Classification Prediction of Alzheimer's Disease and Vascular Dementia Using Physiological Data and ECD SPECT Images.

Alzheimer's disease (AD) and vascular dementia (VaD) are the two most common forms of dementia. However, their neuropsychological and pathological features often overlap, making it difficult to distinguish between AD and VaD. In addition to clinical consultation and laboratory examinations, clinical dementia diagnosis in Taiwan will also include Tc-99m-ECD SPECT imaging examination. Through machine learning and deep learning technology, we explored the feasibility of using the above clinical practice data to distinguish AD and VaD. We used the physiological data (33 features) and Tc-99m-ECD SPECT images of 112 AD patients and 85 VaD patients in the Taiwanese Nuclear Medicine Brain Image Database to train the classification model. The results, after filtering by the number of SVM RFE 5-fold features, show that the average accuracy of physiological data in distinguishing AD/VaD is 81.22% and the AUC is 0.836; the average accuracy of training images using the Inception V3 model is 85% and the AUC is 0.95. Finally, Grad-CAM heatmap was used to visualize the areas of concern of the model and compared with the SPM analysis method to further understand the differences. This research method can quickly use machine learning and deep learning models to automatically extract image features based on a small amount of general clinical data to objectively distinguish AD and VaD.

The Feasibility of Differentiating Lewy Body Dementia and Alzheimer's Disease by Deep Learning Using ECD SPECT Images.

The correct differential diagnosis of dementia has an important impact on patient treatment and follow-up care strategies. Tc-99m-ECD SPECT imaging, which is low cost and accessible in general clinics, is used to identify the two common types of dementia, Alzheimer's disease (AD) and Lewy body dementia (LBD). Two-stage transfer learning technology and reducing model complexity based on the ResNet-50 model were performed using the ImageNet data set and ADNI database. To improve training accuracy, the three-dimensional image was reorganized into three sets of two-dimensional images for data augmentation and ensemble learning, then the performance of various deep learning models for Tc-99m-ECD SPECT images to distinguish AD/normal cognition (NC), LBD/NC, and AD/LBD were investigated. In the AD/NC, LBD/NC, and AD/LBD tasks, the AUC values were around 0.94, 0.95, and 0.74, regardless of training models, with an accuracy of 90%, 87%, and 71%, and F1 scores of 89%, 86%, and 76% in the best cases. The use of transfer learning and a modified model resulted in better prediction results, increasing the accuracy by 32% for AD/NC. The proposed method is practical and could rapidly utilize a deep learning model to automatically extract image features based on a small number of SPECT brain perfusion images in general clinics to objectively distinguish AD and LBD.

Detection of Alzheimer's disease using ECD SPECT images by transfer learning from FDG PET.

OBJECTIVE: To develop a practical method to rapidly utilize a deep learning model to automatically extract image features based on a small number of SPECT brain perfusion images in general clinics to objectively evaluate Alzheimer's disease (AD). METHODS: For the properties of low cost and convenient access in general clinics, Tc-99-ECD SPECT imaging data in brain perfusion detection was used in this study for AD detection. Two-stage transfer learning based on the Inception v3 network model was performed using the ImageNet dataset and ADNI database. To improve training accuracy, the three-dimensional image was reorganized into three sets of two-dimensional images for data augmentation and ensemble learning. The effect of pre-training parameters for Tc-99m-ECD SPECT image to distinguish AD from normal cognition (NC) was investigated, as well as the effect of the sample size of F-18-FDG PET images used in pre-training. The same model was also fine-tuned for the prediction of the MMSE score from the Tc-99m-ECD SPECT image. RESULTS: The AUC values of w/wo pre-training parameters for Tc-99m-ECD SPECT image to distinguish AD from NC were 0.86 and 0.90. The sensitivity, specificity, precision, accuracy, and F1 score were 100%, 75%, 76%, 86%, and 86%, respectively for the training model with 1000 cases of F-18-FDG PET image for pre-training. The AUC values for various sample sizes of the training dataset (100, 200, 400, 800, 1000 cases) for pre-training were 0.86, 0.91, 0.95, 0.97, and 0.97. Regardless of the pre-training condition ECD dataset used, the AUC value was greater than 0.85. Finally, predicting cognitive scores and MMSE scores correlated (R2 = 0.7072). CONCLUSIONS: With the ADNI pre-trained model, the sensitivity and accuracy of the proposed deep learning model using SPECT ECD perfusion images to differentiate AD from NC were increased by approximately 30% and 10%, respectively. Our study indicated that the model trained on PET FDG metabolic imaging for the same disease could be transferred to a small sample of SPECT cerebral perfusion images. This model will contribute to the practicality of SPECT cerebral perfusion images using deep learning technology to objectively recognize AD.

Cerebral Microbleeds, Cerebrospinal Fluid, and Neuroimaging Markers in Clinical Subtypes of Alzheimer's Disease.

Lobar cerebral microbleeds (CMBs) in Alzheimer's disease (AD) are associated with cerebral amyloid angiopathy (CAA) due to vascular amyloid beta (Aß) deposits. However, the relationship between lobar CMBs and clinical subtypes of AD remains unknown. Here, we enrolled patients with early- and late-onset amnestic dominant AD, logopenic variant of primary progressive aphasia (lvPPA) and posterior cortical atrophy (PCA) who were compatible with the AD criteria. We then examined the levels of cerebrospinal fluid (CSF) biomarkers [Aß1-42, Aß1-40, Aß1-38, phosphorylated tau 181 (P-Tau), total tau (T-Tau), neurofilament light chain (NFL), and chitinase 3-like 1 protein (YKL-40)], analyzed the number and localization of CMBs, and measured the cerebral blood flow (CBF) volume by 99mTc-ethyl cysteinate dimer single photon emission computerized tomography (99mTc ECD-SPECT), as well as the mean cortical standard uptake value ratio by 11C-labeled Pittsburgh Compound B-positron emission tomography (11C PiB-PET). Lobar CMBs in lvPPA were distributed in the temporal, frontal, and parietal lobes with the left side predominance, while the CBF volume in lvPPA significantly decreased in the left temporal area, where the number of lobar CMBs and the CBF volumes showed a significant inversely correlation. The CSF levels of NFL in lvPPA were significantly higher compared to the other AD subtypes and non-demented subjects. The numbers of lobar CMBs significantly increased the CSF levels of NFL in the total AD patients, additionally, among AD subtypes, the CSF levels of NFL in lvPPA predominantly were higher by increasing number of lobar CMBs. On the other hand, the CSF levels of Aß1-38, Aß1-40, Aß1-42, P-Tau, and T-Tau were lower by increasing number of lobar CMBs in the total AD patients. These findings may suggest that aberrant brain hypoperfusion in lvPPA was derived from the brain atrophy due to neurodegeneration, and possibly may involve the aberrant microcirculation causing by lobar CMBs and cerebrovascular injuries, with the left side dominance, consequently leading to a clinical phenotype of logopenic variant.

Cerebral Microbleeds in Patients with Parkinson's Disease and Dementia with Lewy Bodies: Comparison Using Magnetic Resonance Imaging and 99 mTc-ECD SPECT Subtraction Imaging.

BACKGROUND: Cerebral microbleeds (CMBs) in patients with Parkinson's disease (PD) or dementia with Lewy bodies (DLB) have not been adequately studied. OBJECTIVE: This study aims to find a difference in the total number, prevalence, and common locations of CMBs between PD and DLB and evaluate 99 mTc-ECD SPECT subtraction images of these two diseases. METHODS: We examined 112 patients with PD (53 males and 59 females; age: 77.4±3.6 years) and 28 age-matched patients with DLB (15 males and 13 females; age: 77.1±6.7 years) using brain magnetic resonance imaging (MRI) and 99 mTc-ECD SPECT subtraction imaging. RESULTS: The total number of CMBs was higher in patients with DLB (41.2%) than in those with PD (11.5%), and the prevalence was significantly higher in the former (0.7±1.1) than the latter (0.2±0.5, p < 0.05). The odds ratio was 5.4 (95% confidence interval [CI]: 1.7-17.4). Furthermore, CMBs were commonly located in the basal ganglia of patients with PD (6 out of 87 patients) but in the occipital lobe of patients with DLB (8 out of 17 patients). 99 mTc-ECD SPECT subtraction imaging indicated lower cerebral blood flow in the posterior cingulate gyrus among the patients with CMB-positive DLB than among those with CMB-positive PD; additionally, the cerebral blood flow was lower in the bilateral basal ganglia and midbrain among patients with CMB-positive DLB compared to those with CMB-negative DLB. CONCLUSION: A reduction in occipital glucose metabolism may be related to CMBs in the occipital lobe of patients with DLB.

A case of interictal dysphoric disorder comorbid with interictal psychosis: Part of the same spectrum or separate entities?

Depressive disorders in epilepsy often present characteristic clinical manifestations atypical in primary, endogenous depression. Here, we report a case of a 64-year-old woman with right mesial temporal lobe epilepsy, who complained of bizarre, antipsychotic-refractory cenesthetic hallucinations in her interictal phase, and was hospitalized after a suicide attempt. Detailed clinical observations revealed mood symptoms, which led to the diagnosis of interictal dysphoric disorder comorbid with interictal psychosis. Sertraline with low-dose aripiprazole markedly alleviated both depressive and psychotic symptoms. This case suggested that the two diagnostic entities may overlap and that depressive symptoms tend to be concurrent when concurring with psychosis, which hampers the appropriate choice of a treatment option.

Emotional stimuli-provoked seizures potentially misdiagnosed as psychogenic non-epileptic attacks: A case of temporal lobe epilepsy with amygdala enlargement.

The association between emotional stimuli and temporal lobe epilepsy (TLE) is largely unknown. Here, we report the case of a depressed, 50-year-old female complaining of episodes of a "spaced out" experience precipitated by emotional stimuli. Psychogenic non-epileptic attacks were suspected. However, video-EEG coupled with emotional stimuli-provoked procedures and MRI findings of amygdala enlargement, led to the diagnosis of left TLE. Accurate diagnosis and explanation improved her subjective depression and seizure frequency. This case demonstrated that emotional stimuli can provoke seizures in TLE and suggested the involvement of the enlarged amygdala and the modulation of emotion-related neural circuits.

Effect of Deep Brain Stimulation on Regional Cerebral Blood Flow in Patients with Medically Refractory Tourette Syndrome.

In this study, alterations in brain perfusion have been investigated in patients with Tourette syndrome (TS) compared with control subjects. In addition, we investigated the effects of deep brain stimulation (DBS) in both globus pallidus internus (GPi) and centromedian-parafascicular/ventralis oralis internus nuclei of the thalamus (CM/Voi) and sham (SHAM) stimulation on cerebral blood flow. In a prospective controlled, randomized, double-blind setting, five severely affected adult patients with TS with predominant motor or vocal tics (mean total tic score on the Yale Global Tic Severity Scale: 39) underwent serial brain perfusion single photon emission computed tomography with (99m)Tc-ECD. Results were compared with data from six age-matched control subjects. All patients were investigated at four different time points: once before DBS implantation (preOP) and three times postoperatively. Postoperative scans were performed in a randomized order, each after 3 months of either GPi, CM/Voi, or SHAM stimulation. At each investigation, patients were injected at rest while awake, but scanned during anesthesia. This procedure ensured that neither anesthesia nor movement artifacts influenced our results. Control subjects were investigated only once at baseline (without DBS or anesthesia). At baseline, cerebral blood flow was significantly reduced in patients with TS (preOP) compared with controls in the central region, frontal, and parietal lobe, specifically in Brodmann areas 1, 4-9, 30, 31, and 40. Significantly increased perfusion was found in the cerebellum. When comparing SHAM stimulation to preOP condition, we found significantly decreased perfusion in basal ganglia and thalamus, but increased perfusion in different parts of the frontal cortex. Compared with SHAM condition both GPi and thalamic stimulation resulted in a significant decrease in cerebral blood flow in basal ganglia and cerebellum, while perfusion in the frontal cortex was significantly increased. Our results provide substantial evidence that, in TS, brain perfusion is altered in the frontal cortex and the cerebellum and that these changes can be reversed by both GPi and CM/Voi DBS.

Decreased regional cerebral blood flow in the bilateral thalami and medulla oblongata determined by an easy Z-score (eZIS) analysis of (99m)Tc-ECD-SPECT images in a case of MM2-thalamic-type sporadic Creutzfeldt-Jakob disease.

We report a case of autopsy-verified MM2-thalamic-type sporadic Creutzfeldt-Jakob disease (sCJD) in a 46-year-old patient with a 16-month history of abnormal behavior, progressive dementia, insomnia, and speech disturbances without family history. Neurological examination revealed progressive dementia, frontal signs, insomnia, speech disturbance, gait disturbance and bilaterally exaggerated tendon reflexes. Both brain MRI and cerebrospinal fluid examinations, including 14-3-3 protein, yielded normal results. An easy Z-score (eZIS) analysis for (99m)Tc-ethyl cysteinate dimer-single photon emission computed tomography ((99m)Tc-ECD-SPECT) revealed decreased regional cerebral blood flow in the bilateral thalami and medulla oblongata. PRNP gene analysis revealed methionine homozygosity at codon 129 without mutation. Neuropathological examinations revealed severe neuronal loss, gliosis, and hypertrophic astrocytosis in the medial thalamus and inferior olivary nucleus. A slight depletion of Purkinje cells was observed. PrP immunostaining showed no obvious PrP deposits in the basal ganglia, thalamus, cerebellum, or brainstem; however, mild synaptic-type PrP deposits with some smaller plaque-like structures were only partially observed in the localized region of the frontal lobe with the spongiform change. Western blot analyses of protease-resistant PrP showed a type 2 pattern. In conclusion, eZIS analysis of (99m)Tc-ECD-SPECT images is useful for detecting both thalamic and medullary lesions. This is the first case of medullary lesions detected in a live patient with MM2-thalamic-type sCJD using SPECT.

Hemichorea in a diabetes mellitus patient following acute ischemic stroke with changes in regional cerebral blood flow.

It is not unusual to observe hemichorea in patients with diabetes mellitus, with origins attributable to recent ischemia. Our patient was a 66-year-old female with diabetes mellitus who suddenly developed right hemichorea, mild muscle weakness of the right upper extremity, ideational apraxia, and acalculia. Her blood glucose was 600 mg/dL, and HbA1c was 13.3%. After the patient underwent head magnetic resonance imaging (MRI), a new cerebral infarction was observed in the left frontal lobe, and treatment was started with edaravone and cilostazol. At the same time, insulin treatment was also started for hyperglycemia. The acalculia and ideational apraxia improved approximately 1 week after treatment initiated, and the hemichorea also decreased. ECD-SPECT was performed on admission, and it was observed that blood flow was decreased in the left frontal lobe and striatum, but increased in the thalamus; two weeks later on follow-up ECD-SPECT, blood flow had increased slightly in the left forebrain and striatum, while it had decreased slightly in the thalamus. This suggests that the cause of hemichorea was related to ischemia. When the activity of the pallidum is impaired, it is presumed that the inhibitory activity towards the thalamus weakens and the thalamic cells become over-excited, causing chorea.

The role of neuroimaging in evaluating patients affected by Creutzfeldt-Jakob disease: a systematic review of the literature.

Diagnosis of Creutzfeldt-Jakob disease during life can be challenging since the huge variability of the symptoms which can be observed, especially in its early stages, may simulate other common forms of dementia. In latest years, noninvasive techniques such as magnetic resonance, positron emission tomography, and single-photon emission tomography have been evaluated to help clinical neurologists to provide a definite diagnosis. We here provide a systematic review of the current knowledge of neuroimaging in CJD in order to establish the actual state of the art.

Development of an automatic ROI setting program for input function determination in 99mTc-ECD non-invasive cerebral blood flow quantification.

Non-invasive quantitative measurements are useful for clinical study as these are simple and pain-free procedures. A new non-invasive semi-automatic quantitative measurement method, the improved brain uptake ratio (IBUR) method using (99m)Tc-ECD SPECT, has recently been reported. If an automatic ROI setting algorithm could be developed to determine the input function for the IBUR method, analysis of regional cerebral blood flow (rCBF) can be completed within a few min without recourse to complex techniques, through a fully automatic rCBF analysis program. The purpose of this study was to develop an automatic input function determination program for (99m)Tc-ECD non-invasive cerebral blood flow quantification and to confirm the feasibility of use of this program. The images of 15 consecutive patients who underwent both (99m)Tc-ECD chest RI angiography and SPECT examinations were used for development of the automatic arterial input function program. The images of 69 consecutive patients were used for validation of the program. The coincidence ratio between the ROI automatic method and the manual setting method was 98%. The mean difference in the ROI location was ±6.4 mm in the X direction and ±8.6 mm in the Y direction. Individual rCBF values obtained using these independent techniques were also reasonably well correlated (r = 0.95). The total time for the IBUR analysis using the automatic method is 2-3 min as compared to 20-30 min for the current analysis method. This technique improves the throughput of nuclear medical examinations.

Comparative Study on Initial Symptoms Using Single Photon Emission Computer Tomography in Schizophrenia

OBJECTIVES: This study was conducted to compare between hallucination group and delusion group in patient with schizophrenia, using Brain (99m)Tc-ECD SPECT. METHODS: Among 16 patients with less than 3 schizophrenic episodes, 8 patients whose initial symptom was hallucination were assigned to the hallucination group, and other 8 patients with initial sumptom of delusion were assinged to the hallucination group. All of the patients clinically evaluated using the PANSS and BPRS. Both groups of patients and 8 healthy subjects underwent (99m)Tc-ECD SPECT. RESULTS: Score of thinking disturbance subscale of BPRS were significantly lower in the hallucination group than the delusion group. In SPECT analysis, the hallucination group showed significantly increased perfusion in some areas of the right temporal lobe, bilateral limbic lobes and left parietal lobe compared to delusion group. Both group had a reduced rCBF in some areas of the frontal lobe. CONCLUSION: The hallucniation group, compared with the delusion group, showed significantly increased regional cerebral blood flow in some regions. Therefore, this data suggests that different neural substrates may affect the process of auditory hallucination and delusion.

Changes in the Regional Cerebral Blood Flow in Postlingual Deaf Patients Measured by ECD-SPECT: Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cochlear implantation improves hearing ability in adults with profound deafness. Using non-invasive functional brain imaging methods, it is now possible to assess regional blood flow and activity of auditory cortex which might be correlated to the outcome of cochlear implantation. The aim of this study was to measure the regional cerebral blood flow in patients with postlingual deafness utilizing controls in a variety of methods. SUBJECTS AND METHOD: Six postlingual deaf adults who were planned to undertake cochlear implantation and 12 normal controls were examined with technetium-99m-labeled ethyl cysteinate dimer single-photon emission computed tomography (99mTc-ECD-SPECT). Images of the regional cerebral blood flow were processed by statistical parametric mapping and analyzed by unpaired t-test. RESULTS: The analysis of the SPECT images of the 6 deaf patients showed decreased cerebral blood flow in both superior, middle temporal and inferior prefrontal lobes compared with controls (p<0.001). Also this decreased auditory cortical blood flow was greater in left hemisphere in all patients. CONCLUSION: The degree of remaining activity of auditory cortex and the lateralization of the dominant auditory hemisphere, which may influence on the outcome of cochlear implantation, could be measured by ECD-SPECT.

Assessment of Hyperperfusion by Brain Perfusion SPECT in Transient Neurological Deterioration after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis Surgery / 핵의학분자영상

PURPOSE: Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis surgery. Materials and METHODS: A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: 50+/-16 yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using (99m)Tc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. RESULTS: In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of the cerebral perfusion ratio on preoperative and tenth postoperative day between patients with TND and other patients. CONCLUSION: In patients with TND, relative and moderate hyperperfusion was observed in affected side after bypass surgery. These finding may help to understand the pathophysiology of TND.

Hemodynamic Outcome of Successful Bypass Surgery in Patients with Atherosclerotic Cerebrovascular Disease: A study with Acetazolamide and (99m)Tc-ECD SPECT / 핵의학분자영상

PURPOSE: The aim of the study was to evaluate the hemodynamic changes after successful bypass surgery in patients with atherosclerotic stenosis in ICA using (99m)Tc-ECD SPECT. MATERIALS AND METHODS: Fourteen patients (M:F=8:6, mean age; 60+/-9 years) who underwent STA-MCA anastomosis for unilateral atherosclerotic cerebrovascular disease were enrolled. (99m)Tc-ECD basal/acetazolamide perfusion SPECT studies were performed before, 10 days and 6 months after bypass surgery. Perfusion reserve was defined as the % changes after acetazolamide over rest image. Regional cerebral blood flow and perfusion reserve were compared preoperative, early-postoperative and late-postoperative scans. RESULTS: The mean resting perfusion and decrease in perfusion reserve in affected ICA territory on preoperative scan was 52.4+/-3.5 and -7.9+/-4.7%, respectively. The resting perfusion was significantly improved after surgery on early-postoperative scan (mean 53.7+/-2.7) and late-postoperative scan (mean 53.3+/-2.5) compared with preoperative images (p<0.05, respectively). Resting perfusion did not showed further improvement on late-postoperative scan compared with early-postoperative scan. The perfusion reserve was -3.7+/-2.6% on early-postoperative scan, and -1.6+/-2.3% on late-postoperative scan, which was significantly improved after surgery. Additionally, further improvement of perfusion reserved as observed on late-postoperative scan (p<0.05). While, in the unaffected ICA territory, no significant changes in the resting perfusion and perfusion reserve was observed. CONCLUSION: The improvement of resting perfusion and perfusion reserve in early-postoperative scan reflects the immediate restoration of the cerebral blood flow by bypass surgery. In contrasts, further improvement of perfusion reserve showing on late-postoperative scan may indicate a good collateral development after surgery, which may indicate good surgical outcome after surgery.

Resting and Acetazolamide-Challenged Technetium 99m-ECD SPECT in Transient Global Amnesia

BACKGROUND AND OBJECTIVE: Transient global amnesia(TGA) is a neurological syndrome affecting preferentially middle-aged or elderly people and characterized by sudden onset of transient impairment of antegrade amnesia with variably retrograde amnesia. TGA was defined over 30 years ago, but the etiology remain unclear. Several mechanisms have been proposed, including arterial thromboembolic ischemic attacks in both posterior cerebral artery territories, epilepsy, and migraine. Although many studies have reported TGA, only a few reported cerebral perfusion studies using SPECT because of the brief duration of the episode. Technetium-99m-ethyl cysteinate dimmer(ECD) is superior to sensitivity of lesion detection and lesion to normal contrast, probably due to lower back diffusion from the brain to the blood and its excellent radiochemical stability. So we evaluate pathophysiologic mechanism of TGA by using 99mTC-ECD SPECT with or without acetazolamide(ACZ) stress. METHODS: We evaluated six patients with transient global amnesia, four women and two men, age ranges 56 to 78 years, mean 62.2 years. Measurements of CBF and vascular reserve using 99mTC-ECD with or without ACD stress were performed during or after TGA episode. RESULTS: One patient, who was evaluated in TGA episode showed that regional cerebral blood flow was decreased in both anteroinferior frontal, both temporal, right thalamus, both inferior parietal and left parietal region with impaired vascular reserve in left inferior temporal and right thalamus. Others, who were evaluated more than 6days in TGA episode showed that regional cerebral blood flow was decreased in left temporal (4), both temporal region (1), left thalamus (2) and both basal ganglia (1) with preserved vascular reserve except one, showed impaired vascular reserve in left thalamus. CONCLUSION: This result show that severe hypoperfusion of bilateral temporal region and impaired vascular reserve in left temporal region in TGA episode. Other patients who were recovered from TGA showed hypoperfusion of left temporal region and preserved vascular reserve. 99mTc-ECD with acetazolamide SEPCT that sensitively detects localized impaired cerebraovascular reserve should help elucidate these processes. But further study with more cases is necessary for evaluation of pathophysiology of TGA.

Regional Cerebral Blood Flow Changes in Alzheimer's Disease Patients Treated with Cholinesterase Inhibitors: A Preliminary Study using 99mTC-ECD SPECT

BACKGROUND: This study aimed to evaluate regional cerebral blood flow (rCBF) changes using 99mTC-ECD SPECT (Ethylene Cysteine Diethylester Single Photon Emission Computed Tomography) and contemporary clinical responses such as cognitive and psychiatric symptoms and activities of daily living (ADL) after cholinesterase inhibitors (ChEI) treatment. METHODS: The subjects were eight probable Alzheimer's disease (AD) patients (four males and four females, mean age 69.63 years) who were recruited from the department of Neurology, at Yeungnam University Medical Center, between August 2000 and April 2002. The clinical diagnosis of AD was based on the DSM-IV and NINCDS-ADRDA criteria. Hachinski ischemic scores of all the patients were below 1. The mean treatment duration was 30.38 weeks which ranged from 24 to 44 weeks. Four patients received Rivastigmine (Exelon(r)) 12 mg after titration, and three patients received Donepezil (Aricept(r)) 10 mg during the whole period and only one patient had Donepezil 10 mg after the initial 5 mg for three weeks. The base line and follow up 99mTC-ECD SPECT studies were done on an average 6 days before the ChEI treatment and 4 days after finishing the study. RESULTS: The most significant increase in blood flow occurred in the bilateral parietal lobes (p<0.05). Reduction in the rCBF is more profound on the left hemisphere in the base line (p<0.05) and it achieved significant increase of rCBF after ChEI treatment compared with the right hemisphere (p<0.05). CONCLUSIONS: Treatment with ChEI for 30.38 weeks increased rCBF and overall increased in global cognitive functions including K-MMSE, ADAS-cog, CDR, CDR-SB, GDS, and NPI and ADCS-ADL scores.

Cerebral Perfusion Assessed with 99m-Tc-ECD-SPECT in Childrens with Attachment Disorder / 신경정신의학

OBJECTIVES: This study aimed to reveal that severe disturbance of attachment relationship with primary care-giver can affect functional brain development by measuring with technetium-99m ethyl cysteinate dimer brain single-photon emission tomography. METHODS: Subjects were 12 children aged 2-6 years who met the diagnostic criteria of reactive attachment disorder. Diagnostic tools were DSM-IV, ICD-10, Strange Situation Procedure(SSP), Vineland Social Maturity Sclae(SMS), and Childhood Autism Rating Scale(CARS). Brain SPECT was performed in all sbjects and each SPECT scan was visually assessed by two nuclear medicine specilalists. RESULTS: Eleven of 12 children had abnormal brain perfusion on SPECT scans, revealing focal areas of decreased perfusions. Perfusion of thalamus was decreased in 10 subjects decreased perfusion of left thalamus(6/10), right thalamus(1/10), and both thalami(3/10). Perfusion of basal ganglia was decreased in 5 children. Four children had decreased perfusion of thalamus as well as of basal ganglia. Decreased perfusion of parietal area was noted in only one child on SPECT scan. All subjets had normal perfusion of frontal, temporal, occipital, cerebellar areas on SPECT scan. CONCLUSIONS: Perfusion abnormalities involving thalamus, basal ganglia in most children with attachment disorder were found in this study. These results suggest that brain development of infant could be impeded by severe pathologic care and early nurturing environment would be important for normal brain development.