Early and delayed distribution of N-isopropyl-[123I]-p-iodoamphetamine in haemorrhagic and ischaemic brain.

Single photon emission computed tomography (SPECT) was used to study redistribution of N-isopropyl-[123I]-p-iodoamphetamine (IAMP) in 10 patients with intracerebral haemorrhage and 7 with ischaemic stroke. Delayed/early IAMP uptake ratios (D/E) were calculated for four different cerebral zones: haematoma or infarct, perilesional, normal and crossed cerebellar diaschisis areas. Delayed uptake was observed in all areas, but there were no significant differences between the haematoma and infarct results nor between the lesional and perilesional results. Delayed redistribution of IAMP therefore did not seem to be associated with neuronal metabolic activity.

[Alzheimer's disease: study by single photon emission tomography (Hm PAO Tc99m)]. / Maladie d'Alzheimer: étude par tomographie d'émission monophotonique (Hm PAO Tc99m).

Single photon emission tomography with Hm PAO Tc99m was used in 27 patients with probable Alzheimer's disease, 9 patients with multi-infarct, dementia, and 11 healthy volunteers. The data were quantified in 4 regions of interest (using the basal ganglia as an internal standard): left and right prefrontal areas (Fg and Fd), and left and right parietal areas (Pg and Pd). Pg and Pd indices were lower in patients with Alzheimer's disease than in patients with multi-infarct dementia, and healthy volunteers (p less than 0.05). The ratio (Fd + Pd)/(Fg + Pg) was lower in patients with dressing apraxia (p less than 0.02), anosognosia (p less than 0.001), spatial agnosia (p less than 0.01), ideomotor apraxia (p less than 0.02), ideatory apraxia (p less than 0.01), and constructive apraxia (p less than 0.01). No correlation could be established between this ratio and the severity of aphasia, or between the indices and mini mental state scores. With Pg and Pd indices lower than 0.90, sensitivity for Alzheimer's disease was 70 p. 100 and specificity, 75 p. 100.

[Tomographical use of Tc hexamethylpropylene amine-oxime. First experience (78 studies)]. / Utilisation tomographique de l'hexaméthylpropylène amine-oxyme Tc. Première expérience (78 études).

A new radiotracer of cerebral perfusion, 99mTc-labelled hexamethylpropylene amine-oxime, has been tried in 78 subjects: 6 controls and 72 patients. Qualitatively, the distribution of this tracer in healthy subjects was very much the same as that obtained with a reference method using 133xenon inhalation. Quantitatively, there was no correlation between the real blood flow rate and the normalized cerebral uptake rate. On the other hand, the asymmetry indices obtained in controls (but also in 16 patients) correlated very closely with those obtained with 133xenon. Our first results in acute ischaemic diseases as well as in the evaluation of vasospasm or Alzheimer-like presenile dementia point to wide fields of application for the new compound. Unlike its predecessors, it is always available and will probably be used, without any logistic investment, with the standard equipment of all Nuclear medicine departments.

[Computerized tomography of the distribution of N-isopropyl-p-123 iodoamphetamine in cerebrovascular pathology. Comparison with studies using the 133-xenon inhalation method]. / Mesure tomographique de la distribution de la N-isopropyl-p-123 iodo-amphétamine en pathologie vasculaire cérébrale. Comparison avec la mesure par inhalation de Xéno133.

123Iodo-Amphetamine (IAMP) brain distribution was studied with a specially dedicated multilevel tomographic system in 30 patients with vascular ischemic (18) or hemorrhagic (12) disorders. Results were compared with clinical data, CT scan and rCBF measurement obtained by the 133Xe continuous inhalation method. Abnormalities with IAMP were found in 27 cases, in good agreement with the results obtained by the Xenon inhalation technique in 21 studies from the 22 where that method was possible. For 80% cases there was also a good agreement between the results obtained by the IAMP and CT scan: one case normal, and 23 observations with abnormalities. This is true for the localization of lesions, but IAMP appears able to shown remote abnormalities, i.e. crossed cerebellar diaschisis or functional deactivation, in the absence of CT scan lesions in the corresponding areas. This is of particular interest in the protracted regressive ischemic neurologic disorders (PRIND): CT scan were normal in all five observations but IAMP showed abnormalities in four cases. IAMP is however very expensive, so it has to be used only when 133Xe inhalation is technically impossible.

[Gallium-67 scintigraphic evaluation of primary dilated myocardiopathies in adults]. / Le bilan scintigraphique au gallium 67 des myocardiopathies primitives dilatées de l'adulte.

Myocardiopathy (MCP) is diagnosed by exclusion in patients with congestive heart failure in the absence of lesions of the coronary vessels or cardiac valves. Endo-myocardial biopsies and several cases of clinical improvement under immunosuppressive therapy suggest that it may be due due to an immune mechanism. Gallium-67 is taken up by the myocardium and may be regarded as a scintigraphic marker of myocardial inflammation. It may therefore be used to determine which patients would benefit from immunosuppressants. Our study involved 47 patients (mean age 40.1 +/- 10.2 years) with MCP evidenced by angiography and coronary arteriography. Isotopic ejection fraction (EF) and Ga-67 uptake by the myocardium were evaluated in all cases. A significant Ga-67 uptake was observed in 22 patients, 20 of whom could be divided into two groups: group I received an immunosuppressive treatment (azathioprine plus prednisone); group II did not receive such treatment. A new radionuclide cardiac examination was carried out 5 months after the beginning of treatment. No significant Ga-67 uptake could be detected in either group. Significant improvement of EF was observed in 6 patients of group I and in 2 patients of group II. Four patients had died: 1 in group I and 3 in group II. Thus, a decrease in Ga-67 uptake was noted in all patients 5 months after the initial examination, irrespective of the treatment received, which suggests that this decrease belongs to the natural history of the disease. The effect of immunosuppressive therapy on MCP, therefore, ought to be re-evaluated.

[Disruptions of hemispheric blood flow and deep cerebral hematomas]. / Perturbations du débit sanguin hémisphérique et hématomes cérébraux profounds.

Cerebral blood flow measurements with single photon emission tomography and 133Xe inhalation was performed in 18 patients with hematomas, 14 thalamo-capsular, 4 capsulo-lenticular. In thalamo-capsular cases and in standard conditions, ipsilateral hemispheric C.B.F. and contralateral cerebellar C.B.F. were decreased; a concomitant depression of frontal and temporal C.B.F. was often noted. A similar change was found in capsulo-lenticular cases, the frontal C.B.F. being however less depressed. An attenuation of interhemispheric asymmetry was often found after acetazolamide intravenous injection. A significant correlation was demonstrated between interhemispheric asymmetry index (AI) and frontal and temporal AI.

[Simultaneous scintigraphy exploration using MDP - 99 Tc and 67GA in infectious osteoarticular pathology. Initial results]. / Exploration scintigraphique simultanée au MDP - 99mTc et au 67Ga en pathologie infectieuse ostéoarticulaire. Résultats initiaux.

A new investigation in infectious osteoarticular pathology is presented, involving the use of two tracers: one for bone metabolism (MDP - 99mTc), the other for the infectious process (67Ga). The initial results of a prospective study of 72 scintigraphic examinations are reported. Analysis of the results reveals the value in using 67Ga to determine the stage of development of the lesion and consequently to adapt the treatment. Classical bone scintigraphy, whose value remains the early detection of signs compared to radiography, does not allow us to follow the course of the lesion over time. The need to combine scintigraphic techniques has already been recognised (Lisbona, Gaucher) but there has usually been sequential meaning, apart from the risk of false negatives (early osteitis), repeated visits by the patients over a period of time. The simultaneous use of 2 tracers, technically possible, avoids these problems and produces a rapid result (generally 6 hours after the injection).

[Brain scanning with 201 thallium. Comparative study with D.T.P.A. 99mTc brain radioangiogram]. / Scintigraphie cérébrale au Thallium 201. Etude comparée avec l'angioscintigraphie au D.T.P.A. 99mTc.

Data of brain scans with 201Th and 99mTc - D.T.P.A. are studied in 43 patients. Some of the results sustained earlier data from Ancri (1978): lack of interest through vascular diseases, good sensitivity for the focalized brain lesions (24/25). But new features are underlined: occurrence of false - positive, intermediary patterns laying between normal scan and focal pathologic distributions but without etiologic correspondence. The quantified contrast is usually better with 99mTc - D.T.P.A. than with 201Th; these data challenge Ancri's ones. Actual indications of Thallium brain scan are discussed.

[Serial and static brain radioangiogram in diagnosis of carotid disease: value, indication and limits by comparative study with EEG, Doppler study and cerebral arteriography (author's transl)]. / La gamma-angioscintigraphie cérébrale dans les occlusions de carotide: validité, place et limite par étude comparée avec l'EEG, la vélocimétrie Doppler, l'artériographie cérébrale.

Value, indication and limits of serial and static brain radioangiogram in carotid disease are studied comparatively with EEG, Doppler study and cerebral arteriography. The isotopic study shows the occlusion and its consequences on middle cerebral artery and cerebral hemisphere. The "Hot-Nose" sign is rarely seen, but then with large focal abnormalities. In 20% of studied cases, isotopic study provides information about the efficiency of suppleance circulation or the existence of a blood derivation. The value of serial and static scintigraphy deserves it a better place among the non invasive diagnosis method of carotid disease.

Fast Diagnosis (6h) of clinically silent pyonephrosis by combined use of 99mTc-MDP and 67Ga citrate.

A fast diagnosis (6h) of clinically latent pyonephrosis by combined use of 99mTc-MDP and 67Ga-citrate is reported. This technique combines the potential early detection of focal infectious processes by 67Ga and the "high-pulse" separation possibility of multiple isotopes. A brief prospective study (6 months) showed the interest of this technique: in six cases focal bone and/or joint infections were found three of which were absolutely latent clinically.

Lateral ventricle visualization during brain scanning with Tc-DTPA.

The visualization of the cerebral ventricles during a brain scan is a relatively rare possibility. The authors had the opportunity of observing four cases. They report them and discuss the 19 cases reported in world literature. There were, in order of importance, 12 cases of ventriculitis, 3 of non tumorous intraventricular erruptions, 2 of tumours infiltration, 1 metabolic encephalopathy and one unexplained case. It is concluded that the visualization of the ventricule during a brain scan (particularly the early visualization) is a good etiological indicator of ventriculitis.