Impact of Follow-Up Ischemia on Myocardial Perfusion Single-Photon Emission Computed Tomography in Patients with Coronary Artery Disease

PURPOSE: Few studies have reported on predicting prognosis using myocardial perfusion single-photon emission computed tomography (SPECT) during coronary artery disease (CAD) treatment. Therefore, we aimed to assess the clinical implications of myocardial perfusion SPECT during follow-up for CAD treatment. MATERIALS AND METHODS: We enrolled 1153 patients who had abnormal results at index SPECT and underwent follow-up SPECT at intervals ≥6 months. Major adverse cardiac events (MACE) were compared in overall and 346 patient pairs after propensity-score (PS) matching. RESULTS: Abnormal SPECT was associated with a significantly higher risk of MACE in comparison with normal SPECT over the median of 6.3 years (32.3% vs. 19.8%; unadjusted p<0.001). After PS matching, abnormal SPECT posed a higher risk of MACE [32.1% vs. 19.1%; adjusted hazard ratio (HR)=1.73; 95% confidence interval (CI)=1.27–2.34; p<0.001] than normal SPECT. After PS matching, the risk of MACE was still higher in patients with abnormal follow-up SPECT in the revascularization group (30.2% vs. 17.9%; adjusted HR=1.73; 95% CI=1.15–2.59; p=0.008). Low ejection fraction [odds ratio (OR)=5.33; 95% CI=3.39–8.37; p<0.001] and medical treatment (OR=2.68; 95% CI=1.93–3.72; p<0.001) were independent clinical predictors of having an abnormal result on follow-up SPECT. CONCLUSION: Abnormal follow-up SPECT appears to be associated with a high risk of MACE during CAD treatment. Follow-up SPECT may play a potential role in identifying patients at high cardiovascular risk.

The SPECT/CT Evaluation of Compartmental Changes after Open Wedge High Tibial Osteotomy

PURPOSE: The purpose of this study was to evaluate compartmental changes using combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT) after open wedge high tibial osteotomy (OWHTO) for providing clinical guidance for proper correction. MATERIALS AND METHODS: Analysis was performed using SPECT/CT from around 1 year after surgery on 22 patients who underwent OWHTO. Postoperative mechanical axis was measured and classified into 3 groups: group I (varus), group II (0°–3° valgus), and group III (>3° valgus). Patella location was evaluated using Blackburne-Peel (BP) ratio. On SPECT/CT, the knee joint was divided into medial, lateral, and patellofemoral compartments and the brighter signal was marked as a positive signal. RESULTS: Increased signal activity in the medial compartment was observed in 12 cases. No correlation was observed between postoperative mechanical axis and medial signal increase. Lateral increased signal activity was observed in 3 cases, and as valgus degree increased, lateral compartment’s signal activity increased. Increased signal activity of the patellofemoral joint was observed in 7 cases, and significant correlation was observed between changes in BP ratio and increased signal activity. CONCLUSIONS: For the treatment of medial osteoarthritis, OWHTO requires overcorrection that does not exceed 3 valgus. In addition, the possibility of a patellofemoral joint problem after OWHTO should be kept in mind.

Single Photon Emission Computerized Tomography and Neuropsychological Tests That Predict a Good Response to Donepezil Therapy for Alzheimer's Disease

BACKGROUND AND PURPOSE: Cholinesterase inhibitors (ChEIs) are effective in Alzheimer's disease (AD) treatment. The aim of this study is 1) to find neuropsychological factors that affect the functional response to ChEI therapy and 2) to determine whether regional cerebral blood flow (rCBF) pretreatment predicts a cognitive change in response to ChEI. METHODS: We prospectively recruited 32 patients diagnosed with probable AD and treated them with donepezil, a ChEI, over one year. The patients were divided into stable (s-AD) and declined (d-AD) AD groups, based on changes in Korean version of Mini-Mental State Examination (K-MMSE) scores. Patients were assessed using the Alzheimer's Disease Co-operative Study-Activities of Daily Living (ADCS-ADL) and Seoul Neuropsychologic Screening Battery, as well as brain single photon emission computerized tomography (SPECT) at baseline and last medical evaluations. The predictors of therapeutic responses were analyzed using general linear models. RESULTS: Based on their cognitive function changes, AD patients were classified into two groups: s-AD (n=14, annual change in K-MMSE score or =0.9). The s-AD at baseline showed significantly better ADCS-ADL function (p=0.04) and had a tendency to preserve frontal function compared to the d-AD group. Global Statistical Parametric Mapping analysis revealed no significant decrease of rCBF between baseline and follow-up SPECT, in either the s-AD or the d-AD groups. However, on regional perfusion analysis of baseline SPECT, the d-AD group demonstrated perfusion deficits in the supramarginal gyrus, inferior occipital gyrus, and rolandic operculum compared with the s-AD group. CONCLUSIONS: Highly preserved ADCS-ADLs predicted a better improvement in MMSE scores in response to ChEI therapy and a more positive functional response in the group with preserved frontal function. rCBF provided hints to the variable response to donepezil therapy with ChEI treatment.

The correlation of cerebral perfusion characteristics and cognitive function on patients with unipolar and bipolar depression / 中华行为医学与脑科学杂志

Objective To analyze the correlation of cerebral perfusion characteristics and cognitive function on patients with unipolar and bipolar depression. Methods The r-CBF imaging was detected by SPECT forall subjects. Evaluated cognitive function of subjects using WAIS-CR and WMA, and analysed data using SPSS.Results Data showed that some regions in the brain, e.g. temporal lobe, frontal lobe, hippocampus, and basal ganglia, had significant alterations of r-CBF in depressed patients as compared with healthy controls (P ＜ 0. 05 ).Compared with UPD, BPD showed increased perfusion in basal ganglia ( 0,22.73%; 4.54%, 36. 36% ) (P ＜0.05 ). Furthermore there was no significant different incognitive deficits between UPD and BPD(P ＞ 0. 05 ) , and correlations between cognitive impairment and hypoperfusion of rCBF (P ＜ 0. 05 ). Conclusion There be exist difference in r-CBF between UPD and BPD. The perfusion of r-CBF in BPD is significantly increased than that in UPD,and it suggest that hyperperfusion in basal ganglia may be the biological basis when bipolar depression turning to manic.

Correlation of Videodensitometric Scale and Single Photon Emission Computerized Tomography in Assessment of Myocardial Microperfusion / 中国康复理论与实践

@#ObjectiveTo evaluate the feasibility and the value of videodensitometric scale (VDS) in assessing myocardial microperfusion. Methods11 Beagles were embolized small coronary artery with polystyrene microbubble (100 μm). Coronary angiography was performed after the embolization and the VDS was calculated. Single photon emission computerized tomography (SPECT) was also performed after embolization and SPECT scores were also calculated. ResultsVDS after embolization was (15.2±3.8); and SPECT score was (17.6±6.4). VDS correlated negatively with SPECT scores (r=－0.85, P<0.05).ConclusionVDS keeps a closely correlation with SPECT. It can be used to assess myocardial microcirculation in clinical.

Effectiveness of Multiple Burrhole Operation in Adult Moyamoya Disease / 대한뇌혈관외과학회지

OBJECTIVE: Most of the studies that have described surgical procedures for moyamoya disease(MMD) have had the aim to improve the blood flow mainly in the middle cerebral artery(MCA) territory. The purpose of this study is to clarify the good indications for a multiple burrhole operation to treat MMD. METHODS: With the patient under local anesthesia, burrhole trephination with a diameter of 1.5 to 2cm at 3 to 5cm lateral to the midline was performed in a total of 18 hemispheres during 12 procedures. The burrholes were opened in the frontal lobe at 19 sites in 10 patients and in the parietal lobe at 22 sites in 12 patients. Revascularization through multiple burrholes and arachnoid openings was performed in 12 patients who suffered from MMD. RESULTS: As seen on the follow up angiograms, good revascularization was achieved in 27 of 41 burrholes, and mainly from the middle meningeal artery and then from the superficial temporal artery. The moyamoya vessels were decreased in four patients. The neovascularization covered 68.4% of the frontal lobe and 63.5% of the parietal lobe. Compared with the preoperative 99mTc-HMPAO-SPECT, 6 patients showed improvement of cerebral blood flow on the postoperative 99mTc-HMPAO-SPECT. Transient ischemic attack disappeared in three of the four patients who presented with this symptom, and the preoperative symptoms improved in both of the patients who presented with headache and cerebral infarction. CONCLUSIONS: A multiple burrhole operation is a simple technique. The results of our series suggest that the revascularization obtained for adult MMD patients who underwent a multiple burrhole operation is similar to that obtained with other indirect surgeries, but long term follow up studies are needed.

Preliminary study on detection of hypoxic brain tissue around the focus of cerebral hemorrhage using HL-91 single photon emission computerized tomography / 临床神经病学杂志

Objective To investigate the applied value of 99Tcm-HL-91 single photon emission computerized tomography(SPECT) in detecting the hypoxic brain tissue around the focus of cerebral hemorrhage.Methods 26 patients with cerebral hemorrhage were examined by HL-91 SPECT.And the results were compared with their skull CT imagings and other 5 healthy controls.Results 17 case(65.38%) of cerebral hemorrhage group were found hypoxic imaging positive,and the hypoxic zone was closely related to the focus of cerebral hemorrhage in CT imaging.9 cases of cerebral hemmorhage group were found hypoxic imaging negative,6 cases of which were small quantity cerebral hemorrhage,including 2 cases