technetium-tc-99m-exametazime and Cerebral-Palsy

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

In infants who have experienced prenatal or perinatal injury, it is often difficult, on the basis of clinical examination and conventional investigations (electroencephalogram, cranial ultrasound scan), to diagnose those with brain damage and to predict the type and the severity of subsequent neurological handicaps. We investigated the predictive value of 99mTc-HMPAO brain SPECT performed in the first weeks of life in high-risk neonates. Right-left asymmetries in tracer uptake had no predictive value, regardless of their localization or severity. On the other hand, a change in antero-posterior rCBF distribution was found in 7/10 of neonates with adverse outcome (death, major neurological sequelae) and in none of the 78 neonates with no major motor neurological sequelae. Compared to conventional investigations, 99mTc-HMPAO brain SPECT did not provide additional predictive information when neurological examination, electroencephalogram and cranial ultrasonography were all normal or all abnormal. Conversely, in the 30 patients with anomalies on one or two of the above investigations, SPECT showed an abnormal antero-posterior pattern in 4/6 neonates with major neurological sequelae and no change in the antero-posterior rCBF distribution in the 24 infants who developed normally. In conclusion, our results suggest that 99mTc-HMPAO brain SPECT, when performed in the first weeks of life, can be useful in high-risk neonates to predict occurrence of major neurological handicaps. Because of the relative invasive character of HMPAO scan in neonates and the overall accuracy of the noninvasive tests, radionuclide examination should not be performed in every high-risk neonate. According to our results, 99mTc-HMPAO brain SPECT might be indicated in those children where noncongruent results were obtained with conventional studies.

Topics: Cerebral Palsy; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Organotechnetium Compounds; Oximes; Predictive Value of Tests; Risk; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The outlook for children with cerebral palsy is determined by the severity of motor problems and the presence of associated disabilities, in which early detection remains a medical challenge. The authors studied 13 children (aged 13 months to 12 years) with cerebral palsy by means of single photon emission computed tomography (SPECT) of the brain with technetium-99m hexamethylpropyleneamineoxime (HMPAO). In all children with hemiplegia, SPECT demonstrated hypoperfusion in the hemisphere contralateral to the motor deficit. SPECT demonstrated normal findings in patients with mild diplegia; bilateral hypoperfusion in the superior motor cortex in patients with moderate di- or tetraplegia; and bilateral reduction of perfusion in the superior motor, inferior motor, prefrontal, and parietal cortices in patients with severe di- or tetraplegia. Results suggest that Tc-99m HMPAO SPECT of the brain is a valuable complementary tool for thorough neurologic assessment in cerebral palsy.

Topics: Brain; Cerebral Palsy; Cerebrovascular Circulation; Child; Child, Preschool; Female; Humans; Infant; Male; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon