Mitigating the dilemma in dementia: A case series of the first amyloid brain PET scans in the Philippines

@#Diagnosis of Alzheimer dementia is done clinically using criteria set by different neurological associations. Inevitably, clinicians encounter cases that do not fulfill the set definitions and have to resort to supporting data to form a clinical judgment. Part of the ancillary work-up for dementia is the brain amyloid PET scan that has recently been available in the Philippines. It involves a radiopharmaceutical with high-affinity binding to amyloid plaques which for a time were thought to be central pathological finding for Alzheimer dementia. This study describes the first four amyloid PET scans in the Philippines and detail the protocol as well as interpretation of such studies. The procedure is not as simple and reproducible as one might think hence following the recommended protocol and interpretation guidelines are of utmost importance. We recommend standardization of the reporting of results for all centers that will cater to patients being worked up for dementia, which include reporting SUVRs for both whole cerebellum and cerebellar cortex. More studies are recommended to generate a local Florbetaben SUVR cutoff.

Value of Thallium-201 SPECT and SPECT/CT Brain Imaging in Differentiating Malignant From Nonmalignant Lesions: A Comparative Case-Series Study With Pathologic and/or Clinical Correlation

Background@#Thallium-201 single-photon emission computed tomography/computed tomography(SPECT/CT) brain scan is an imaging modality which can be done to differentiate between malignant and nonmalignant lesions among patients with nonconclusive findings on conventional neuroimaging. This study describes the results of thallium-201 SPECT/CT brain imaging and relate it to histopathologic and/or clinical findings and evaluate the value of thallium-201 SPECT/CT brain imaging in differentiating malignant from nonmalignant lesions. @*Methods@#This is a retrospective case series study of 10 patients with cerebral lesions who un-derwent thallium-201 SPECT/CT brain imaging in a hospital in the Philippines from 2010 to 2021. @*Results@#A total of 10 patients underwent thallium-201 SPECT/CT brain scan. Six had nega-tive results while 4 had positive results. All of the patients who had positive results were found to have malignancy, whether recurrent or newly diagnosed. All of the patients with negative scan were found to have either an infectious and inflammatory disease and responded to treatment albeit in different degrees. Two of the 10 patients underwent biopsy whose results were consistent with the thallium-201 SPECT/CT brain scan results. @*Conclusion@#Thallium-201 brain scan combined with SPECT and SPECT/CT has been demon-strated to be useful in distinguishing malignant from nonmalignant lesions and is more cost-effective versus other imaging techniques. The findings in this study support the role of thallium scintigraphy in the diagnosis of patients with brain lesions most significantly when there is a need to differentiate between a malignant and benign condition.