Soybean isoflavones alleviate cerebral ischemia/reperfusion injury in rats by inhibiting ferroptosis and inflammatory cascade reaction / 南方医科大学学报

OBJECTIVE@#To explore the mechanism that mediates the effect of soybean isoflavones (SI) against cerebral ischemia/reperfusion (I/R) injury in light of the regulation of regional cerebral blood flow (rCBF), ferroptosis, inflammatory response and blood-brain barrier (BBB) permeability.@*METHODS@#A total of 120 male SD rats were equally randomized into sham-operated group (Sham group), cerebral I/R injury group and SI pretreatment group (SI group). Focal cerebral I/R injury was induced in the latter two groups using a modified monofilament occlusion technique, and the intraoperative changes of real-time cerebral cortex blood flow were monitored using a laser Doppler flowmeter (LDF). The postoperative changes of cerebral pathological morphology and the ultrastructure of the neurons and the BBB were observed with optical and transmission electron microscopy. The neurological deficits of the rats was assessed, and the severities of cerebral infarction, brain edema and BBB disruption were quantified. The contents of Fe2+, GSH, MDA and MPO in the ischemic penumbra were determined with spectrophotometric tests. Serum levels of TNF-α and IL-1βwere analyzed using ELISA, and the expressions of GPX4, MMP-9 and occludin around the lesion were detected with Western blotting and immunohistochemistry.@*RESULTS@#The rCBF was sharply reduced in the rats in I/R group and SI group after successful insertion of the monofilament. Compared with those in Sham group, the rats in I/R group showed significantly increased neurological deficit scores, cerebral infarction volume, brain water content and Evans blue permeability (P < 0.01), decreased Fe2+ level, increased MDA level, decreased GSH content and GPX4 expression (P < 0.01), increased MPO content and serum levels of TNF-α and IL-1β (P < 0.01), increased MMP-9 expression and lowered occludin expression (P < 0.01). All these changes were significantly ameliorated in rats pretreated with IS prior to I/R injury (P < 0.05 or 0.01).@*CONCLUSION@#SI preconditioning reduces cerebral I/R injury in rats possibly by improving rCBF, inhibiting ferroptosis and inflammatory response and protecting the BBB.

Research progresses of arterial spin labeling imaging in mild cognitive impairment / 中国医学影像技术

Mild cognitive impairment (MCI) is a prodromal stage of Alzheimer's disease (AD), the pathogenesis of AD is still unclear. Cerebral blood flow is an important indicator of brain function. Various causes lead to decreased regional cerebral blood flow (rCBF) and damage brain. Arterial spin labeling (ASL) MRI is an imaging technology that measure rCBF by magnetizing hydrogen protons in labeled arterial blood as endogenous tracers. The progresses of ASL imaging in early diagnosis and monitoring progression as well as evaluation on therapeutic effects of MCI were reviewed in this article.

Protective Effect of Dandeng Tongnao Capsule (DDTN) on Cerebral Ischemia Reperfusion Rats / 中国药学杂志

OBJECTIVE: To observe the protective effects of Dandeng Tongnao capsule (DDTN) on cerebral ischemia reperfusion injury in rat and explore its mechanism so as to reevaluation the clinical efficacy of DDTN. METHODS: Middle cerebral artery occlusion (MCAO) model in rats was established using filament method and reperfusion was processed with filament removed 2 h later. Therefore, the MCAO models were established to observe the effect of DDTN-L group (0.21 g•kg-1) and DDTN-H group (0.84 g•kg-1) on infract volume via TTC staining. Regional cerebral blood flow(rCBF) of corpus striatum of the side of cerebral infraction was measured by using laser doppler flow (LDF). Pathological changes of neuron in hippocampuses were observed via hematoxylin and eosin (HE) staining and transmission electron microscopy (TEM).The changes of amino acid in cerebral ischemia were detected by microdialysis system. The level of Ca2+ was evaluated by flow cytometer (FCM). RESULTS: The results showed that the cerebral blood flow increased and infract volume reduced at 7, 14 d in DDTN group. Analysis of HE staining and TEM scan suggested that DDTN (0.21, 0.84 g•kg-1) remarkably alleviated neuronal injury of hippocampal CA1 area during I/R. The contents of Ca2+ and excitatory amino acids were significantly decreased in DDTN group. CONCLUSION: DDTN could prevent cerebral injury of MCAO rats via decreasing the intracellular Ca2+ concentration, and inhibiting the release of excitatory amino acids.

Clinical study of electroacupuncture and Shenmai injection combined with conventional western therapy as treatments for the sudden deafness / 国际中医中药杂志

Objective To observe the clinical effect of electroacupuncture and Shenmai injection combined with conventional western therapy as treatments for the sudden deafness.Methods A total of 186 patients with sudden deafness were randomly divided into two groups. Each group included 93 patients. The control group was treated with the pipe-expanding and anti-inflammatory, but the treatment group was treated with electroacupuncture and Shenmai injection based on the control group. Both groups were treated for 11 days.Before and after treatments, the regional cerebral blood flow (rCBF) was detected. The MADSEN was used to detect ocular vestibular evoked myogenic potential (oVEMP), including N1-Pl amplitude, N 1-Pl incubation period, N1-Pl wave duration and extraction rate of oVEMP.Results The recovery rate of control group was 63.4% (59/93) and total effective rate was 90.3% (84/93), which was 88.6% (75/93) and 97.8% (91/93) in combined treatment group, and there was significant difference between the 2 groups (χ2=5.923,P<0.05). After 11 days of treatment, the Tinnitus (17.2%vs. 30.1%,χ2=7.152), vertigo and survival rate (15.1%vs. 21.5%, χ2=6.023) in combined treatment group showed significantly lower than those in the control group (P<0.05). The threshold (39.59 ± 5.36 dBHLvs. 45.85 ± 5.08 dBHL,t=2.903) in combined treatment group showed significantly lower than those in the control group (P=0.034). The N1 amplitude (10.62 ± 0.84μVvs. 7.14 ± 0.59μV;t=3.259,P=0.017), P1 amplitude (11.79 ± 0.91μVvs. 9.90 ± 0.82μV;t=2.871,P=0.037), extraction rate of oVEMP (95.7%vs. 81.7%;χ2=7.963,P=0.012) in combined treatment group showed significantly higher than those in the control group. The N1 incubation period (7.86 ± 0.82 msvs. 9.78 ± 1.24 ms;t=3.729,P=0.009) and Pl incubation period (6.57 ± 0.77 msvs. 9.39 ± 1.15 ms;t=3.064,P=0.025) in combined treatment group showed significantly lower than those in the control group.Conclusions The Electroacupuncture and Shenmai injection combined with conventional western therapy could improve blood circulation produce a synergistic therapeutic effect on damaged tissue, improve cochlear hair cells and vestibular nerve regeneration, and repaire the functions.

Changes in Regional Cerebral Perfusion after Nicergoline Treatment in Early Alzheimer's Disease: A Pilot Study

BACKGROUND AND PURPOSE: Nicergoline is an ergoline derivative that is used to treat cognitive deficits in cerebrovascular disease and various forms of dementia. Although therapeutic effects of nicergoline have been established, little is known about its effects on cerebral perfusion in Alzheimer's disease (AD). The aim of this study was to examine the role of nicergoline in regional cerebral blood flow (rCBF) of AD patients using technetium-99m hexa-methyl-propylene-amine-oxime single photon emission computed tomography (SPECT). METHODS: Sixteen patients with early AD underwent a comprehensive clinical assessment including cognitive testing and SPECT scans before and after nicergoline treatment. Nicergoline (30 mg twice daily) was administered for an average duration of 1.5 years. Clinical and cognitive functioning was assessed using the Mini-Mental State Examination, Clinical Dementia Rating (CDR), CDR-Sum of Boxes, Global Deterioration Scale, Barthel Activities of Daily Living Index, Instrumental Activities of Daily Living, and Geriatric Depression Scale. RESULTS: Nicergoline treatment induced changes in the severity of dementia, cognitive function, activities of daily living, and depressive symptoms, which were not statistically significant. During the follow-up, the patients showed significant increases in their relative rCBF in the superior frontal gyrus, precentral gyrus, and postcentral gyrus. CONCLUSIONS: Nicergoline treatment improves perfusion of the frontal and parietal regions in early AD patients. It is possible that the increased perfusion in the superior frontal gyrus may be related to the mechanisms that delay or prevent progressive deterioration of cognitive functions in AD.

Effect of local mild hypothermia on regional cerebral blood flow in patients with cerebral infarction assessed by 99mTc-ECD SPECT imaging / 实用医学杂志

Objective To investigate the frequency of lesions detection in patients with cerebral infarction (CI) with SPECT/CT. To investigate fluctuation of regional cerebral blood flow (rCBF) and its relationship with clinical symptoms. Methods Sixty-seven CI patients without cerebellar lesion were randomly selected. The rCBF in the regions of interest (ROI) was examined by SPECT/CT, which was collected from the frontal lobe, temporal lobe, parietal lobe, occipital lobe, thalamus, basal ganglia and cerebellum. The rCBF index was calculated. The association between fluctuation of rCBF index and clinical symptoms of patients was explored. Results There were 251 positive regions in all viewing regions , the total positive rate was 31.2%. The left side was 38.1%, while the right side was 24.4% (χ2=17.522,P 0.05). However, the average rCBF on the left parietal lobe was lower (P 0.05). rCBF≥0.7 is a clinical sign of abnormal ROI. Conclusion 30% of ROI of CI patients have lesions and the positive rate of the left side was higher. The biological rCBF values of all lobes were different. Therefore, rCBF index could be used to reflect whether the ROI is normal. rCBF≥0.7 could be used as a sign to quantitatively assess abnormal ROI in clinical practice.

Longitudinal Cerebral Perfusion Changes in Parkinson's Disease with Subjective Cognitive Impairment

BACKGROUND AND PURPOSE: Although subjective cognitive impairment (SCI) is often accompanied by Parkinson's disease (PD) and may predict the development of mild cognitive impairment or dementia, longitudinal brain perfusion changes in PD patients with SCI remain to be elucidated. The current prospective study examined cerebral perfusion changes in PD patients with SCI using technetium-99m hexamethylpropylene amine oxime single photon emission computed tomography (SPECT). METHODS: Among 53 PD patients at baseline, 30 patients were classified into the PD with SCI group and 23 patients were assigned to the PD without SCI group. The mean follow-up interval was 2.3±0.9 years. The Mini-Mental State Examination, Clinical Dementia Rating, and Global Deterioration Scale were used to assess impairments in cognitive function. Brain SPECT images were acquired at baseline and follow-up. RESULTS: Significant differences between the two groups were not found for demographic variables, PD severity, or cognitive function at either baseline or follow-up. At baseline, the PD with SCI group showed decreased perfusion in the left angular gyrus compared to the PD without SCI group. Longitudinal analysis revealed widespread perfusion reductions primarily in the bilateral temporo-parieto-occipital areas and cerebellum in the PD with SCI group. Relative to the PD without SCI group, an excessive decrease of perfusion was found in the left middle frontal gyrus of the PD with SCI patients. CONCLUSIONS: Our findings suggest that perfusion deficits in the middle frontal area may play an important role in the pathophysiology of SCI in PD.

Effect of Electroacupuncture on Regional Cerebral Blood Flow in Patients with Post-stroke Depression / 中国康复理论与实践

Objective To explore the therapeutic effects of electroacupuncture on regional cerebral blood flow (rCBF) in patients with post-stroke depression. Methods 21 patients with post-stroke depression were randomly divided into electroacupuncture group (n=11) and drug group (n=10). The electroacupuncture group received electroacupuncture on double Hegu (LI4) and Taichong (LR3) once a day for 8 weeks, while the drug group took fluoxetine hydrochloride dispersible tablets 20 mg a day for 8 weeks. They were evaluated with Hamilton Self-rating Scale for Depression (HAMD) before, and 2 weeks, 4 weeks and 8 weeks after treatment respectively. The rCBF were measured with single positron emission computerized tomography (SPECT) before and 8 weeks after treatment. Results The score of HAMD de-creased more in the electroacupuncture group than in the drug group 2 weeks after treatment (P0.05). The rCBF was significantly greater in the electroacupuncture group than in the drug group. Conclusion That electroacupuncture is effective on post-stroke depression, which may be related with the increase of the rCBF levels.

Study on regional cerebral blood flow and correlated factors in patients with hepatolenticular degeneration / 中国医师进修杂志

Objective To study the regional cerebral blood flow (rCBF) and correlated factors in patients with hepatolenticular degeneration (HLD).Methods The rCBF of lentiform nucleus,thalamus and other sites in 14 patients with HLD of cerebral type (cerebral type group) and 10 patients with HLD of non-cerebral type (non-cerebral type group) were determined by magnetic resonance-perfusion imaging technology,meanwhile 13 healthy volunteers were selected as control group,and calculated the relative regional cerebral blood flow (rrCBF) for avoiding perfusion time lag.The correlation between the clinical symptom scores,the content of urinary copper,duration and rrCBF in HLD patients were evaluated.Results The rrCBF of cerebral type group in the left and right frontal lobe,temporal lobe,lentiform nucleus,caudate nucleus,thalamus,midbrain,pons and the left hippocampus,cerebellar cortex,dentate nucleus were lower than those of control group (1.91 ±0.35 vs.2.44 ±0.64,1.80 ±0.30 vs.2.37 ±0.65,1.37 ±0.35 vs.2.14 ±0.91,1.58 ±0.52 vs.2.39 ±0.99,1.61 ±0.38 vs.2.59 ±0.74,1.52 ±0.64 vs.2.63 ±0.73,1.88 ±0.32 vs.2.61 ±0.67,1.70 ±0.40 vs.2.35 ±0.50,1.48 ±0.13 vs.2.01 ±0.59,1.46 ±0.38 vs.2.38 ±0.99,1.47 ±0.55 vs.2.02 ±0.72,1.27 ±0.48 vs.1.91 ±0.51,1.24 ±0.38 vs.1.47 ±0.29,1.25 ±0.39 vs.1.53 ±0.37,1.74 ±0.27 vs.2.40 ±0.89,1.79 ±0.50 vs.2.22 ±0.66,2.15 ±0.41 vs.2.64 ± 0.61),and there were significant differences (P ＜ 0.05 or ＜ 0.01).There were no significant differences in the rrCBF of the parietal and occipital lobe,etc between cerebral type group and control group (P ＞ 0.05).The rrCBF of cerebral type group in the left and right lentiform nucleus were lower than those of non-cerebral type group (1.61 ± 0.38 vs.1.94 ± 0.58,1.52 ± 0.64 vs.1.99 ± 0.59),and there were significant differences (P ＜ 0.05).The clinical symptom scores were positively correlated with the rrCBF of the left and right lentiform nucleus in 24 patients with HLD (r =-0.792 and-0.764,P ＜ 0.01),the content of urinary copper and duration had no correlation with the rrCBF of the left and right lentiform nucleus(P ＞ 0.05).Conclusions The rCBF of cerebral type and non-cerebral type HLD is significantly reduced,cerebral type patients have lower rCBF than non-cerebral type patients.The rCBF is correlated with the clinical symptom scores.

Single emission computed tomography of cerebral blood flow between unipolar depressed patients and bi-polar depressed patients / 中国神经精神疾病杂志

Objective To investigate the characteristic of regional cerebral blood flow (r-CBF) in patients with major depression disorder (MDD) and bipolar depressed (BPD). Methods The r-CBF imaging was detected by using sin?gle emission computed tomography (SPECT) in 22 treatment naive patients with MDD, 22 treatment naive patients with BPD and 15 healthy controls. The r-CBF was compared between patients and controls. Results Compared to controls, the r-CBF in the bilateral temporal lobe, parietal lobe and basal ganglia significantly decreased in MDD and BPD pa?tients (P<0.001). The r-CBF in the basal ganglia was significantly lower in MDD patients than in BPD patients. Conclu?sion The r-CBF is abnormal in MDD and BPD at the resting state. The r-CBF in the basal ganglia is the main differ?ence between MDD and BPD. The difference might be regarded as a biomarker in distinguishing BPD patients from MDD patients.

Effect of Electroacupuncture on Regional Cerebral Blood Flow in Patients with Post-stroke Depression / 中国康复理论与实践

@#Objective To explore the therapeutic effects of electroacupuncture on regional cerebral blood flow (rCBF) in patients with post-stroke depression. Methods 21 patients with post-stroke depression were randomly divided into electroacupuncture group (n=11) and drug group (n=10). The electroacupuncture group received electroacupuncture on double Hegu (LI4) and Taichong (LR3) once a day for 8 weeks, while the drug group took fluoxetine hydrochloride dispersible tablets 20 mg a day for 8 weeks. They were evaluated with Hamilton Self-rating Scale for Depression (HAMD) before, and 2 weeks, 4 weeks and 8 weeks after treatment respectively. The rCBF were measured with single positron emission computerized tomography (SPECT) before and 8 weeks after treatment. Results The score of HAMD decreased more in the electroacupuncture group than in the drug group 2 weeks after treatment (P<0.05), and there was no significant difference between the two groups 4 and 8 weeks after treatment (P>0.05). The rCBF was significantly greater in the electroacupuncture group than in the drug group. Conclusion That electroacupuncture is effective on post-stroke depression, which may be related with the increase of the rCBF levels.

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.

Regional cerebral blood flow and cognitive function in patients with obsessive-compulsive disorder / Fluxo sanguineo regional cerebral e funcao cognitiva em pacientes com transtorno obsessivo compulsivo

Objective: To explore the relationship between regional cerebral blood flow (CBF) and cognitive function in obsessive-compulsive disorder (OCD). Method: Single-photon emission computed tomography (SPECT) was performed for 139 OCD patients and 139 controls, and the radioactivity rate (RAR) was calculated. Cognitive function was assessed by the Wisconsin Card Sorting Test (WCST). Results: The RARs of the prefrontal, anterior temporal, and right occipital lobes were higher in patients than controls. For the WCST, correct and classification numbers were significantly lower, and errors and persistent errors were significantly higher in OCD patients. Right prefrontal lobe RAR was negatively correlated with correct numbers, right anterior temporal lobe RAR was positively correlated with errors, and the RARs of the right prefrontal lobe and left thalamus were positively correlated with persistent errors. Conclusion: OCD patients showed higher CBF in the prefrontal and anterior temporal lobes, suggesting that these areas may be related with cognitive impairment. .

Objetivo: Estudar a relação entre a perfusão sanguínea regional cerebral e as funções cognitivas em pacientes com transtorno obsessivo compulsivo (TOC). Método: Foram estudados 139 pacientes com TOC e 139 controles. As imagens do fluxo sanguíneo cerebral foram feitas por single photon emission computed tomography e o radioactivity rate (RAR) foi calculado usando como referência a radioatividade do córtex cerebelar. As funções cognitivas foram avaliadas através do Wisconsin Card Sorting Test (WCST). Resultados: O RAR do lobo pré-frontal, do lobo temporal anterior e do lobo occipital direito foram mais elevados nos pacientes do que nos controles (P<0.05). Quanto ao WCST, os escores de números corretos (P<0.01) e de classificação (P<0.05) foram menores no grupo TOC do que nos controles; entretanto, os escores de erros e de erros persistentes nos controles foram mais elevados do que nos pacientes (P<0.01). O RAR do lobo pré-frontal direito estava relacionado de modo negativo com os números corretos; o RAR do lobo temporal anterior apresentava correlação positiva com os erros; o RAR do lobo pré-frontal direito e do tálamo esquerdo apresentavam correlação positiva com erros persistentes. Conclusão: Pacientes com TOC apresentaram perfusão sanguínea cerebral mais intensa no lobo pré-frontal e no lobo temporal anterior. O lobo pré-frontal direito, o lobo temporal e o tálamo esquerdo podem estar relacionados com alterações cognitivas. .

Effect of Electroacupuncture on Regional Cerebral Blood Flow in Patients with Post-stroke Depression / 中国康复理论与实践

@#Objective To explore the therapeutic effects of electroacupuncture on regional cerebral blood flow (rCBF) in patients with post-stroke depression. Methods 21 patients with post-stroke depression were randomly divided into electroacupuncture group (n=11) and drug group (n=10). The electroacupuncture group received electroacupuncture on double Hegu (LI4) and Taichong (LR3) once a day for 8 weeks, while the drug group took fluoxetine hydrochloride dispersible tablets 20 mg a day for 8 weeks. They were evaluated with Hamilton Self-rating Scale for Depression (HAMD) before, and 2 weeks, 4 weeks and 8 weeks after treatment respectively. The rCBF were measured with single positron emission computerized tomography (SPECT) before and 8 weeks after treatment. Results The score of HAMD decreased more in the electroacupuncture group than in the drug group 2 weeks after treatment (P<0.05), and there was no significant difference between the two groups 4 and 8 weeks after treatment (P>0.05). The rCBF was significantly greater in the electroacupuncture group than in the drug group. Conclusion That electroacupuncture is effective on post-stroke depression, which may be related with the increase of the rCBF levels.

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.

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.

Effect of hypertensive agent on regional cerebral blood flow in patients with hypertensive intracerebral hemorrhage / 中华急诊医学杂志

Objective To investigate effects of hypertensive agents on regional cerebral blood flow (rCBF)and prognosis in patients with hypertensive intracerebral hemorrhage (HICH). Method Thirty patients withFILCH were divided into group A,B and C according to mean arterial pressure(MAP) with various ranges of <10%, 10 ～ 20%, and > 20%, respectively. Patients of three groups were checked with single photon emissioncomputed tomography (SPECT),and computerized tomography of head successively, 24 hours, 3 ～ 5 days, and 12～ 15 days after admission for the assessment of therapeutic effects. The rtes of the decrease in rCBF compared be-twecn groups were analyzed with t test. Neurologic function defect scale, activities of living scale and number of re-bleeding compared between two groups were analyzed by X2 test, respectively. Results There were statisticallysignificant differences in the rate of the decrease in rCBF. The neurologic function defect scale and activities of liv-ing scale at 24 hours, 3 ～ 5 days, and 12 ～ 15 days after admission compared between group C and group A, andbetween group C and group B showed significant differences ( P < 0.05). There were statistically significant differ-enees in rebleeding during acute phase of HICH between group A and group B or group C (P < 0.05).Conclusions If the systolic blood pressure is above 185mmHg or diastolic blood pressure over 95mmHg,it is ra-tional and safe to lower the MAP by about 15% with hypotensive gents so as to minimize the impact on regionalcerebral blood flow.

The Effect of Low-frequency Repetitive Transcranial Magnetic Stimulation (rTMS) on Unilateral Spatial Neglect and Changes in Regional Cerebral Blood Flow (rCBF) / The Japanese Journal of Rehabilitation Medicine

Objective : To describe the effect of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) on unilateral spatial neglect (USN) in 22 right-handed stroke patients with right hemispheric damage and the corresponding change of regional cerebral blood flow (rCBF) before and after rTMS, speculating on the neural basis for recovery from USN. Methods : The time of onset to the initiation of rTMS was 70 to 220 days (mean : 128.3 days), on chronic stage in all patients. The therapeutic schedule consisted of 7 sessions of 1 Hz-rTMS delivered every other day for two weeks, with 14 sessions in two patients. Each session consisted of one train of 500 pulses applied over P5 (10/20 EEG system) at 90% motor threshold using a figure-eight-shaped coil. Assessment was made using the Japanese edition of the Behavioural Inattention Test (BIT) and a computed visual search task at four times as well as a cold-xenon CT (Xe-CT) at two times. Results : rTMS induced a significant improvement of USN patient performance in cancellation tasks and the BIT figure copy task as well as in visual search reaction time, an improvement which lasted 2 weeks after rTMS. Xe-CT showed a significant increase in rCBF in the right cerebellum after rTMS. Conclusions : It is conceivable that low-frequency rTMS may be useful for improving USN and it is a promising therapeutic tool. Also, the cerebellum, by forming a neural network with the parietal and frontal lobe, may play an important role in patient recovery from spatial neglect.

Effect of Repetitive Transcranial Magnetic Stimulation in Drug Resistant Depressed Patients / 핵의학분자영상

PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) has recently been clinically applied in the treatment of drug resistant depressed patients. There are mixed findings about the efficacy of rTMS on depression. Furthermore, the influence of rTMS on the physiology of the brain is not clear. We prospectively evaluated changes of regional cerebral blood flow (rCBF) between pre- and post-rTMS treatment in patients with drug resistant depression. MATERIALS AND METHODS: Twelve patients with drug-resistant depression (7 male, 5 female; age range: 19~52 years; mean age: 29.3+/-9.3 years) were given rTMS on right prefrontal lobe with low frequency (1 Hz) and on left prefrontal lobe with high frequency (20 Hz), with 20-minute-duration each day for 3 weeks. Tc-99m ECD brain perfusion SPECT was obtained before and after rTMS treatment. The changes of cerebral perfusion were analyzed using statistical parametric mapping (SPM; t=3.14, uncorrected p<0.01, voxel=100). RESULTS: Following areas showed significant increase in rCBF after 3 weeks rTMS treatment: the cingulate gyrus, fusiform gyrus of right temporal lobe, precuneus, and left lateral globus pallidus. Significant decrement was noted in: the precental and middle frontal gyrus of right frontal lobe, and fusiform gyrus of left occipital lobe. CONCLUSION: Low-frequency rTMS on the right prefrontal cortex and high-frequency rTMS on the left prefrontal cortex for 3 weeks as an add-on regimen have increased and decreased rCBF in the specific brain regions in drug-resistant depressed patients. Further analyses correlating clinical characteristics and treatment paradigm with functional imaging data may be helpful in clarifying the pathophysiology of drug-resistant depressed patients.

Regional Cerebral Perfusion Abnormalities Assessed with Brain SPECT in Early-onset Schizophrenia: Statistical Parametric Mapping Analysis

OBJECTIVES: A voxel based investigation of cerebral blood flow was conducted to identify functional differences during resting state between children with early-onset schizophrenia and normal controls. METHODS: 19 children and adolescents with early-onset schizophrenia(8 boys and 11 girls, mean age 14.0+/-1.7 years old) and 17 comparison children(13 boys and 4 girls, mean age 11.0+/-1.9 years old) were examined by HMPAO-SPECT. The SPECT images were compared using statistical parametric mapping analyses, controlling for age and sex. RESULTS: Increased cerebral blood flow in left medial and inferior frontal gyrus, right superior and middle frontal gyrus, both inferior temporal gyrus, and right cerebellar tonsil was found in children and adolescents with early-onset schizophrenia compared to control subjects. In addition, decreased cerebral blood flow in right thalamus, left posterior cingulate gyrus, right anterior cingulate gyrus and relatively wide areas from left medical frontal gyrus to superior parietal lobule were found in children and adolescents with early-onset schizophrenia compared to control subjects. CONCLUSION: The results of the current study provide additional evidences for brain areas involving the onset of schizophrenia in early age.