technetium-tc-99m-bicisate and Lewy-Body-Disease

Cerebral microbleeds (CMBs) in patients with Parkinson's disease (PD) or dementia with Lewy bodies (DLB) have not been adequately studied.. 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.. 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.. 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.. A reduction in occipital glucose metabolism may be related to CMBs in the occipital lobe of patients with DLB.

Topics: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Basal Ganglia; Cerebrovascular Circulation; Cysteine; Female; Glucose; Gyrus Cinguli; Humans; Intracranial Hemorrhages; Lewy Body Disease; Magnetic Resonance Angiography; Male; Mental Status and Dementia Tests; Mesencephalon; Neuropsychological Tests; Occipital Lobe; Organotechnetium Compounds; Parkinson Disease; Prevalence; Tomography, Emission-Computed, Single-Photon

Chronic low serum vitamin D concentrations are common among the elderly. Recent studies have suggested that its metabolite, 25-hydroxyvitamin D (25-OHD), might be important for preserving cognitive functions through specific brain protective effects. However, this hypothesis is still under discussion. The aim of this study was to assess the correlation between serum 25-OHD concentrations and regional cerebral blood flow in neurodegenerative diseases such as Alzheimer's disease (AD) and dementia of Lewy bodies (DLB).. Radionuclide brain single-photon emission computed tomography/computed tomography (SPECT/CT) images and 25-OHD dosage in noninstitutionalized patients were obtained within 14 days. SPECT/CT examination was carried out using technetium-99m-ethyl cysteinate dimer in 20 consecutive patients (12 AD and eight DLB). Reconstructed images were spatially normalized using Statistical Parametric Mapping version 5 software to a default SPECT template. Voxel-based multiple regression correlation analyses, with age and mini mental state examination scores as confounding factors, were carried out. Findings were considered significant for a threshold P-value less than 0.01 (corrected at cluster level).. A positive correlation was found between 25-OHD concentrations and regional cerebral blood flow in the left precuneus cortex (Talairach coordinates: -14, -42, 63) in AD patients. No correlation was detected in DLB patients.. The results of this study confirm the relationship between 25-OHD concentrations and AD and therefore underline the hypothesis of a potential neuroprotective effect against brain degeneration. These encouraging findings need to be confirmed by larger prospective correlation series.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Cerebrovascular Circulation; Cysteine; Female; Humans; Lewy Body Disease; Male; Middle Aged; Multimodal Imaging; Organotechnetium Compounds; Positron-Emission Tomography; Regional Blood Flow; Tomography, X-Ray Computed; Vitamin D

Topics: Aged; Aged, 80 and over; Creutzfeldt-Jakob Syndrome; Cysteine; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Humans; Lewy Body Disease; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

Clinical diagnostic criteria for dementia with Lewy bodies (DLB) include abnormal findings on MIBG myocardial scintigraphy and occipital hypoperfusion as supportive features. In this study, 36 patients with probable DLB underwent MIBG scintigraphy and brain perfusion SPECT. The results of SPECT were analyzed using three different cerebral blood flow (CBF)-analyzing programs, an easy Z-score imaging system (e-ZIS), 3DSRT, and FineSRT. Among these assessments, delayed heart-to-mediastinum (dH/M) ratios on MIBG scintigraphy showed superior sensitivity (92%) to detect characteristic abnormalities in DLB. The sensitivities of CBF-analyzing programs to detect occipital hypoperfusion were 67%, 74%, and 81% for e-ZIS, 3DSRT, and FineSRT, respectively. Our results demonstrate that the combination of MIBG scintigraphy and brain perfusion SPECT could increase the accuracy of the clinical diagnosis of DLB. MIBG scintigraphy could be recommended for DLB patients in the clinical setting.

Topics: 3-Iodobenzylguanidine; Brain; Cerebrovascular Circulation; Cysteine; Female; Heart; Humans; Iodine Radioisotopes; Lewy Body Disease; Male; Organotechnetium Compounds; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

Supportive features in the diagnostic criteria for dementia with Lewy bodies (DLB) include occipital hypoperfusion and decreased cardiac uptake of (123)I-metaiodobenzylguanidine (MIBG). In this study, we performed both brain perfusion single photon emission computed tomography (SPECT) and MIBG myocardial scintigraphy in the same subjects and evaluated their sensitivity to detect the characteristic features of DLB.. Twenty-five patients with probable DLB (76.8 +/- 5.1 years old, 10 male) underwent (99m)Tc-ethylcysteinate dimer brain perfusion SPECT and (123)I-MIBG myocardial scintigraphy. The results of SPECT were analyzed using a qualitative analysis program, easy Z score imaging system (eZIS), and an automated quantitative analysis program, 3DSRT.. Qualitative analysis using eZIS demonstrated occipital hypoperfusion in 17 subjects (68%). The quantified mean blood perfusion in the occipital segment on the 3DSRT template was 40.7 +/- 5.03 ml/100 g/min (right) and 40.5 +/- 5.38 ml/100 g/min (left), and in 19 DLB patients these values were below the normal limit. Twenty-four of 25 subjects (96%) had decreased cardiac MIBG uptake in the delayed image.. MIBG myocardial scintigraphy was superior to brain perfusion SPECT in detecting a characteristic feature of DLB. Our results suggest that combining SPECT and MIBG scintigraphy could increase the accuracy of clinical diagnosis of DLB.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Alzheimer Disease; Brain; Cerebrovascular Circulation; Cysteine; Diagnosis, Differential; Female; Heart; Humans; Lewy Body Disease; Male; Occipital Lobe; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

We performed brain perfusion single photon emission computed tomography (SPECT) to evaluate computer-assisted automated discrimination of early Alzheimer's disease (AD) from other types of dementia using the easy Z-score imaging system (eZIS).. eZIS analysis of brain perfusion SPECT images was used in patients with early AD, vascular dementia (VD), mixed dementia (VD + AD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and normal controls. Significant changes in regional cerebral blood flow (rCBF) in the volume of interest were assessed in the posterior cingulate gyrus, precuneus and parietal cortices; the severity and extent of decreases in rCBF and the ratio of the extent of the decrease in rCBF to the decrease in whole-brain blood flow (rCBF ratio) were determined.. The severity of the decrease in rCBF in AD patients was significantly greater than in VD and FTD patients and controls. The extent of the decrease in rCBF in AD patients was significantly greater than in FTD patients and controls. The rCBF ratio in AD patients was higher than in VD and FTD patients and controls.. The eZIS indices, especially the rCBF ratio, may be useful in establishing the differential diagnosis between early-stage AD and FTD or VD, but the differentiation of AD from VD + AD or DLB remains difficult.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Alzheimer Disease; Brain; Cysteine; Dementia; Dementia, Vascular; Diagnosis, Differential; Disease Progression; Female; Humans; Image Processing, Computer-Assisted; Lewy Body Disease; Male; Middle Aged; Neuropsychological Tests; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

We examined clinical presentations, neuropsychological findings, and perfusion patterns of (99m)Tc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) in patients with early stage dementia with Lewy bodies (DLB) (n = 17) and Parkinson's disease (PD) (n = 16), with age-matched healthy controls (n = 10). Seven paired regions of interest (ROIs) were drawn manually including inferior frontal, temporal, parietal, occipital, parieto-occipital junction, striatum and thalamus for semiquantitative measurement. Neuropsychological tests were applied for clinical correlation. The SPECT results showed significant hypoperfusion in DLB group in frontal, parietal, thalamus, temporal ROIs compared with controls (P < 0.01) whilst signals in temporal areas was significantly reduced compared with PD group (P < 0.05). Neuropsychological tests showed that DLB patients had deficits in mental manipulation, short-term memory, abstract thinking, drawing and semantic verbal fluencies (P < 0.05, compared with control). In addition, DLB group had lower scores than those with PD in mental manipulation, drawing and semantic verbal fluency (P < 0.05). Our study showed that even in early stages of DLB, neuropsychological and perfusion patterns were evident and may be different from PD group, despite they shared certain similarities both in neuropsychological and image findings compared with age-matched controls.

Topics: Aged; Aged, 80 and over; Brain; Cerebrovascular Circulation; Cognition Disorders; Cysteine; Diagnosis, Differential; Disease Progression; Early Diagnosis; Female; Humans; Lewy Body Disease; Male; Middle Aged; Neuropsychological Tests; Organotechnetium Compounds; Parkinson Disease; Predictive Value of Tests; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

Despite improved diagnostic accuracy, differentiation of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) on the basis of clinical findings remains problematic. The purpose of this retrospective study was to evaluate the utility of technetium-99m ethyl cysteinate dimer (ECD) single-photon emission tomography (SPET) as a potential tool for the diagnosis of DLB and discrimination from AD. Cerebral perfusion patterns detected by (99m)Tc-ECD SPET were compared in patients presenting with a probable diagnosis of DLB ( n=34) or AD ( n=28). Tracer distribution was quantified using the region of interest technique in eight symmetrical paired zones and expressed as a perfusion index (ratio of mean uptake in a brain region to that in the cerebellum). Comparison of findings in the DLB and AD groups demonstrated significant differences in mean perfusion indexes in the right occipital region ( P=0.004), left occipital region ( P=0.005) and left medial temporal region ( P=0.013). Mean perfusion indexes in the right and left occipital regions were lower in DLB than in AD patients. Conversely, the mean perfusion index in the left medial temporal region was lower in AD than in DLB patients. DLB was correctly identified in 22 patients (sensitivity, 65%) while AD was correctly identified in 20 patients (specificity, 71%). In the DLB group, right and left occipital perfusion indexes were 0.95 or more in all eight non-hallucinating patients, and bilateral occipital hypoperfusion was observed in 15 of the 26 patients with visual hallucinations (57.7%). To our knowledge, this is the first study in which (99m)Tc-ECD SPET has been used exclusively for the diagnosis of DLB. The results suggest that brain perfusion scintigraphy could be helpful in distinguishing DLB from AD if diagnosis based on clinical criteria alone is difficult. The findings also support a link between visual hallucinations and structural/functional changes in the occipital region in DLB patients.

Topics: Aged; Alzheimer Disease; Brain; Cysteine; Diagnosis, Differential; Feasibility Studies; Female; Hallucinations; Humans; Lewy Body Disease; Male; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon