as panic disorder by DSM-IV were treated with CBT for 8 weeks and twelve healthy volunteers joined in this study. Serial (99m)Tc-ECD brain perfusion SPECT images were acquisited and PDSS-SR (Self-Report version of Panic Disorder Severity Scale) and ACQ (Agoraphobic Cognitive Question) scores were measured just before and after CBT in all patients. Data were analyzed using SPM2. RESULTS: Subjective symptoms were improved, and PDSS-SR and ACQ scores were significantly reduced (14.9+/-3.9 vs. 7.0+/-1.8, p<0.05; 30.3+/-8.5 vs. 21.6+/-3.4, p<0.05, respectively) after CBT in panic patients. Before CBT, a significant increase of rCBF was found in the cingulate gylus, thalamus, midbrain, both medial frontal and temporal lobes of the panic patients compared to the normal volunteers. After CBT, we observed a significant rCBF decrease in the left parahippocamus, right insula and cingulate gyrus, both frontal and temporal lobes, and a significant rCBF increase in both the occipital lobes, left insula, both frontal and left parietal lobes. CONCLUSION: These data suggested that CBT is effective for panic disorder and diminish the activity of the brain areas associated with fear in panic disorder.

Cerebral Perfusion Assessed with 99m-Tc-ECD-SPECT in Childrens with Attachment Disorder / 신경정신의학

OBJECTIVES: This study aimed to reveal that severe disturbance of attachment relationship with primary care-giver can affect functional brain development by measuring with technetium-99m ethyl cysteinate dimer brain single-photon emission tomography. METHODS: Subjects were 12 children aged 2-6 years who met the diagnostic criteria of reactive attachment disorder. Diagnostic tools were DSM-IV, ICD-10, Strange Situation Procedure(SSP), Vineland Social Maturity Sclae(SMS), and Childhood Autism Rating Scale(CARS). Brain SPECT was performed in all sbjects and each SPECT scan was visually assessed by two nuclear medicine specilalists. RESULTS: Eleven of 12 children had abnormal brain perfusion on SPECT scans, revealing focal areas of decreased perfusions. Perfusion of thalamus was decreased in 10 subjects decreased perfusion of left thalamus(6/10), right thalamus(1/10), and both thalami(3/10). Perfusion of basal ganglia was decreased in 5 children. Four children had decreased perfusion of thalamus as well as of basal ganglia. Decreased perfusion of parietal area was noted in only one child on SPECT scan. All subjets had normal perfusion of frontal, temporal, occipital, cerebellar areas on SPECT scan. CONCLUSIONS: Perfusion abnormalities involving thalamus, basal ganglia in most children with attachment disorder were found in this study. These results suggest that brain development of infant could be impeded by severe pathologic care and early nurturing environment would be important for normal brain development.