Clinical impact of correlative [123I]-FP-CIT brain imaging and neurological findings in suspect Parkinson's disease.

PURPOSE: Here we report our experience in a general hospital setting using [(123)I]-FP-CIT SPECT to diagnose patients with suspect Parkinson's disease (PD). MATERIALS AND METHODS: Thirty consecutive patients (19M, 11W, mean age: 61+/-13 years) were prospectively studied. Patients underwent MRI (27) at 1.5T or CT (3) when MRI was contraindicated, to rule out focal brain abnormalities. Motor and cognitive function were evaluated by neurologists with UPDRS and Hoehn e Yahr Scale. [(123)I]-FP-CIT striatal uptake, assessed with SPECT, was classified as normal, non-diagnostic, abnormal (unilateral or bilateral). Imaging results (SPECT+MRI) were correlated with the neurological findings. RESULTS: In 5 patients the [(123)I]-FP-CIT brain SPECT was normal, suggesting that their symptoms could be related to a benign disorder such as essential tremor. Two patients had non-diagnostic [(123)I]-FP-CIT brain SPECT, with MRI/CT findings compatible with subcortical cerebrovascular disease. In the remaining 23 patients abnormal striatal [(123)I]-FP-CIT uptake correlated with neurological findings, significantly increasing the probability of Parkinson's disease. In these patients MRI/CT scans were normal, or showed a mild BA, or mild cerebral vascular disease (mild CVD). CONCLUSIONS: Our results suggest that [(123)I]-FP-CIT scan could be used routinely in clinical practice to support the diagnosis of PD and to differentiate between other conditions. Moreover, FP-CIT could significantly impact treatment selection and follow-up of these patients.

[Biohumoral markers and right ventricular dysfunction in acute pulmonary embolism: the answer to thrombolytic therapy]. / Marker bioumorali e disfunzione del ventricolo destro in corso di tromboembolia polmonare: risposta alla terapia trombolitica.

BACKGROUND: Recent data suggest that brain natriuretic peptide (BNP) and troponin I (TnII) are useful markers of right ventricular dysfunction (RVD) and initial myocardial injury in acute pulmonary embolism. The aim of this study was to evaluate biohumoral activation and right ventricular function in patients with acute pulmonary embolism diagnosed at pulmonary scintigraphy. METHODS: We observed 12 patients with massive pulmonary embolism (MPE), 8 with non-massive pulmonary embolism (NMPE) and RVD, 6 with NMPE without RVD. All the patients with MPE and 5 patients with NMPE-RVD received thrombolytic therapy (urokinase or recombinant tissue-type plasminogen activator), the others were treated with heparin. At the beginning and after pharmacological treatment all the 26 patients underwent standard echocardiography and blood test analysis. RESULTS: BNP and Tn1 were significantly high in MPE (BNP p < 0.001 and Tn1I p < 0.005 vs NMPE) and in NMPE-RVD (BNP p < 0.03 and Tnl p < 0.02 vs NMPE). MPE and NMPE-RVD had similar RVD (p = NS), thrombolysis significantly reduced BNP, TnI, systolic pulmonary pressure, both in MPE (p < 0.001) and in NMNPE-RVD (BNP and Tnl p < 0.05, systolic pulmonary pressure p < 0.001). COULSION: Our data sustain the utility of BNP and Tnl as markers of RVD in acute pulmonary embolism; they focus on patients with NMPE-RVD and high levels of BNP and Tnl in whom an aggressive therapy as the thrombolytic one is necessary; they suggest the importance of biohumoral markers as indicators of the efficacy of pharmacological treatment in patients with acute pulmonary embolism.