technetium-tc-99m-bicisate and Memory-Disorders

The purpose of this atlas is to present a review of the literature showing the advantages of SPECT brain perfusion imaging (BPI) in mild or moderate traumatic brain injury (TBI) over other morphologic imaging modalities such as x-ray CT or MRI. The authors also present the technical recommendations for SPECT brain perfusion currently practiced at their center. For the radiopharmaceutical of choice, a comparison between early and delayed images using Tc-99m HMPAO and Tc-99m ECD showed that Tc-99m HMPAO is more stable in the brain with no washout over time. Therefore, the authors feel that Tc-99m HMPAO is preferable to Tc-99m ECD. Recommendations regarding standardizing intravenous injection, the acquisition, processing parameters, and interpretation of scans using a ten grade color scale, and use of the cerebellum as the reference organ are presented. SPECT images of 228 patients (age range, 11 to 88; mean, 40.8 years) with mild or moderate TBI and no significant medical history that interfered with the results of the SPECT BP were reviewed. The etiology of the trauma was in the following order of frequency: motor vehicle accidents (45%) followed by blow to the head (36%) and a fall (19%). Frequency of the symptoms was headache (60.9%), memory problems (27.6%), dizziness (26.7%), and sleep disorders (8.7%). Comparison between patients imaged early (<3 months) versus those imaged delayed (>3 months) from the time of the accident, showed that early imaging detected more lesions (4.2 abnormal lesions per study compared to 2.7 in those imaged more than 3 months after the accident). Of 41 patients who had mild traumatic injury without loss of consciousness and had normal CT, 28 studies were abnormal. Focal areas of hypoperfusion were seen in 77% (176 patients, 612 lesions) of the group of 228 patients. The sites of abnormalities were in the following order: basal ganglia and thalami, 55.2%, frontal lobes, 23.8%, temporal lobes, 13%, parietal, 3.7%, insular and occipital lobes together, 4.6%.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Basal Ganglia; Brain Injuries; Cerebrovascular Circulation; Child; Cysteine; Dizziness; Frontal Lobe; Headache; Humans; Image Processing, Computer-Assisted; Injections, Intravenous; Magnetic Resonance Imaging; Memory Disorders; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Thalamus; Time Factors; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Unconsciousness

This preliminary study determined if subjects with memory loss problems demonstrate changes in memory and cerebral blood flow (CBF) after a simple 8-week meditation program. Fourteen subjects with memory problems had an IV inserted and were injected with 250 MBq of Tc-99m ECD while listening to a neutral stimulus CD. They then underwent a pre-program baseline SPECT scan. Then subjects were guided through their first meditation session with a CD, during which they received an injection of 925 MBq ECD, and underwent a pre-program meditation scan. Subjects completed an 8-week meditation program and underwent the same scanning protocol resulting in a post-program baseline and meditation scan. A region of interest (ROI) template obtained counts in each ROI normalized to whole brain to provide a CBF ratio. Baseline and meditation scans and neuropsychological testing were compared before and after the program. The meditation program resulted in significant increases (p< 0.05) in baseline CBF ratios in the prefrontal, superior frontal, and superior parietal cortices. Scores on neuropsychological tests of verbal fluency, Trails B, and logical memory showed improvements after training. This preliminary study evaluated whether an 8-week meditation program resulted in improvements in neuropsychological function and differences in CBF in subjects with memory loss. While the findings are encouraging, there are a number of limitations that can be addressed in future studies with more participants and more detailed analyses.

Topics: Aged; Brain Mapping; Cerebrovascular Circulation; Cognition Disorders; Cysteine; Female; Humans; Male; Memory Disorders; Mental Status Schedule; Middle Aged; Negotiating; Neuropsychological Tests; Organotechnetium Compounds; Tomography, Emission-Computed, Single-Photon

Eight patients (seven women), mean +/- SD T1 age 68.57 +/- 12.43 years, average educational level 5.83 +/- 3.70 years, had two Tc-99m ECD SPECT examinations separated by an average 8.49 +/- 5.59 months. Patients were imaged using standard Harlem Hospital acquisition and processing protocols with approximately 30 mCi of ECD on a Prism 3000 triple head gamma camera. Images were interpreted by an independent reader blinded to the patients' clinical history and imaging date. T1 psychiatric diagnosis was seven Alzheimer's dementia (AD) and one depression. Eight T1 images were interpreted as abnormal, six indicative of AD. Binomial 95% two-tail confidence interval for T1 agreement between diagnosis and interpretation was 0.25 0.63 0.92. T2 diagnosis was seven AD and one none. Seven T2 images were abnormal and indicative of AD, and one was normal. T2 confidence interval was 0.34 0.75 0.97. These findings suggest SPECT's value in assessing AD in uneducated socioeconomically disadvantaged geriatric patients.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Brain; Cerebrovascular Circulation; Cysteine; Diagnosis, Differential; Diagnostic Errors; Educational Status; Female; Geriatric Assessment; Humans; Male; Memory Disorders; Minority Groups; Neuropsychological Tests; Organotechnetium Compounds; Pilot Projects; Regional Blood Flow; Single-Blind Method; Socioeconomic Factors; Tomography, Emission-Computed, Single-Photon; Urban Population

Two radiopharmaceuticals, 99Tcm-hexamethyl propylene amine oxime (99Tcm-HMPAO) and 99Tcm-ethyl cysteinate dimer (99Tcm-ECD), are currently used to determine cerebral blood flow. 99Tcm-ECD is, by virtue of its greater stability, superseding 99Tcm-HMPAO for routine examinations. Since the clinical assessment of 99Tcm-ECD images is usually based on experience with 99Tcm-HMPAO, we used both radiopharmaceuticals to compare regional cerebral blood flow in the same individuals. Eleven healthy subjects aged 67.1 +/- 6.3 years (mean +/- S.D.) underwent 99Tcm-ECD followed by 99Tcm-HMPAO single photon emission tomography. Cerebral blood flow was quantified in cortical and central regions of interest (basal ganglia, ventricles, white matter) in relation to cerebellar uptake. The intra-subject comparison of cerebral blood flow in the cortical areas revealed higher levels of perfusion in the posterior parietal, parieto-occipital and temporo-occipital areas using 99Tcm-ECD. In contrast to the cortical areas, cerebral blood flow in the central areas was greater using 99Tcm-HMPAO, especially in the centrum semiovale, basal ganglia, frontal white matter and frontal horns. This difference in cerebral blood flow when imaging healthy individuals with 99Tcm-ECD and 99Tcm-HMPAO should be taken into account in clinical practice when changing from one radiopharmaceutical to the other.

Topics: Aged; Brain; Cerebrovascular Circulation; Cysteine; Female; Humans; Male; Memory Disorders; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Reference Values; Technetium Tc 99m Exametazime; Tomography, Emission-Computed; Xenon Radioisotopes

Repetitive transcranial magnetic stimulation (rTMS) and intensive cognitive rehabilitation (CR) were administered to two patients with cognitive dysfunction following brain injury. The first case was a 67-year-old man who presented with memory dysfunction, attention dysfunction, and decreased insight following diffuse axonal injury. High-frequency rTMS (10 Hz, 2400 pulses/day) targeting the anterior cingulate using a navigation system and CR were administered for 12 days at 1 year from the onset of injury. The patient showed improved neuropsychological performance and activities of daily living. In addition, single photon emission computer tomography with Tc-ECD showed improved perfusion in the anterior cingulate gyrus. The second case was a 68-year-old man who presented with dysfunction of memory, attention, and executive function following a cerebral infarction in the middle cerebral artery region within the right hemisphere. This patient received 12 days (except for Sundays) of low-frequency rTMS (1 Hz, 1200 pulses/day) targeting the left dorsolateral prefrontal cortex and the left posterior parietal cortex and CR. Following this intervention, the patient's neuropsychological performance and activities of daily living improved. Furthermore, single photon emission computer tomography showed changes in perfusion in the rTMS target sites and areas surrounding the targets. We have shown the safety and efficacy of rTMS therapy using a navigation system combined with intensive CR on two patients with cognitive dysfunction following brain injury. In addition, we observed changes in the areas around the rTMS target sites in brain imaging data.

Topics: Aged; Brain Injuries; Cerebrovascular Circulation; Cognition Disorders; Cysteine; Electroencephalography; Functional Laterality; Humans; Male; Memory Disorders; Organotechnetium Compounds; Physical Conditioning, Human; Radiopharmaceuticals; Recovery of Function; Tomography, Emission-Computed, Single-Photon; Transcranial Magnetic Stimulation

Déjà vu is a common experience among the normal population. However, in individuals with temporal lobe epilepsy, it often occurs as a seizure manifestation. The specific cause of such déjà vu is not yet known. Here, we report a case of epilepsy with persistent déjà vu. The patient described the state as if he were living the same life he had lived before. Blood perfusion single-photon-emission computed tomography (SPECT) performed during the persistent déjà vu showed hyperperfusion in the left medial temporal area; discontinuation of déjà vu was accompanied by disappearance of the hyperperfused area on SPECT. Analysis with three-dimensional co-registration of SPECT and MRI revealed that the hyperperfused area during the persistent déjà vu was in the entorhinal cortex of the left temporal lobe. According to recent theories of recognition memory, malfunction of the parahippocampal area may cause déjà vu. It is also suggested that epileptic activity in the parahippocampal area, especially the entorhinal cortex, may elicit déjà vu.

Topics: Anticonvulsants; Cysteine; Deja Vu; Entorhinal Cortex; Epilepsy, Temporal Lobe; Humans; Male; Memory Disorders; Middle Aged; Neuropsychological Tests; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

Perfusion brain single photon emission computed tomography (SPECT) is currently used to evaluate patients with cognitive impairments. Although widely available, it has been reported to be significantly less sensitive than F-18 FDG positron emission tomography. Optimization of SPECT parameters using nonuniform attenuation correction (NUAC) and scatter correction (SC) might improve the accuracy of the method. This study assessed the effect of x-ray CT-based NUAC and triple-energy window (TEW-SC) on brain SPECT compared with Chang-uniform (UAC). A total of 31 patients with memory complaints underwent Tc-99m ECD SPECT/CT. CT-NUAC+TEW-SC and Chang-UAC were applied and compared. The images were spatially normalized to a default SPECT template supplied with Statistical Parametric Mapping software (SPM2). A paired t test image was then reconstructed. Regional cerebral blood flow measurements were apparently reduced in the frontal white-matter and in the frontotemporal cortex when CT-NUAC+TEW-SC were used. These findings need to be considered when interpreting Tc-99m ECD SPECT after applying CT-AC+TEW-SC. Further prospective studies with clinical correlations are needed.

Topics: Aged; Aged, 80 and over; Brain; Cysteine; Female; Humans; Male; Memory Disorders; Middle Aged; Organotechnetium Compounds; Retrospective Studies; Scattering, Radiation; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Diffusion-weighted imaging (DWI) has been reported to be a useful technique for diagnosing Creutzfeldt-Jakob disease (CJD). The present study reported DWI results in cases of familial CJD with a V180I mutation (CJD180) in the prion protein gene as well as neurological findings.. A retrospective analysis of 3 patients with V180I was performed. Cerebrospinal fluid (CSF) analysis, brain MRI, single-photon emission computed tomography (SPECT), and magnetic resonance spectroscopy (MRS) were included. CSF was analyzed for biochemical markers, and each patient underwent brain MRI, SPECT, and MRS analysis. A brain biopsy from the frontal cortex, which corresponded to the area of increased DWI signals, was utilized for neuropathological analysis.. CSF analysis results revealed elevated total tau protein and the absence of 14-3-3 protein, as well as decreased concentrations of neuron-specific enolase, S100 protein, and prostaglandin E(2). All patients presented with unique MRI features. Brain biopsy showed severe spongiform morphology, but comparatively preserved neurons and mild astrocytic gliosis. Accumulations of PrP(Sc) were not detected using the 3F4 antibody, and microglial activation was subtle. SPECT revealed hypoperfusion throughout both hemispheres. MRS revealed a reduced N-acetyl aspartate/creatine ratio.. Results from this study suggested that increased DWI signals could reflect severe spongiform changes in CJD180 patients.

Topics: Aged; Biomarkers; Brain; Creutzfeldt-Jakob Syndrome; Cysteine; Diffusion Magnetic Resonance Imaging; Enzyme-Linked Immunosorbent Assay; Female; Humans; Image Processing, Computer-Assisted; Immunohistochemistry; Magnetic Resonance Spectroscopy; Male; Memory Disorders; Organotechnetium Compounds; Primary Progressive Nonfluent Aphasia; Pyridines; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

We report a functional neuroimaging study of a 43-year-old woman with Nasu-Hakola disease (NHD). Regional cerebral blood flow (rCBF) images were measured with technetium-99m ethyl cysteinate dimer single photon emission computed tomography (SPECT). rCBF was decreased in the bilateral frontal lobes and thalamus. This finding was consistent with the known underlying neuropathology in patients with NHD. Brain SPECT is useful for demonstrating the pathophysiologic brain region in patients with NHD.

Topics: Adult; Brain; Cerebrovascular Circulation; Chromosome Disorders; Cysteine; Dementia, Vascular; Female; Humans; Lipodystrophy; Memory Disorders; Organotechnetium Compounds; Osteochondrodysplasias; Radionuclide Imaging; Radiopharmaceuticals; Syndrome

Usually, dementia, gait disturbance and urinary incontinence are an integral part of the clinical presentation of normal pressure hydrocephalus (NPH). However, NPH with transient visual cognitive disorders has not been reported previously. We herein describe an extremely rare case of NPH that presented with transient visual cognitive disorders and long lasting visual memory disturbances that subsided after CSF shunting. A 38-years-old man developed transient prosopagnosia, topographical disorientation, color vision disturbance, and visual objective agnosia that progressed over 5 years. Magnetic resonance images showed ventriculomegaly with ischemic lesions in the paraventricular deep white matter. ECD-SPECT showed a reduction of the cerebral blood flow (CBF) in the periventricular deep white matter. Three months after CSF shunting, the radiological findings normalized with dramatic improvement of the extremely rare symptoms.

Topics: Adult; Agnosia; Cerebral Ventricles; Cerebral Ventriculography; Confusion; Cysteine; Humans; Hydrocephalus, Normal Pressure; Magnetic Resonance Imaging; Male; Memory Disorders; Organotechnetium Compounds; Prosopagnosia; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt

Topics: Adult; Brain; Cerebrovascular Circulation; Cysteine; Humans; Male; Memory; Memory Disorders; Organotechnetium Compounds; Radiopharmaceuticals; Schizophrenia; Schizophrenic Psychology; Tomography, Emission-Computed, Single-Photon; Verbal Learning

Regional cerebral blood flow (rCBF) during a verbal learning task was measured using 99mTc-ethyl-cysteinate dimer and single photon emission computed tomography in 10 patients with schizophrenia and nine normal controls. Verbal repetition was used as a control task. The schizophrenic patients showed failure to spontaneously utilize implicit category information to learn the word lists. In the normal controls, rCBF in the left inferior frontal and left anterior cingulate regions was significantly increased during the verbal learning task, compared with the verbal repetition task. In contrast, there was no significant frontal lobe activation by the verbal learning in the schizophrenic patients. The patients had lower rCBF during the verbal learning task than the controls in the bilateral inferior frontal, left anterior cingulate, right superior frontal, and bilateral middle frontal regions. Activation in the left inferior frontal region was significantly positively correlated with categorical clustering in the task in the controls, but no such correlation was found in the patients. These results indicate that memory organization deficits in schizophrenia may be related to dysfunction in the prefrontal areas, especially in the left inferior frontal region.

Topics: Adult; Cysteine; Frontal Lobe; Functional Laterality; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Male; Memory Disorders; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Schizophrenia; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Verbal Learning