SPECT cerebral con 99Tc- MIBI para discriminar entre infiltración tumoral y absceso cerebral en casos de tomografía computarizada y resonancia magnética no concluyentes. Presentación de un caso / 99mTc-MIBI Brain SPECT to discriminate between tumor infiltration and brain abscess in cases of computed tomography and magnetic resonance unconvincing. Case Presentation

La diferenciación entre abscesos y metástasis cerebrales en pacientes con algún grado de inmunosupresión y con neoplasias hematológicas resulta en ocasiones difícil. Los estudios funcionales como la tomografía de emisión de fotón único (SPECT) y la tomografía por emisión de positrones (PET) son herramientas diagnósticas eficaces para este propósito. Presentamos el caso de una paciente con diagnóstico de leucemia mieloide crónica en crisis blástica a quien se le informó múltiples abscesos cerebrales; diagnóstico basado en que no existió captación de 99mTc - MIBI en SPECT cerebral y en la buena respuesta al tratamiento antimicrobiano en ocasión en que los estudios de tomografía computarizada (TC) cerebral y resonancia magnética (RM) cerebral no fueron concluyentes. Teniendo en cuenta los resultados de la SPECT se decidió postergar el esquema de quimioterapia, ya que esta podría desencadenar complicaciones probablemente fatales en la paciente.

The differentiation between brain abscess and brain metastasis in patients with some grade of immune suppression and hematological neoplasm is difficult in some situations. Functional studies like Single-Photon Emission Tomography (SPECT) and Positron Emission Tomography (PET) are useful for this purpose. We present the case of a patient with diagnosis of chronic myelogenous leukemia in blast crisis that a diagnosis of brain abscess was made. The diagnosis had a base in 99mTc - MIBI brain SPECT did not show MIBI uptake and the good treatment response to antibiotics when brain CT scan and MRI were not conclusive. Attending to the SPECT result, chemotherapy was postponed because of probably fatal complications in this patient with brain abscess.

A new method for intraoperative localization of epilepsy focus by means of a gamma probe / Um novo método para a localização intraoperatória de foco de epilepsia mediante utilização de gamaprobe

Objective To evaluate the utility of a new multimodal image-guided intervention technique to detect epileptogenic areas with a gamma probe as compared with intraoperative electrocorticography. Materials and Methods Two symptomatic patients with refractory epilepsy underwent magnetic resonance imaging, videoelectroencephalography, brain SPECT scan, neuropsychological evaluation and were submitted to gamma probe-assisted surgery. Results In patient 1, maximum radioactive count was initially observed on the temporal gyrus at about 3.5 cm posteriorly to the tip of the left temporal lobe. After corticotomy, the gamma probe indicated maximum count at the head of the hippocampus, in agreement with the findings of intraoperative electrocorticography. In patient 2, maximum count was observed in the occipital region at the transition between the temporal and parietal lobes (right hemisphere). During the surgery, the area of epileptogenic activity mapped at electrocorticography was also delimited, demarcated, and compared with the gamma probe findings. After lesionectomy, new radioactive counts were performed both in the patients and on the surgical specimens (ex-vivo). Conclusion The comparison between intraoperative electrocorticography and gamma probe-assisted surgery showed similarity of both methods. The advantages of gamma probe include: noninvasiveness, low cost and capacity to demonstrate decrease in the radioactive activity at the site of excision after lesionectomy. .

Objetivo Avaliar a utilidade de um novo método de intervenção multimodal guiado por imagem, permitindo a detecção de áreas epileptogênicas mediante utilização de gamaprobe em comparação à eletrocorticografia intraoperatória. Materiais e Métodos Dois pacientes sintomáticos com epilepsia refratária realizaram ressonância magnética, videoeletroencefalograma, SPECT cerebral, avaliação neuropsicológica e foram submetidos a neurocirurgia usando gamaprobe. Resultados No paciente 1 as contagens radioativas inicialmente estavam no máximo no giro temporal, cerca de 3,5 cm posterior à ponta do lobo temporal esquerdo. Após corticotomia, o gamaprobe apontou o ponto máximo na cabeça do hipocampo, de acordo com os achados de eletrocorticografia intraoperatória. No paciente 2 as contagens foram máximas na região occipital em sua transição com os lobos temporal e parietal (hemisfério direito). Na cirurgia, a área mapeada da atividade epileptogênica na eletrocorticografia foi também delimitada, demarcada e comparada aos dados do gamaprobe. Após a lesionectomia, procedeu-se uma nova radiocontagem no paciente e na peça cirúrgica (ex-vivo). Conclusão A comparação entre os métodos mostrou acurácia praticamente similar. As vantagens do gamaprobe foram a de não ser invasivo, ser de baixo custo e também ser relevante para mostrar a redução da atividade radioativa no local da exérese. .

Cerebral perfusion and automated individual analysis using SPECT among an obsessive-compulsive population / Perfusão cerebral e análise individual automatizada utilizando SPECT em uma população com transtorno obsessivo-compulsivo

OBJECTIVE: To make individual assessments using automated quantification methodology in order to screen for perfusion abnormalities in cerebral SPECT examinations among a sample of subjects with OCD. METHODS: Statistical parametric mapping (SPM) was used to compare 26 brain SPECT images from patients with OCD individually with an image bank of 32 normal subjects, using the statistical threshold of p < 0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). The maps were analyzed, and regions presenting voxels that remained above this threshold were sought. RESULTS: Six patients from a sample of 26 OCD images showed abnormalities at cluster or voxel level, considering the criteria described above, which represented 23.07 percent. However, seven images from the normal group of 32 were also indicated as cases of perfusional abnormality, representing 21.8 percent of the sample. CONCLUSION: The automated quantification method was not considered to be a useful tool for clinical practice, for analyses complementary to visual inspection.

OBJETIVO: Avaliar uma amostra de pacientes com transtorno obsessivo-compulsivo (TOC), individualmente, empregando uma metodologia de quantificação automatizada para rastrear anormalidades de perfusão em exames de SPECT cerebral. MÉTODOS: Foi utilizado o Statistical Parametric Mapping (SPM) para comparar 26 imagens de SPECT cerebral de pacientes com TOC, individualmente, com um banco de 32 imagens de voluntários normais, usando o limiar estatístico de p < 0,05 (corrigido para comparações múltiplas ao nível do voxel individual ou clusters). Os mapas foram analisados procurando por regiões que apresentassem voxels acima desse limiar. RESULTADOS: Seis pacientes da amostra de 26 imagens com TOC mostraram anormalidades ao nível do cluster ou voxel, considerando os critérios descritos acima, os quais representaram 23,07 por cento. Contudo, sete imagens do grupo de 32 voluntários normais também foram apontadas com anormalidades de perfusão, que representou 21,8 por cento da amostra. CONCLUSÃO: O método de quantificação automatizada não foi considerado como uma ferramenta útil na prática clínica, como forma de análise complementar à inspeção visual.

Evaluación del compromiso neuropsiquiátrico mediante SPECT cerebral en las enfermedades colágeno-vasculares / Evaluation of neuropsychiatric involvement by brain SPECT in systemic connective tissue diseases

Objetivo: Estudiar el valor del SPECT cerebral en el diagnóstico y control evolutivo del compromiso del SNC en las enfermedades colágenovasculares (ECV) con sintomatología neuropsiquiátrica (SNP). Materiales y métodos: Se analizaron retrospectivamente 31 pacientes consecutivos portadores de ECV con SNP evaluados mediante SPECT cerebral con 99mTc-ECD y mapas estadísticos de superficie cortical. Veintiuno de ellos presentaban LES y 6 una enfermedad de Behçet. A 18 pacientes se efectuó además TC, a 8 RM y a 10 estudio neuropsicológico (ENP). Seis pacientes se realizaron SPECT de control. Resultados: Veintiocho pacientes presentaron SPECT patológico. La TC fue anormal en sólo 3/18 (sensibilidad 90,3 por ciento vs. 16,7 por ciento; p<0,001). La RM mostró alteraciones en 5/8 pacientes y el ENP en 7/10. Aunque todos estos pacientes presentaron SPECT patológico, los valores de sensibilidad no difirieron significativamente. Los pacientes con mayor SNP presentaron trastornos de perfusión más extensos (p<0,035). Los pacientes estudiados evolutivamente mostraron mejoría de los defectos con la respuesta al tratamiento y agravamiento con la reaparición de síntomas. Conclusiones: El SPECT cerebral presenta elevada sensibilidad en la detección del compromiso neuropsiquiátrico en las ECV. Su utilidad podría extenderse al control evolutivo y la evaluación de la respuesta terapéutica.

Objetive: 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 Behçet 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 percent vs. 16.7 percent; 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.

Estudio sobre las alteraciones de la perfusión cerebral valorado mediante SPECT cerebral, en pacientes usuarios de drogas de abuso / Study of brain perfusion anomalies assessed with cerebral SPECT in drug abuse patients

El abuso de sustancias psicotóxicas representa un gran problema de Salud Pública en los diferentes distritos estatales. Este trabajo pretende determinar cuáles son los efectos nocivos de estas sustancias sobre el parénquima cerebral de los pacientes en los que se ha demostrado un consumo activo de drogas prohibidas. Para ello se empleó la técnica de SPECT cerebral con ECD - 99mTc aplicada a aquellos pacientes adictos, a los cuales previamente se les realizó una encuesta para conocer el tipo de droga, el tiempo y la duración de su adicción. Como resultado se detectó que el mayor número de defectos de perfusión corticales, es decir, déficits funcionales, se localizaron en la corteza órbito-frontal y en los lóbulos temporales, lo cual explicaría los importantes trastornos de conducta y personalidad que manifiestan estos pacientes. Se demostró con este método que el SPECT cerebral es un excelente método para detectar las zonas afectadas por estas drogas psicoadictivas, su extensión y la evolución y posible respuesta al tratamiento.

Psychoactive drug abuse is a major public health problem in many districts. This study seeks to determine the harmful effects of such drugs on the brain parenchyma of patients known to abuse illegal drugs. Brain scans were obtained using 99 M Tc- ECD SPECT from drug addicts that had been previously surveyed to ascertain the type of drug, the timing and duration of their addiction SPECT findings showed a larger number of cortical perfusion defects, that is to say functional defects located in the orbital-frontal cortex and in the temporal lobes that may explain the significant behavior and personality disorders these patients display. Cerebral SPECT showed to be an excellent method to detect areas affected by psychoactive drugs, their extent, likely evolution and response to treatment.

Diagnosis of regional cerebral blood flow abnormalities using SPECT: agreement between individualized statistical parametric maps and visual inspection by nuclear medicine physicians with different levels of expertise in nuclear neurology

INTRODUCTION: Visual analysis is widely used to interpret regional cerebral blood flow (rCBF) SPECT images in clinical practice despite its limitations. Automated methods are employed to investigate between-group rCBF differences in research studies but have rarely been explored in individual analyses. OBJECTIVES: To compare visual inspection by nuclear physicians with the automated statistical parametric mapping program using a SPECT dataset of patients with neurological disorders and normal control images. METHODS: Using statistical parametric mapping, 14 SPECT images from patients with various neurological disorders were compared individually with a databank of 32 normal images using a statistical threshold of p<0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). Statistical parametric mapping results were compared with visual analyses by a nuclear physician highly experienced in neurology (A) as well as a nuclear physician with a general background of experience (B) who independently classified images as normal or altered, and determined the location of changes and the severity. RESULTS: Of the 32 images of the normal databank, 4 generated maps showing rCBF abnormalities (p<0.05, corrected). Among the 14 images from patients with neurological disorders, 13 showed rCBF alterations. Statistical parametric mapping and physician A completely agreed on 84.37 percent and 64.28 percent of cases from the normal databank and neurological disorders, respectively. The agreement between statistical parametric mapping and ratings of physician B were lower (71.18 percent and 35.71 percent, respectively). CONCLUSION: Statistical parametric mapping replicated the findings described by the more experienced nuclear physician. This finding suggests that automated methods for individually analyzing rCBF SPECT images may be a valuable resource to complement visual inspection in clinical practice.

Alterations of Regional Cerebral Blood Flow in Major Depressive Disorder / 핵의학분자영상

PURPOSE: The authors analyzed how the regional cerebral blood flow (rCBF) findings of patients with major depression differ from the normal control, and our results were compared to previous reports. MATERIALS AND METHODS: Twelve patients fulfilling DSM-IV criteria for major depression who were off all psychotropic medications for >4weeks (male: 7, female: 5, age range: 19~52 years, average age: 29.3+/-9.9 years) and 14 normal volunteers (male: 8, female: 6, age range: 19~53 years, average age: 31.4+/-9.2 years) were recruited. Images of brain perfusion SPECT were obtained using Tc-99m ECD and patterns of the rCBF were compared between patients with major depression and the healthy control subjects. RESULTS: The patients with major depression showed increase of the r-CBF in right lingual gyrus, right fusiform gyrus, left lingual gyrus, left precuneus, and left superior temporal gyrus, and showed decrease of r-CBF in right pons, left medial frontal gyrus, cingulate gyrus of left limbic lobe, cingulate gyrus of right frontal lobe, and cingulate gyrus of right limbic lobe compared to the normal control. CONCLUSION: The Tc-99m ECD brain perfusion SPECT findings in our study did not differ from the previously reported regional cerebral blood flow pattern of patients with major depression. Especially, decreased rCBF pattern typical to major depression patients in the right pons, left medial frontal gyrus, and cingulate regions was clearly demonstrated.

Assessment of Cerebral Hemodynamic Changes in Pediatric Patients with Moyamoya Disease Using Probabilistic Maps on Analysis of Basal/Acetazolamide Stress Brain Perfusion SPECT / 핵의학분자영상

To evaluate the hemodynamic changes and the predictive factors of the clinical outcome in pediatric patients with moyamoya disease, we analyzed pre/post basal/acetazolamide stress brain perfusion SPECT with automated volume of interest (VOIs) method. METHODS: Total fifty six (M:F=33:24, age 6.7+/-3.2 years) pediatric patients with moyamoya disease, who underwent basal/acetazolamide stress brain perfusion SPECT within 6 before and after revascularization surgery (encephalo-duro-arterio-synangiosis (EDAS) with frontal encephalo-galeo-synangiosis (EGS) and EDAS only followed on contralateral hemisphere), and followed-up more than 6 months after post-operative SPECT, were included. A mean follow-up period after post-operative SPECT was 33+/-21 months. Each patient's SPECT image was spatially normalized to Korean template with the SPM2. For the regional count normalization, the count of pons was used as a reference region. The basal/acetazolamide-stressed cerebral blood flow (CBF), the cerebral vascular reserve index (CVRI), and the extent of area with significantly decreased basal/acetazolamide-stressed rCBF than age-matched normal control were evaluated on both medial frontal, frontal, parietal, occipital lobes, and whole brain in each patient's images. The post-operative clinical outcome was assigned as good, poor according to the presence of transient ischemic attacks and/or fixed neurological deficits by pediatric neurosurgeon. RESULTS: In a paired t-test, basal/acetazolamide-stressed rCBF and the CVRI were significantly improved after revascularization (p<0.05). The significant difference in the pre-operative basal/acetazolamide-stressed rCBF and the CVRI between the hemispheres where EDAS with frontal EGS was performed and their contralateral counterparts where EDAS only was done disappeared after operation (p<0.05). In an independent student t-test, the pre-operative basal rCBF in the medial frontal gyrus, the post-operative CVRI in the frontal lobe and the parietal lobe of the hemispheres with EDAS and frontal EGS, the post-operative CVRI, and deltaCVRI showed a significant difference between patients with a good and poor clinical outcome (p<0.05). In a multivariate logistic regression analysis, the deltaCVRI and the post-operative CVRI of medial frontal gyrus on the hemispheres where EDAS with frontal EGS was performed were the significant predictive factors for the clinical outcome (p=0.002, p=0.015). CONCLUSION: With probabilistic map, we could objectively evaluate pre/post-operative hemodynamic changes of pediatric patients with moyamoya disease. Specifically the post-operative CVRI and the post-operative CVRI of medial frontal gyrus where EDAS with frontal EGS was done were the significant predictive factors for further clinical outcomes.

Two Patients with Hemiparesis as Manifestation of Status Epilepticus

Inhibitory motor seizure or ictal hemiparesis is very infrequent seizure type and sometimes difficult to differentiate from acute cerebrovascular disease. We report two patients with hemiparesis as manifestation of status epilepticus. One patient showed epileptic discharge on midline frontocentral region by EEG-Video monitoring, another patient showed continuous slowing wave associated with hyperperfusion findings of brain SPECT on left fronto-temporo-parietal region. Both patients showed normal brain imaging.

Dopamine Transporter Density of the Basal Ganglia Assessed with I-123 IPT SPECT in Methamphetamine Abusers / 대한핵의학회잡지

PURPOSE: Functional imaging of dopamine transporter (DAT) defines integrity of the dopaminergic system, and DAT is the target site of drugs of abuse such as cocaine and methamphetamine. Functional imaging the DAT may be a sensitive and selective indicator of neurotoxic change by the drug. The aim of the present study is to evaluate the clinical implications of qualitative/quantitative analyses of dopamine transporter imaging in methamphetamine abusers. MATERIALS AND METHODS: Six detoxified methamphetamine abusers (abuser group) and 4 volunteers (control group) were enrolled in this study. Brain MRI was performed in all of abuser group. Abuser group underwent psychiatric and depression assessment using brief psychiatric rating scale (BPRS) and Hamilton depression rating scale (HAMD), respectively. All of the subjects underwent I-123 IPT SPECT (IPT SPECT). IPT SPECT image was analysed with visual qualitative method and quantitative method using basal ganglia dopamine transporter (DAT) specific/non-specific binding ratio (SBR). Comparison of DAT SBR between abuser and control groups was performed. We also performed correlation tests between psychiatric and depression assessment results and DAT SBR in abuser group. RESULTS: All of abuser group showed normal MRI finding, but had residual psychiatric and depressive symptoms, and psychiatric and depressive symptom scores were exactly correlated (r=1.0, p=0.005) each other. Five of them showed abnormal finding on qualitative visual I-123 IPT SPECT. Abuser group had lower basal ganglia DAT SBR than that of control (2.38+/-0.20 vs 3.04+/-0.27, p=0.000). Psychiatric and depressive symptoms were negatively well correlated with basal ganglia DAT SBR (r=-0.908, p=0.012, r=-0.924, p=0.009). CONCLUSION: These results suggest that dopamine transporter imaging using I-123 IPT SPECT may be used to evaluate dopaminergic system of the basal ganglia and the clinical status in methamphetamine abusers.

Akinetic-Rigid Syndrome in a Case of Post-traumatic Encephalopathy: Brain SPECT Finding

Head trauma has been mentioned as an uncommon cause of secondary Parkinsonism. We report a 68-year-old woman who developed a rapidly evolving post-traumatic encephalopathy with predominant akinetic-rigid syndrome. The clinical manifestations were mainly bradykinesia, rigidity, cognitive dysfunction and emotional lability. Brain SPECT showed perfusion defect in the left basal ganglia and thalamus. The parkinsonian symptoms improved moderately with levodopa.

The Clinical Usefulness of Tc-99m ECD Brain SPECT in Acute Measles Encephalitis / 대한핵의학회잡지

PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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%). CONCLUSION: We conclude that SPECT is more useful than MRI for the detection of brain involvement in patients with acute measles encephalitis.

A Case of Frontotemporal Dementia with Family History

The average age of frontotemporal dementia onset is much younger than that of the Alzheimer's disease. Behavioral disturbances occur at the early stage of frontotemporal dementia, and social dysfunction and personality deterioration may ensue. For this reason, it may be misdiagnosed as other psychiatric disorders. Therefore, more careful observation and concern is required for proper diagnosis. This report is about the case of a patient who had been misdiagnosed of disorders like schizotypal personality disorder, schizophrenia, obsessive compulsive disorder etc., and therefore have been treated for those. We reviewed this case based on the data of neuropsychiatric history, family history, neuropsychological test, brain MRI, and SPECT, and considered this case as frontotemporal dementia with family history. This is the first frontotemporal dementia case with family history in Korea, so hereafter we may discover the gene locus associated with this case. This study can be very useful for the following frontotemporal dementia studies in Korea.

The Findings and Significances of Brain SPECT in Acute Mealses Encephalitis

PURPOSE: Acute measles encephalitis(ME) is characterized by an abrupt onset of fever and obtundation, frequently accompanied by seizures and multifocal neurological signs. The aim of this study was to clarify the clinical manifestation, progression and the brain SPECT patterns in patients with acute ME. METHODS: This study included 11 children with acute ME admitted to Chonbuk National University Hospital. Ten patients received a first dose of measles vaccine, one patient did not receive a first dose, and no patients received a second dose. ME was diagnosed based on characteristic clinical pictures, measles antibodies by ELISA and abnormal CSF findings. Brain MRI and brain SPECT were performed in 11 patients with acute ME. RESULTS: There were four males and seven females whose ages at onset ranged between 18 months and 14 years(mean : 10.5 years). The main clinical neurologic pictures were loss of consciousness(10) and seizure(five). The titer of IgG and IgM antimeasles antibodies in serum were positive in 10 patients. In CSF, nine patients had IgG antibodies and one patient had IgM antibodies. The concentration of protein(mean : 124+/-60 mg/dL) and WBC counts(mean : 158+/-157/microL) in CSF were elevated in all patients. In electroencephalographic examination, nine patients showed increased slow waves. Seven of 11 patients(63.6%) revealed high signal intensity on the brain MRI. In contrast, all patients showed hypoperfusion in brain SPECT examination. According to brain SPECT, the perfusion deficits were frequently observed in the frontal lobe(nine), temporal (nine), parietal(eight) and thalamus(eight). CONCLUSION: Brain SPECT is more sensitive than MRI for the evaluation of brain damage in early stages of acute ME.

Cerebrovascular Reactivity in Dementia of Alzheimer's Type Assessed by Acetaxolamide Brain SPECT / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the abnormality of cerebrovascular reactivity in patients with dementia of Alzheimer's type by the acetazolamide brain SPECT, which has been used in the assessment of cerebrovascular diseases. METHODS: Eighteen patients with dementia of Alzheimer's type, as diagnosed by the criteria of DSM-IV and NINCDS-ADRDA, and ten normal comparison subjects were recruited. They were rated by Mini-Mental Status Examination, Mattis Ddementia Rating Scale, and Hamilton Depression Rating Scale. Acetazolamide brain SPECT scans of dementia patients and comparison subjects were analyzed by 3-dimensional volume of interest method. RESULTS: The results were as follows. There were significant differences in the values of cerebrovascular reactivity between the two groups. The cerebrovascular reactivity of dementia patients was significantly decreased in the right frontal lobes, and increased in left temporal lobe, compared to comparison subjects(p<0.05). CONCLUSION: These results imply the possible role of the abnormality of cerebrovascular reactivity in the pathophysiology of dementia of Alzheimer's type.

SPECT Imaging of Dopamine Transporter with I-123 IPT in Normal Controls and Parkinson's Patients

OBJECTIVES: Dopamine transporter concentrations have been known to decrease in Parkinson's disease(PD). The aim of the present study was to evaluate the correlation between SPECT measurements of [I-123]N-(3-iodopropene-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane(IPT) as an imaging agent for measuring changes in transporter concentrations with PD. PATIENTS AND METHODS:IPT labelled with 4.87+/-1.29mCi(180.19+/-47.73 MBq) of [I-123] was intravenously injected into 23 patients(age:58+/-12) with PD and three normal controls(NC)(age:37+/-7) as bolus. Brain SPECT were then performed at 1 hour and 2 hours after injection on a double headed camera. The statistical parameters were the contrast ratio of left basal ganglia(BG) and right basal ganglia to occipital cortex(OCC) per milli curies of injected radiotracer at 1 hour and 2 hours. The correlations were evaluated between these parameters and Hoehn-Yahr classification of the patients. RESULTS: The(BG-OCC)/OCC/mCi ratios at 1 hour and 2 hours for PD and NC were 0.14+/-0.07 and 0.27+/-0.07(1 hour) and 0.12+/-0.07 and 0.34+/-0.04(2 hour), respectively. The(BG-OCC)/OCC/mCi ratios of Parkinson's disease were decreased with higher grade of Hoehn-Yahr classification of the patients. The ratio between BG and OCC for PD were clearly separated from NC and may be useful outcome measures for clinical diagnosis. CONCLUSION: The findings suggest that IPT may be a very useful tracer for early diagnosis and treatment of PD and study of dopamine re-uptake site.

Contralateral Hyperperfusion on Single Photon Emission ComputedTomograhy (SPECT) in the Patient with Todd's Paralysis

It has been known that the usual findings of SPECT in patients with Todd's paralysis is the hypoperfusion of the corresponding hemisphere. We experienced a patient who developed transient hemiparesis after a seizure attack with hyperperfusion rather than hypoperfusion over the corresponding hemisphere on brain SPECT. A 36-year-old female presented with left hemiparesis after a secondarily generalized tonic seizure. No additional seizure-like attack was noted during admission. EEG showed intermittent focal slow waves over the right frontotemporal area on admission and returned to a normal pattern 72 hours after admission. Tc-99m ECD SPECT showed hyperperfusion on the right frontoparietal area in spite of the normalization of EEG. The degree of hyperperfusion was diminished as time passed for at least 72 hours. We report a patient who had Todd's paralysis associated with contralateral frontoparietal hyperperfusion. Todd's paralysis may be explained as the result of focal discharges that lead to local vasomotor changes.

A Case of Primary Lateral Sclerosis Showing Degeneration ofCorticospinal Tract on Magnetic Resonance Imaging

Primary lateral sclerosis (PLS) is a rare upper motor neuron disease characterized by selective degeneration of corticospinal and corticobulbar tracts. It is important to rule out other diseases presenting as progressive spastic paraparesis, such as multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS). Though that is not so difficult as the development of imaging technique and neurophysiological tool, if one shows slow progressive spastic paraparesis clinically, and there is no abnormal CSF or EMG findings, it is not easy to differentiate between primary progressive MS and PLS. In fact, PLS is so rare that it has long been debated whether PLS is a disease entity or syndrome or a nothing. But we present a PLS patient whose brain MRI shows diffuse signal change along the bilateral corticospinal tracts and the hypoperfusion of frontal motor cortex is proved by brain SPECT.

Reversible Cerebral Hypoperfusion in Cyclosporine Neurotoxicity: A Case Report / 대한핵의학회잡지

We experienced a case of cerebral hypoperfusion due to cyclosporine neurotoxocity confirmed only by Tc-99m ECD brain SPECT. A 53-year-old female had received allogenic peripheral blood stem cell transplantation due to refractory plasmacytoid lymphoma. Cyclosporine and steroid had been administrated to prevent graft versus host disease. Twenty days after transplantation, she became delirious and suffered from generalized tonic-clonic seizure. Immediately, brain MRI and MR angiography were performed and these studies did not show any abnormal findings. However, Tc-99m ECD brain SPECT showed diffuse hypoperfusion in the left cerebral hemisphere and blood cyclosporine level was 962.6 ng/ml. Cyclosporine administration was stopped and discontinuation of cyclosporine resulted in disappearance of all neurological symptoms. The same neurological symptoms recurred with cyclosporine re-administration for management of exacerbated graft versus host disease. In this case, Tc-99m ECD brain SPECT proved very helpful in the diagnosis of cycloporine neurotoxicity.

A Case of Aphasic Status with Brain 99m-Tc Ethyl Cysteinate Diethylester Single Photon Emission Computed Tomography Demonstrating Focal Hyperperfusion

We present a 79-year-old male with aphasic status that was confirmed by a 99m-Tc ethyl cysteinate diethylester (ECD) single photon emission computed tomography (SPECT). He was admitted to our hospital due to a sudden onset of aphasia. In a Korean-version Western Aphasia Battery (K-WAB) test, the patient was diagnosed with Wernicke's aphasia (aphasia quotient (AQ)=54.50). In a brain magnetic resonance image (MRI) revealed the lesion of an old intracranial hemorrhage in the left posterior temporal area. An electroencephalography (EEG) showed continuous slowing in the left temporal area. SPECT demonstrated focal hyperperfusion in the left temporal cortex anterior to the lesion. After the administration of phenytoin, the aphasia was much improved (follow-up K-WAB : AQ=70.00). In follow-up studies two months later, EEG showed no interval changes and SPECT revealed no focal hyperperfusion in the left temporal area. Simple partial seizure is not easy to diagnose especially when manifesting with nonmotor symptoms such as aphasia. In this case, Wernicke's apha-sia was the only manifestation of epileptic seizure, the EEG did not show any definite epileptiform discharges. SPECT showed focal hyperperfusion in the left temporal area which was supposed to be a seizure focus. We conclude that SPECT might be useful in diagnosing a simple partial seizure manifesting as aphasia without EEG change.