technetium-tc-99m-exametazime and Asphyxia-Neonatorum

In this study, technetium 99m hexamethylpropyleneamine oxime (99mTc-HMPAO) single photon emission computed tomography (SPECT) was performed on 18 asphyxiated and epileptic children who also had a status epilepticus episode, and the results were compared with those for 21 children without a status epilepticus episode. All patients underwent a detailed neurologic history, interictal electroencephalography, computed tomography, and/or magnetic resonance imaging. Visual evaluation of the SPECT study showed that 16 patients of group 1 had 56 hypoperfused regions in cerebral blood flow. However, in group 2, visual evaluation showed only six detectable hypoperfusion areas in five patients. When an asymmetric index value of 3 was considered as a cutoff point, 82 regions in group 1 and 57 regions in group 2 were above this value after the quantitative SPECT evaluation. The mean number of pathologic brain regions was found to be higher in group 1 (5.1 +/- 4.3) than in group 2 (2.7 +/- 2.4) (P = .014). The localization of hypoperfused regions that were observed in temporal and frontal regions was generally similar in both groups. In conclusion, the functional activities of the brain vary in both asphyctic and epileptic children, with and without status epilepticus. These children might be candidates for refractory convulsive disease, and interictal SPECT can be a reliable method for the detection of brain lesions in these patients.

Topics: Adolescent; Asphyxia Neonatorum; Brain; Case-Control Studies; Cerebrovascular Circulation; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Radiopharmaceuticals; Status Epilepticus; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Brain SPECT imaging was performed in 13 children with cerebral palsy (6 girls, 7 boys; age, 7-17 years) due to perinatal asphyxia with mental retardation and involved limbs were studied. The involved coronal slices were summated to a picture for the calculation of the perfusion defect indices as the quantitative and objective estimation of the perfusion defects in each brain. The records of IQ tests were scored from severe to mild mental retardation. Two experienced nuclear medicine physicians analyzed the results of the Tc-99m HMPAO brain SPECTs by visual interpretation. The involved limbs were judged by two pediatricians to be either the right or left side. The relationship among the Tc-99m HMPAO brain SPECTs, IQ test, and physical examinations of the extremities were established. The results showed that two cases of mild mental retardation had the smaller perfusion defect indices (< 0.1), six cases of severe mental retardation had the larger perfusion defect indices (> 0.30), and the other group was between the first two groups. Two cases of mild mental retardation did not have significant perfusion defects in the brain and involved limbs, and two cases with decreased visual acuity had definite perfusion defects in the occipital regions. The other cases had the matched perfusion defects of the brain with the involved limbs. The authors encourage the potential use of Tc-99m HMPAO brain SPECTs to predict the outcome of mental development and limb involvement.

Topics: Adolescent; Asphyxia Neonatorum; Brain; Cerebral Palsy; Cerebrovascular Circulation; Child; Extremities; Female; Humans; Infant, Newborn; Intellectual Disability; Intelligence Tests; Male; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

This study was designed to rate the clinical value of [123I]iodoamphetamine (IMP) or [99mTc] hexamethyl propylene amine oxyme (HM-PAO) brain single photon emission computed tomography (SPECT) in neonates, especially in those likely to develop cerebral palsy. The results showed that SPECT abnormalities were congruent in most cases with structural lesions demonstrated by ultrasonography. However, mild bilateral ventricular dilatation and bilateral subependymal porencephalic cysts diagnosed by ultrasound were not associated with an abnormal SPECT finding. In contrast, some cortical periventricular and sylvian lesions and all the parasagittal lesions well visualized in SPECT studies were not diagnosed by ultrasound scans. In neonates with subependymal and/or intraventricular hemorrhage the existence of a parenchymal abnormality was only diagnosed by SPECT. These results indicate that [123I]IMP or [99mTc]HM-PAO brain SPECT shows a potential clinical value as the neurodevelopmental outcome is clearly related to the site, the extent, and the number of cerebral lesions. Long-term clinical follow-up is, however, mandatory in order to define which SPECT abnormality is associated with neurologic deficit.

Topics: Amphetamines; Asphyxia Neonatorum; Brain; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Iodine Radioisotopes; Male; Muscle Hypertonia; Muscle Hypotonia; Organometallic Compounds; Oximes; Seizures; Technetium; Technetium Tc 99m Exametazime; Tomography, Emission-Computed