Rapid change of estrogen levels induce reversible cerebral vasoconstriction syndrome and cerebral venous sinus thrombosis: A report of two cases

@#Reversible cerebral vasoconstriction syndrome (RCVS) presents with characteristic clinical, brain imaging, and angiographic findings. The most common clinical feature of RCVS is a severe acute headache, which is often referred to as a thunderclap headache owing to the nature of its presentation. It may occur spontaneously or may be provoked by various precipitating factors. We present two cases of RCVS concomitant with cerebral venous sinus thrombosis (CVST). Patient 1 was a 42-yearold woman admitted to our hospital with severe headache radiating to the neck, with associated vomitting. She had a history of ovarian cancer and underwent an operation for resection of the tumor a month prior to presentation. After resection, her estradiol (E2) levels were reduced from 288 pg/ ml to 31 pg/ml (normal range, 0-49 pg/ml). Initial imaging upon admission to our hospital revealed left posterior convexity subarachnoid hemorrhage. Magnetic resonance angiography (MRA) showed findings consistent with RCVS affecting the left posterior cerebral artery. Magnetic resonance venography (MRV) showed CVST of the left transverse and sigmoid sinuses. Single photon emission computed tomography (SPECT) showed a left posterior ischemic lesion. These findings improved following treatment with nimodipine and anticoagulant. Patient 2 was a 39-year-old woman presented with holocranial headache associated with vomiting. She was diagnosed with an ovarian tumor. She underwent an operation three months prior to presentation. After tumor resection, her E2 level decrease from 193 pg/ml to 19 pg/ml (normal range, 0-49 pg/ml). MRA confirmed the presence of a vasospasm involving the right anterior cerebral artery. MRV confirmed the presence of thrombosis involving the superior sagittal sinus. She was discharged on postpartum day 31 without neurological deficits after treatment with anticoagulants. At 3 month follow-up, both MRA and MRV were within the normal limits. In conclusion, this is the first report of two women diagnosed with RCVS with concomitant CVST following ovarian tumor resection. The rapid change of perioperative E2 levels may have contributed to the development of CVST and RCVS.

Evaluation of the therapeutic efficacy for methamphetamine dependence through visual digital neural molecular imaging techniques / 中华行为医学与脑科学杂志

Objective To evaluate the therapeutic effects of methamphetamine (MA) dependence and the repairment of DA neuronal function by SPECT corpus striatum DAT visual digital neural molecular imaging techniques.Methods 25 MA dependent patients (BPRS score ≥ 35) were treated by self-designed treatment program for more than 6 months.The clinical therapeutic effects were scored with reducing rate of BPRS.MA dependent patients were examined by SPECT corpus striatum DAT imaging before and after treatment,while healthy volunteers were examined only once.The SPECT corpus striatum DAT images were analyzed visually and quantitatively.Results The reducing rate of BPRS showed that the total effective rate was 80.0％.Visual analysis of SPECT corpus striatum DAT images showed that the distribution of DAT in the corpus striatum was regionally reduced or defected in various degrees before treatment,and was significantly increased after treatment.Quantitative analysis showed that the bilateral striatal V ((19.26 ± 2.85) cm3),m((20.22±2.99) g) and Ra(4.78±0.79) ％) of MA dependent patients were significantly lower compared with those of the healthy volunteers(respectively (35.39±4.42) cm3,(37.16±4.64) g and (7.93± 0.86) ％) (all P＜ 0.01) before treatment and were significantly improved (P＜ 0.01) after treatment (V:(22.80±4.28) cm3,m:(23.93± 4.49) g and Ra:(5.64 ± 0.99) ％) with a 76.0％ corpus striatum DAT improvement rate.However,the bilateral striatal V,m and Ra of MA dependent patients after treatment were still lower than those of the healthy volunteers (P＜0.01).There was no significant difference between the striatal DAT improvement rate and the BPRS reduction rate (P＞ 0.05).Conclusion SPECT corpus striatum DAT visual digital neural molecular imaging techniques are reliable in the evaluation of the treatment programs for MA dependence and the repair of DA neuronal function.

Molecular Neuroimaging in Posttraumatic Stress Disorder

Over the past decade, an increasing number of neuroimaging studies have provided insight into the neurobiological mechanisms of posttraumatic stress disorder (PSTD). In particular, molecular neuroimaging techniques have been employed in examining metabolic and neurochemical processes in PTSD. This article reviews molecular neuroimaging studies in PTSD and focuses on findings using three imaging modalities including positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance spectroscopy (MRS). Although there were some inconsistences in the findings, patients with PTSD showed altered cerebral metabolism and perfusion, receptor bindings, and metabolite profiles in the limbic regions, medial prefrontal cortex, and temporal cortex. Studies that have investigated brain correlates of treatment response are also reviewed. Lastly, the limitations of the molecular neuroimaging studies and potential future research directions are discussed.

Comparative study of the osteoblastic activity of two implant systems (Endopore versus Entegra) utilizing single photon emission computed tomography (SPECT): experimental study in pigs model / Estudio comparativo de la actividad osteoblástica de dos sistemas de implantes (Endopore versus Entegra) utilizando tomografía computarizada por emisión de fotones individuales: estudio experimental en modelos porcinos

Implantology has been an important component of dental management for over forty years, and during that period, many configurations of implant materials and methods have been developed. As empirical and clinical research yield new implant materials, there has been need to test and compare these materials to provide the most cost-effective and efficient implants. Evaluation of efficiency of implants has relied heavily on histological and radiological methods, but these one-dimensional measurement methods fail to evaluate the osteoblastic activity and osseointegration properties of putative implants. In this report, we describe the use of a quantitative single photon emission computed tomography (SPECT) as a tool for comparing the osseointegrating capabilities of two types of implants.

La implantología ha sido un componente importante del tratamiento odontológico durante más de cuarenta años, y durante ese período, se han desarrollado muchas configuraciones de materiales y métodos de implante. A medida que la investigación empírica y clínica proporciona nuevos materiales de implante, ha surgido la necesidad de probar y comparar estos materiales para lograr que los implantes sean lo más costo-efectivos y eficientes posible. La evaluación de la eficiencia de los implantes ha dependido considerablemente de los métodos histológicos y radiológicos, pero estos métodos de medición unidimensional no son útiles a la hora de evaluar la actividad osteoblástica y las propiedades osteointegradoras de los implantes putativos. En este reporte, describimos el uso de la tomografía computarizada por emisión de fotones individuales (SPECT) como herramienta para comparar las capacidades osteointegradoras de dos tipos de implantes.

Effects of the Constraint-Induced Movement Therapy on Cortical Reorganization in Patients with Hemiplegic Cerebral Palsy

OBJECTIVE: To investigate the effects of modified constraint- induced movement therapy (CIMT) on motor function and cortical activation in children with hemiplegic cerebral palsy (CP). METHOD: Five children with hemiplegic cerebral palsy were studied with Jebsen hand function test and quality of upper extremity skills test (QUEST), dynamic electromyography (EMG), and single photon emission computed tomography (SPECT) at rest before and after the CIMT period. Children were treated with a 4-week protocol of modified CIMT, consisting of twice-weekly 2-hour sessions of structured activities and a home program for non-treatment days. Children wore orthoses on their less affected upper extremities for 6 hours per day, during which time they were engaged in play, functional activities and 2-hour protocol of motor tasks. RESULTS: Improvements in upper-extremity function were found in Jebsen hand function test and QUEST. Increased muscle activities in elbow extensors were observed in dynamic EMG during affected hand grip. In right hemiplegic patients, regional cerebral perfusion increased in right Brodmann area (BA) 3 and lentiform nucleus. In left hemiplegic patients, regional cerebral perfusion increased in right BA 6, 9, 21, left BA 19 and left cerebellum, but decreased in left BA 11. CONCLUSION: Modified CIMT appears to change local cerebral perfusion in areas known to participate in movement planning and execution. These changes might be a sign of cortical activation after CIMT in the children with hemiplegic cerebral palsy. Results of this study suggest that modified CIMT may be an effective way of treating children with hemiplegic CP.

Effects of Cognitive Behavioral Therapy and Citalopram on Regional Cerebral Blood Flow in Patients with Depression Disorder / 中国康复理论与实践

@# Objective To explore the effects of cognitive behavioral therapy and citalopram on regional cerebral blood flow(rCBF)in the patients with depression disorder.Methods 38 patients with depression disorder were divided into the cognitive behavioral therapy group(n=18),and citalopram group(n=20).The rCBF changes and scores of Hanmilton Depression Scale(HAMD)of all patients in two groups were evaluated with 99Tcm-ECD single photon emission computed tomography(SPECT)and HAMD before and after treatment.Results After treatment,the symptoms of all patients in two groups improved,but the cases of the citalopram group got a rapid improvement compared with those of the cognitive behavioral therapy group.Both of two methods could increase blood flow in right basal ganglion;while,the blood flow also increased in right limbic system in the cognitive behavioral therapy group,and in right temporol lobule in the citalopram group.Conclusion Both cognitive behavioral therapy and citalopram are effect on symptoms of depression disorder,but affect blood flow in different parts.

Diagnostic Performance of Combined Single Photon Emission Computed Tomographic Scintimammography and Ultrasonography Based on Computer-Aided Diagnosis for Breast Cancer / 핵의학분자영상

PURPOSE: We investigated whether the diagnostic performance of SPECT scintimammography (SMM) can be improved by adding computer-aided diagnosis (CAD) of ultrasonography (US). MATERIALS AND METHODS: We reviewed breast SPECT SMM images and corresponding US images from 40 patients with breast masses (21 malignant and 19 benign tumors). The quantitative data of SPECT SMM were obtained as the uptake ratio of lesion to contralateral normal breast. The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program. The diagnostic performance of SPECT SMM and CAD of US alone was determined using receiver operating characteristic (ROC) curve analysis. The best discriminating parameter (D-value) combining SPECT SMM and the CAD of US was created. The sensitivity, specificity and accuracy of combined two diagnostic modalities were compared to those of a single one. RESULTS: Both SPECT SMM and CAD of US showed a relatively good diagnostic performance (area under curve = 0.846 and 0.831, respectively). Combining the results of SPECT SMM and CAD of US resulted in improved diagnostic performance (area under curve =0.860), but there was no statistical differerence in sensitivity, specificity and accuracy between the combined method and a single modality. CONCLUSION: It seems that combining the results of SPECT SMM and CAD of breast US do not significantly improve the diagnostic performance for diagnosis of breast cancer, compared with that of SPECT SMM alone. However, SPECT SMM and CAD of US may complement each other in differential diagnosis of breast cancer.

Observing the change of cerebral blood flow perfusion in acute vertebral artery stenosis in dogs by ~(99)Tc~m-ECD imaging / 中国临床药理学与治疗学

AIM: To observe the early changes of local cerebral blood supply in dogs during the acute vertebral artery stenosis by 99 TcmECD cerebral blood flow perfusion imaging(CBFPI).METHODS: Twenty-four dogs were randomized into groups of normal controls(A),moderate stenosis(B),severe stenosis(C) and arterial occlusion(D),with 6 in each group.Group A were free from any intervention,but Group B,C and D were undergone ligation of the right vertebral arteries by the extent of 50%～69%(Group B),70%～99%(Group C) or 100%(Group D).The imaging agents were injected intravenously 0.5-1 h after ligation and the single photon emission computed tomography(SPECT) was performed after 1 h.RESULTS: CBFPI examination of the early changes of cerebral blood supply during the acute vertebral artery stenosis by visualization showed that the sensitivity was 33.3%,83.3% and 100% in Group B,C and D,respectively,with an average sensitivity of 72.2%,while semi-quantitative assessment suggested that the sensitivity was 50%,100% and 100% in the three groups,respectively,with an average sensitivity of 83.3%.When examining the activity ratio for regions of interest(ROI) by semi-quantitative 99 Tcm-ECD CBFPI,the findings suggested that Group D and C decreased significantly(exception in cerebellum in Group C),but Group B had no evident changes,as compared with Group A.By comparison of the groups of B-C,B-D and C-D,differences were observed in the right temporal lobes,whereas the changes in left temporal lobes were seen in Group B-C or B-D.The changes were seen in occipital lobes when groups of B and D were compared,but with no differences in cerebellum.CONCLUSION: The degree of stenosis in vertebral arteries may involve varied regions,the temporal lobe is susceptive,followed by occipital lobe,while cerebellum is somewhat resistant from the involvement.

A Case of Alveolar Soft Part Sarcoma in the Orbit Diagnosed as C avernous Hemangioma befo re Operation

Alveolar soft part sarcoma is a very rare malignant neoplasm which originates from the soft tissue. The common site is lower extremity and it is especially rare to occur primarily in the orbit. It is characterized that tumor shows organoid arrangement of lobules separated by numerous delicate vascular septa and individual tumor cell contained PAS positive crystalline granules in the cytoplasm. Moreover, because of hypervascular tumor, it is easy to misdiagnosed as a cavernous hemangioma which commonly occurs in the orbit. We experienced a 29-year-old male who had suffered from unilateral proptosis.Before operation, ultrasonography, MRI and single photon emission computed tomography (SPECT) were performed and we suspected that the retro-orbital mass was a cavernous hemangioma. Using Kr onlein method,lateral orbitotomy was performed and large well encapsulated tumor mass (2.5 x2.5 x2.0 cm)was excised. On histopathological examination the tumor was confirmed as an alveolar soft part sarcoma. Therefore, we report this interesting case with review of the literature.