technetium-tc-99m-bicisate and Multiple-System-Atrophy

The purpose of this study was to investigate the feasibility and utility of dual-isotope SPECT for differential diagnosis of idiopathic Parkinson's disease (IPD) and multiple system atrophy (MSA).. Simultaneous (99m)Tc-ECD/123I-FP-CIT studies were performed in nine normal controls, five IPD patients, and five MSA patients. Projections were corrected for scatter, cross-talk, and high-energy penetration, and iteratively reconstructed while correcting for patient-specific attenuation and variable collimator response. Perfusion and dopamine transporter (DAT) function were assessed using voxel-based statistical parametric mapping (SPM2) and volume of interest quantitation. DAT binding potential (BP) and asymmetry index (AI) were estimated in the putamen and caudate nucleus.. Striatal BP was lower in IPD (55%) and MSA (23%) compared to normal controls (p<0.01) , and in IPD compared to MSA (p<0.05). AI was greater for IPD than for MSA and controls in both the caudate nucleus and the putamen (p<0.05). There was significantly decreased perfusion in the left and right nucleus lentiformis in MSA compared to IPD and controls (p<0.05).. Dual-isotope studies are both feasible in and promising for the diagnosis of parkinsonian syndromes.

Topics: Cysteine; Diagnosis, Differential; Feasibility Studies; Female; Humans; Image Enhancement; Male; Middle Aged; Multiple System Atrophy; Organotechnetium Compounds; Parkinson Disease; Radionuclide Imaging; Reproducibility of Results; Sensitivity and Specificity; Tropanes

Statistical parametric mapping was performed to investigate differences in regional cerebral blood flow (rCBF) between patients with idiopathic Parkinson's disease (IPD), patients with multiple system atrophy (MSA), and healthy volunteers. In addition, a voxel-based covariance analysis was performed with disease-specific parameters and clinical patient data such as disease duration, medication, and clinical subscores.. For this purpose, (99m)Tc-ethylcysteine dimer (ECD) SPECT was performed on 81 IPD patients (50 men, 31 women; age, 62.6 +/- 10.2 y), 15 MSA patients (9 men, 6 women; age, 61.5 +/- 9.2 y), and 44 age- and sex-matched healthy volunteers (27 men, 17 women; age, 59.2 +/- 11.9 y).. Significant hypoperfusion was observed in IPD compared with healthy subjects in a symmetric subcortical-cortical network including the basal ganglia, thalami, prefrontal and lateral frontal cortex, and parietooccipital cortex (voxel P value P(height) < 0.001, corrected for multiple comparisons). For MSA, only symmetric hypoperfusion was seen in the putamen and thalamus with respect to healthy subjects and to IPD (P(height) < 0.01, corrected). Prolonged disease duration or higher Hoehn and Yahr stage results in hypoperfusion of the posterior associative cortex. There is a negative correlation between perfusion of the caudate heads and limbic system and the standardized dosage of dopamine agonists in the patients with PD, whereas for MSA a bilateral decrease in putamen activity was noted (P(height) < 0.001, uncorrected). Cognitive performance was positively correlated with limbic perfusion and inversely correlated with posterior associative cortical areas, but not with prefrontal regions.. Voxel-based analysis of (99m)Tc-ECD perfusion SPECT shows detailed differences between IPD and MSA, which may be of use in the differentiation of both disease entities, and is able to elucidate cerebral perfusion correlates of disease severity, dopamine agonist medication, and cognitive performance.

Topics: Algorithms; Brain; Cysteine; Diagnosis, Differential; Female; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Multiple System Atrophy; Organotechnetium Compounds; Parkinson Disease; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon

The clinical differentiation between typical idiopathic Parkinson's disease (IPD) and atypical parkinsonian disorders such as multiple system atrophy (MSA) is complicated by the presence of signs and symptoms common to both forms. The goal of this study was to re-evaluate the contribution of brain perfusion single-photon emission tomography (SPET) with anatomical standardisation and automated analysis in the differentiation of IPD and MSA. This was achieved by discriminant analysis in comparison with a large set of age- and gender-matched healthy volunteers. Technetium-99m ethyl cysteinate dimer SPET was performed on 140 subjects: 81 IPD patients (age 62.6+/-10.2 years; disease duration 11.0+/-6.4 years; 50 males/31 females), 15 MSA patients (61.5+/-9.2 years; disease duration 3.0+/-2.2 years; 9 males/6 females) and 44 age- and gender-matched healthy volunteers (age 59.2+/-11.9 years; 27 males/17 females). Patients were matched for severity (Hoehn and Yahr stage). Automated predefined volume of interest (VOI) analysis was carried out after anatomical standardisation. Stepwise discriminant analysis with cross-validation using the leave-one-out method was used to determine the subgroup of variables giving the highest accuracy for this differential diagnosis. Between MSA and IPD, the only regions with highly significant differences in uptake after Bonferroni correction were the putamen VOIs. Comparing MSA versus normals and IPD, with putamen VOI values as discriminating variables, cross-validated performance showed correct classification of MSA patients with a sensitivity of 73.3%, a specificity of 84% and an accuracy of 83.6%. Additional input from the right caudate head and the left prefrontal and left mesial temporal cortex allowed 100% discrimination even after cross-validation. Discrimination between the IPD group alone and healthy volunteers was accurate in 94% of the cases after cross-validation, with a sensitivity of 91.4% and a specificity of 100%. The three-group classification (MSA, IPD and healthy volunteers) resulted in an overall accuracy of 86% post hoc, with 98% of normals, 78% of IPD and 93% of MSA correctly classified. These values were slightly lower after cross-validation: 96% for healthy volunteers, 77% for IPD and 67% for MSA. In conclusion, using age- and gender-matched healthy volunteer data and anatomical standardisation, it is possible to differentiate between IPD and MSA with high discriminating power in clinically relevant circums

Topics: Brain; Cysteine; Diagnosis, Differential; Discriminant Analysis; Female; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Multiple System Atrophy; Organotechnetium Compounds; Parkinson Disease; Radiopharmaceuticals; Reference Standards; Reference Values; Subtraction Technique; Tomography, Emission-Computed, Single-Photon

Multiple system atrophy, cerebellar type (MSA-C) sometimes shows asymmetrical findings on magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT).. To assess the frequency and clinical significance of asymmetrical MRI and (99m)Tc-ethyl cysteinate dimer perfusion (ECD) SPECT findings of the cerebellum, middle cerebellar peduncle (MCP), and pons in MSA-C patients.. We retrospectively reviewed 28 patients with MSA-C who underwent MRI and (99m)Tc-ECD SPECT and evaluated laterality of atrophy and signal changes on MRI, and laterality of perfusion on (99m)Tc-ECD SPECT transversely and longitudinally.. Laterality was identified for 64%, 61%, and 21% of atrophy in the cerebellum, MCP, and pons, respectively, on MRI and for 71% of atrophy in the cerebellum on perfusion SPECT. Concerning comparisons between the latest MRI and SPECT findings, laterality of cerebellar/MCP atrophy on MRI and decreased cerebellar perfusion on SPECT was matched in 57%, mismatched in 11%, and absent in 25% of patients. On past images, MRI and SPECT showed matched laterality in 33%, mismatched laterality in 27%, no laterality in 13%, and SPECT precedent laterality in 27% of patients. Including the latest and past images, asymmetrical changes were observed in 75% of patients. We could not identify any correlation between laterality of image findings and cerebellar symptoms in most patients.. Asymmetrical changes on MRI and perfusion SPECT are common in MSA-C patients. Perfusion SPECT is useful for diagnosing MSA-C in the early stages from a functional perspective.

Topics: Aged; Cysteine; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multiple System Atrophy; Organotechnetium Compounds; Radiopharmaceuticals; Retrospective Studies; Tomography, Emission-Computed, Single-Photon

Because it is often difficult to precisely diagnose and distinguish progressive supranuclear palsy (PSP) from corticobasal degeneration (CBD), multiple system atrophy-parkinsonism (MSA-P) and Parkinson's disease (PD) at the onset of the disease, we compared the patients and clarified the features of these diseases.. We compared 77 PSP, 26 CBD, 26 MSA-P and 166 PD patients from clinical and imaging points of view including cerebral blood flow (CBF) in the frontal eye field.. The clinical characteristics of PSP were supranuclear gaze disturbance, optokinetic nystagmus (OKN) impairment and falls at the first visit. On head MRI, midbrain tegmentum atrophy was much more frequently detected in PSP than in all of the other groups. Heart-to-mediastinum average count ratio (H/M) in iodine-123 meta-iodobenzyl guanidine ((123)I-MIBG) myocardial scintigraphy was not decreased in PSP, CBD, MSA-P and PD-Yahr 1 (-1), but patients of PD-2, 3, 4 and 5 showed a significant decrease compared with the PSP group. The CBF in the left frontal eye field of PD-3 group and that in right frontal eye field of PD-3 and PD-4 groups were lower than that of PSP group, although other groups showed a tendency without a significant decrease compared with PSP group.. PSP is distinguishable from CBD, MSA-P and PD even at the early stage with extra-ocular movement (EOM) disturbance, falls, atrophy of the midbrain tegmentum, and H/M in (123)I-MIBG myocardial scintigraphy, and the reduction of CBF in area 8 could serve as a supplemental diagnostic method for distinguishing PSP from PD-3 or PD-4.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Basal Ganglia; Cerebral Cortex; Cerebrovascular Circulation; Cysteine; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Multiple System Atrophy; Neurodegenerative Diseases; Organotechnetium Compounds; Parkinson Disease; Parkinsonian Disorders; Radiopharmaceuticals; Supranuclear Palsy, Progressive; Tomography, Emission-Computed, Single-Photon

In the present study, we compared the patterns of regional cerebral blood flow (rCBF) between cerebellar variant of multiple system atrophy (MSA-C) and the late-onset cortical cerebellar ataxia (LCCA) using FineSRT.. We performed (99m)Tc ethylcysteinate dimer (ECD) single-photon emission computed tomography in 11 patients with MSA-C (mean age 65.7 years), 7 patients with LCCA (mean age 62.0 years), and 12 age-matched healthy controls (mean age 64.1 years). The rCBF in the region of interest (ROI) was measured by the noninvasive Patlak plot method and calculated using FineSRT, which is a fully automated the ROI technique.. All patients with MSA-C had various degrees of atrophy in the brainstem and middle cerebellar peduncles and 4 of 11 patients showed a clear 'hot cross bun' sign in pontine base on T2-weighted MR images. All patients with LCCA showed the various degrees of atrophy in cerebellum without brainstem. FineSRT revealed the significantly decreased rCBF in the caudate tail, fusiform, lingual, cerebellum, midbrain, and pons in MSA-C group compared with controls. Moreover, MSA-C group showed significantly decreased rCBF in the pons compared with LCCA group.. We suggest that a widespread brain involvement is present in patients with MSA-C and the decreased rCBF in the pons may support the differential diagnosis between MSA-C and LCCA.

Topics: Aged; Brain; Brain Mapping; Cerebellum; Cerebrovascular Circulation; Cysteine; Female; Functional Laterality; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Multiple System Atrophy; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Spinocerebellar Degenerations; Stereotaxic Techniques; Tomography, Emission-Computed, Single-Photon

Spatial covariance analysis has been used with FDG PET to identify a specific metabolic network associated with Parkinson's disease (PD). In the current study, we utilized a new, fully automated voxel-based method to quantify network expression in ECD SPECT images from patients with classical PD, patients with multiple system atrophy (MSA), and healthy control subjects.. We applied a previously validated voxel-based PD-related covariance pattern (PDRP) to quantify network expression in the ECD SPECT scans of 35 PD patients, 15 age- and disease severity-matched MSA patients, and 35 age-matched healthy control subjects. PDRP scores were compared across groups using analysis of variance. The sensitivity and specificity of the prospectively computed PDRP scores in the differential diagnosis of individual subjects were assessed by receiver operating characteristic (ROC) analysis.. PDRP scores were significantly increased (p < 0.001) in the PD group relative to the MSA and control groups. ROC analysis indicated that the overall diagnostic accuracy of the PDRP measures was 0.91 (AUC). The optimal cutoff value was consistent with a sensitivity of 0.97 and a specificity of 0.80 and 0.71 for discriminating PD patients from MSA and normal controls, respectively.. Our findings suggest that fully automated voxel-based network assessment techniques can be used to quantify network expression in the ECD SPECT scans of parkinsonian patients.

Topics: Algorithms; Brain; Cysteine; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Multiple System Atrophy; Organotechnetium Compounds; Parkinson Disease; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Signal Transduction; Tomography, Emission-Computed, Single-Photon

Single-photon emission computed tomography brain imaging with special reference of bladder function was performed in eight multiple system atrophy (MSA) patients (two men, six women; mean age, 61 years) and age-matched five normal control subjects (three men, two women; 62 years). In both groups imagings were obtained in three conditions; empty bladder, storage, and micturition. [99mTc]-labelled ECD (555 MBq) was intravenously injected, which was immediately trapped and stabilized within the brain. Using NEUROSTAT software, which could also cancel morphologic differences between MSA and canonical brain, statistical difference between normalized mean tracer counts of both groups in each phase was calculated and visualized. In the storage phase, there was a significant decrease in tracer activity in bilateral cerebellar vermis, particularly of the right side in the MSA group (P < 0.05), which is also known to be involved in the neural control of micturition. In the micturition phase, the area of decrease in tracer activity in the cerebellar vermis became wider in the MSA group. In the resting state, no statistically significance was seen between both groups. In conclusion, it is suggested that the decrease in tracer activity in the cerebellar vermis during urinary storage and micturition is contributing to the micturitional disturbance in this disorder.

Topics: Aged; Brain Mapping; Cerebellum; Cysteine; Female; Functional Laterality; Humans; Male; Middle Aged; Multiple System Atrophy; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Urinary Bladder; Urination

Positron emission tomography (PET) and network analysis have been used to identify a reproducible pattern of regional metabolic covariation that is associated with idiopathic Parkinson's disease (PD). The activity of this PD-related pattern can be quantified in individual subjects and used to discriminate PD patients from atypical parkinsonians. Because PET is not commonly available, we sought to determine whether similar discrimination could be achieved using more routine single photon emission computed tomography (SPECT) perfusion methods. Twenty-three subjects with PD (age, 63 +/- 9 years), 22 subjects with multiple system atrophy (MSA; age, 64 +/- 7 years), and 20 age-matched healthy controls (age, 62 +/- 13 years) underwent SPECT imaging of regional cerebral perfusion with Tc-99m ethylene cysteinate dimer (ECD). Using network analysis, we determined whether a PD-related pattern existed in the SPECT data, and whether its expression discriminated PD from MSA patients. Additionally, we compared the accuracy of group discrimination achieved by this pattern with that of the PET-derived PD-related pattern applied to the SPECT data. Network analysis of the SPECT data identified a significant pattern characterized by relative increases in cerebellar, lentiform, and thalamic perfusion covarying with decrements in the frontal operculum and in the medial temporal cortex. Subject scores for this pattern discriminated PD patients from controls (P < 0.01) and from MSA patients (P < 0.03). Subject scores for the PET-derived PD-related pattern computed in the individual SPECT scans more accurately distinguished PD patients from controls (P < 0.005) and from MSA patients (P = 0.0002). A significant PD-related covariance pattern can be identified in SPECT perfusion data. Moreover, the disease related pattern identified previously with PET can be applied to individual SPECT perfusion scans to provide group discrimination between PD patients, healthy controls, and individuals with MSA. Because of significant individual subject overlap between groups, however, the clinical utility of this method in the differential diagnosis of Parkinsonism remains uncertain.

Topics: Aged; Brain; Cysteine; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Multiple System Atrophy; Nerve Net; Organotechnetium Compounds; Parkinson Disease; Parkinsonian Disorders; Regional Blood Flow; Sensitivity and Specificity; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon