technetium-tc-99m-exametazime and Basal-Ganglia-Diseases

The aim of this SPECT study was to determine whether there is a correlation between rCBF (99mTc-HMPAO) and D2 receptor binding (123I-IBZM) in disorders of the extrapyramidal system and in which situation the 99mTc-HMPAO scan could predict the outcome of the 123I-IBZM study. 13 patients with Parkinson's syndrome and 13 patients with hyperkinetic extrapyramidal disorders were studied. In all patients the two SPECT studies were performed within 2-7 days. ROIs were placed over the basal ganglia (BG), the frontal cortex (FC) and the cerebellum (CE). The ratios BG/FC and BG/CE were calculated. In both groups the scatter was lower when the frontal cortex was used as reference region. Among the patients with hyperkinetic extrapyramidal disorders the two patients with Huntington's chorea had lower rCBF and D2 receptor binding compared to other hyperkinetic extrapyramidal disorders. There was no correlation between D2 receptor binding and rCBF in the basal ganglia. The 99mTc-HMPAO studies did not provide clinically useful information, except in Huntington's chorea.

Topics: Adult; Aged; Basal Ganglia; Basal Ganglia Diseases; Benzamides; Brain; Cerebellum; Cerebrovascular Circulation; Dopamine Antagonists; Frontal Lobe; Humans; Huntington Disease; Iodine Radioisotopes; Middle Aged; Organotechnetium Compounds; Oximes; Parkinson Disease; Parkinson Disease, Secondary; Pyrrolidines; Receptors, Dopamine D2; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A case of idiopathic basal ganglia calcification in a 56-year-old woman with parkinsonism and cognitive impairment is described. The nigrostriatal dopaminergic pathway and regional cerebral blood flow were evaluated using dopamine transporter (DAT) brain single photon emission tomography combined with a low-dose x-ray computerized tomography transmission (hybrid SPECT/CT) and Tc-99m HMPAO brain perfusion SPECT study, respectively. DAT SPECT/CT imaging revealed a reduction in DAT binding in both striatum regions coinciding with bilateral calcifications in the basal ganglia. Brain perfusion scan showed hypoperfusion in basal ganglia regions, posterior parietal cortex bilaterally, left frontopolar and dorsolateral prefrontal cortex, and left temporal lobe. These findings correlated well with the clinical condition of the patient. Mineralization may play a critical role in the pathogenesis of neuronal degeneration. Cortical perfusion changes in patients may better explain the patient's altered cognitive and motor functions.

Topics: Basal Ganglia Diseases; Brain; Calcinosis; Cerebrovascular Circulation; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Middle Aged; Perfusion Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The diagnosis of corticobasal degeneration (CBD) is difficult despite the existence of some typical clinical features. Single photon emission computerized tomography (SPECT) in CBD presents an original pattern (with asymmetric hypoperfusion in pre- and retrorolandic regions) that could facilitate the differential diagnosis of CBD relative to the other degenerative parkinsonian syndromes. The objective of our study was to compare the regional cerebral blood flow measurements studied by SPECT in both CBD and Parkinson's disease (PD) using a multivariate procedure. Twenty-one patients with probable CBD and 20 patients with probable PD underwent brain (99m)Tc HmPaO SPECT. We used factorial discriminant analysis (FDA) to study the relative fixation of 26 regions of interest (ROIs) drawn on two transverse slices, together with the asymmetry indexes of 13 pairs of ROIs. FDA performed using the full set of parameters classified all the patients correctly. In order to classify the patients more easily, a predictive score using a selection of parameters was established. The most discriminating ROIs were the temporoinsular, temporoparietal, and frontal medial regions. We believe that this semiautomatic classification may be a precious tool for reinforcing the current clinical differential diagnosis of CBD and PD.

Topics: Aged; Basal Ganglia Diseases; Cerebrovascular Circulation; Discriminant Analysis; Female; Humans; Male; Middle Aged; Multivariate Analysis; Parkinson Disease; Statistics, Nonparametric; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Basal Ganglia Diseases; Calcinosis; Child; Electroencephalography; Epilepsy; Female; Humans; Hypoparathyroidism; Magnetic Resonance Imaging; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

To examine neurological, neuropsychological, psychiatric, and cerebral perfusion correlates of leukoaraiosis in Alzheimer's disease.. A consecutive series of patients with probable Alzheimer's disease was assessed with a comprehensive neuropsychological battery, a structured psychiatric evaluation, the unified Parkinson's disease rating scale, MRI, and single photon emission computed tomography with technetium 99m hexamethylpropyleneamine oxime (HMPAO) and regional cerebral perfusion measurements.. Patients with Alzheimer's disease and leukoaraiosis were significantly more apathetic and had significantly more extrapyramidal signs than patients with Alzheimer's disease without leukoaraiosis. Patients with Alzheimer's disease with leukoaraiosis also had significantly lower bilateral perfusion in the basal ganglia, thalamus, and frontal lobes than patients with Alzheimer's disease without leukoaraiosis. On the other hand, there were no significant differences between groups in age, duration of illness, depression scores, severity of delusions, or deficits on specific neuropsychological tasks.. Leukoaraiosis in Alzheimer's disease may produce significant basal ganglia, and thalamic and frontal lobe dysfunction, which may be associated with more severe apathy and extrapyramidal signs.

Topics: Aged; Alzheimer Disease; Analysis of Variance; Basal Ganglia Diseases; Brain; Brain Diseases; Cerebrovascular Circulation; Female; Humans; Magnetic Resonance Imaging; Male; Neurologic Examination; Neuropsychological Tests; Organotechnetium Compounds; Oximes; Psychiatric Status Rating Scales; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Aged, 80 and over; Basal Ganglia Diseases; Blood Flow Velocity; Brain Mapping; Cerebral Infarction; Chorea; Corpus Striatum; Dominance, Cerebral; Humans; Male; Neural Inhibition; Neurons; Organotechnetium Compounds; Oximes; Regional Blood Flow; Technetium Tc 99m Exametazime; Thalamic Nuclei; Thalamus; Tomography, Emission-Computed, Single-Photon

Fahr's disease is histopathologically characterized by massive bilateral calcifications of the cerebral basal ganglia, the dentate nuclei of the cerebellum and both the cerebral and cerebellar cortices. We report a case of Fahr's disease in which a 99mTc-hexamethyl-propylenamine oxime (99mTc-HMPAO) brain SPECT study was used to evaluate regional cerebral blood flow to the calcified regions. There was markedly decreased perfusion to the basal ganglia bilaterally as well as decreased perfusion to the cerebral cortices that correlated well with the patient's clinical condition.

Topics: Adult; Basal Ganglia; Basal Ganglia Diseases; Brain; Calcinosis; Cerebellar Nuclei; Cerebral Cortex; Cerebrovascular Circulation; Humans; Male; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Basal Ganglia; Basal Ganglia Diseases; Cerebral Cortex; Diagnosis, Differential; Frontal Lobe; Humans; Image Processing, Computer-Assisted; Nerve Degeneration; Organotechnetium Compounds; Oximes; Parietal Lobe; Parkinson Disease; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Four patients with clinical signs of cerebellar stroke were studied twice by SPECT using 99mTc-HMPAO as a tracer for cerebral blood flow (CBF). When first scanned 6 to 22 days after onset, all had a region of very low CBF in the symptomatic cerebellar hemisphere, and a mild to moderate CBF reduction (average 10%) in contralateral hemispheric cortex. In all four cases clinical signs of unilateral cerebellar dysfunction were still present when rescanned 1 to 4 months later and the relative CBF decrease in the contralateral cortex of the forebrain also remained. The basal ganglia contralateral to the cerebellar lesion CBF showed variable alterations. A relative CBF decrease was seen in upper part of basal ganglia in all four cases, but it was not a constant phenomenon. A relative CBF increase in both early and late SPECT scans was seen at low levels of neostriatum in two cases. The remote CBF changes in cerebellar stroke seen in the forebrain are probably caused by reduced or abolished cerebellar output. The term "Crossed Cerebral Diaschisis" may be used to describe these CBF changes that would appear to reflect both decreased and increased neuronal activity.

Topics: Aged; Basal Ganglia Diseases; Cerebellar Diseases; Cerebellum; Cerebral Infarction; Cerebrovascular Circulation; Functional Laterality; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Technetium 99m hexamethylpropylene-amine oxime (HMPAO) is trapped by cerebral grey matter and the basal ganglia on its first pass through the brain. To assess its potential for studying patients with diseases of the basal ganglia, a study of 15 normal volunteers and 32 patients with known or suspected basal ganglia disease have been investigated. Sixteen patients with idiopathic Parkinson's disease showed no abnormality of the basal ganglia and varying degrees of cerebral underperfusion consistent with their intellectual status. Eight patients with Huntington's chorea showed a characteristic pattern of reduced or absent caudate nucleus uptake. Patients with diseases affecting the basal ganglia, such as Fahr's disease, Wilson's disease and hemibalismus had varying degrees of basal ganglia underperfusion as demonstrated by an HMPAO scan. We believe that this new radiopharmaceutical for the demonstration of cerebral blood flow shows significant potential for the diagnosis and management of patients with basal ganglia disease.

Topics: Adult; Aged; Aged, 80 and over; Basal Ganglia Diseases; Cerebral Hemorrhage; Hepatolenticular Degeneration; Humans; Huntington Disease; Middle Aged; Organometallic Compounds; Oximes; Parkinson Disease; Technetium; Technetium Tc 99m Exametazime; Thalamic Diseases; Tomography, Emission-Computed; Tomography, X-Ray Computed

One hundred fourteen patients suffering from neuropsychiatric conditions have been studied using 99mTc-labeled hexamethylpropyleneamine oxime (HM-PAO) and single photon emission computed tomography (SPECT). Ninety-one patients had a firm clinical diagnosis while 23 were examined without knowledge of the clinical diagnosis. Of the 91 patients, 51 were suffering from dementia, 25 multi-infarct type and 26 Alzheimer's disease. In 19 of the Alzheimer's patients, a characteristic pattern of decreased perfusion in the parieto-occipital regions was demonstrated while those with multi-infarct type showed varying degrees of irregular uptake in the cerebral cortex. These appearances are similar to those shown with positron emission tomography (PET) and we believe that HM-PAO will provide a widely available method for identifying patients with Alzheimer's disease. Twenty-nine patients were suffering from diseases involving the basal ganglia. Fifteen patients with Parkinson's disease showed no significant abnormality in basal ganglia uptake, while 7 or 8 patients with Huntington's disease who had full examinations showed decreased uptake in the caudate nuclei. Similarly, four of six patients with other basal ganglia diseases showed impaired uptake by basal ganglia, and it is concluded that HM-PAO may be useful for the diagnosis and management of this type of patient. Twenty-three patients received HM-PAO imaging as part of their diagnostic work-up; in 19 of them, detailed follow-up was obtained, which indicated that in 7 cases the result of the HM-PAO scan altered the clinical diagnosis and in 9 cases resulted in a change in management. In the remaining 13 cases, the study was found to be helpful in confirming the diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Alzheimer Disease; Basal Ganglia Diseases; Brain; Dementia; Female; Humans; Huntington Disease; Male; Middle Aged; Organometallic Compounds; Oximes; Parkinson Disease; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime

Technetium-99m hexamethylpropyleneamineoxime ([99mTc]HM-PAO) brain single photon emission computed tomography (SPECT) was performed with a dual head rotating scintillation camera. Normal tracer distribution and side/side differences of counting rates were obtained in 11 healthy volunteers. Almost stable gray/white matter ratios were found (1.97-2.1) in one normal subject during 2 hr after tracer administration. Eighty-three investigated patients had the following diagnoses (in parentheses is percent of positive findings in each group): cerebral vascular disease 18 (94.4%), epilepsy 23 (82.6%), extrapyramidal disorders 8 (100%), dementia 12 (100%), headache 11 (63.6%), psychiatric disorders 11 (27.3%). In addition, SPECT was performed in 28 male volunteers during motor or visual imagery tasks and a significant increase (p = 0.035) of relative tracer deposition was observed in the left inferior occipital region during visual imagery when compared with motor imagery. The results indicate that [99mTc]HM-PAO SPECT is valuable for demonstrating pathologic and physiologic changes of the brain.

Topics: Adult; Aged; Basal Ganglia Diseases; Brain; Cerebrovascular Circulation; Cerebrovascular Disorders; Dementia; Epilepsy; Female; Headache; Humans; Imagination; Male; Mental Disorders; Middle Aged; Organometallic Compounds; Oximes; Technetium; Technetium Tc 99m Exametazime; Tomography, Emission-Computed