technetium-tc-99m-exametazime and Meningioma

On brain perfusion SPECT, a primary brain lesion presents as a localized defect that corresponds to the mass lesion. (99m)Tc-HMPAO images generally show a focal defect in the region of abnormality, whether containing necrotic tissue, recurrent tumor, or both. Further characterization with MR imaging is needed to confirm the diagnosis, as demonstrated in this case report.

Topics: Adult; Female; Humans; Magnetic Resonance Imaging; Meningioma; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

It has been known that an isolation of Wernicke's area from auditory input results in pure word deafness. In this report, a 73-year-old female case with tentorial meningioma suffering from pure word deafness is reported. The patient initially presented with hydrocephalus, and was treated with a ventriculo-peritoneal(V-P) shunt. A year after the V-P shunt, she suffered from a symptom of deafness. On admission, her repetition and auditory comprehension were severely impaired, while reading and visual comprehension were almost normal. Auditory brain stem response(ABR) revealed normal latency between wave I and V, while wave VI and VII was disappeared. Middle latency response(MLR) showed no wave peak. On MRI, tentorial meningioma compressed bilateral medial geniculate bodies, but not auditory radiation or temporal lobe. 99mTc-HMPAO single photon emission computed tomography(SPECT) showed hypoperfusion in the left temporal lobe, considered as a diaschisis resulting from the isolation of left temporal lobe from auditory input via bilateral medial geniculate bodies.

Topics: Aged; Audiometry, Pure-Tone; Brain; Deafness; Female; Humans; Meningeal Neoplasms; Meningioma; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

To determine whether the absolute value for the stump pressure might be a useful index of symmetrical cerebral blood flow (CBF), and to examine correlations with the stump pressure ratio (initial mean stump pressure/preocclusion mean arterial pressure), fifty candidates for ICA injury or permanent occlusion were evaluated preoperatively. Each was continuously monitored for mean stump pressure and arterial pressure before, during (for a total of 20 min), and after balloon test occlusion. During the occlusion, CBF was measured by 99 m Tc-hexamethyl-propyleneamine oxime (99 m Tc-HMPAO) single photon emission computed tomography (SPECT). The stump pressure and the stump pressure ratio were then compared with the results of 99 m Tc-HMPAO SPECT. Patients who failed to tolerate even brief periods of carotid occlusion and showed asymmetric decreases in CBF on SPECT were divided into high and moderate risk groups. Those with no significant changes in CBF on the occluded site formed the minimum risk group. Mean stump pressure was over 50 mmHg in 10 of a total of 25 patients in the high and moderate risk groups, and below 50 mmHg in 5 of the 25 patients in the minimum risk group. The stump pressure ratio did not exceed 56% in any but two patients in the high and moderate risk groups, and values were at least 60% in all patients of the minimum risk group. Decrease of CBF in two moderate risk group cases was localized in the posterior circulation. Difference in symmetrical CBF between the stump pressure ratio vs. the absolute value of mean stump pressure were statistically significant (p < 0.01, Fisher's Exact Test). Maintenance of a stump pressure ratio of 60% or more during test occlusion may be a more useful index for a good collateral circulation than any absolute value for mean stump pressure.

Topics: Blood Pressure; Brain Neoplasms; Carotid Artery, Internal; Carotid Stenosis; Catheterization; Cerebrovascular Circulation; Electroencephalography; Granuloma; Humans; Intracranial Aneurysm; Meningioma; Paraganglioma; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Vascular Surgical Procedures

To evaluate stroke risk assessment of balloon test occlusion of the internal carotid artery (ICA) with enlarged haemodynamic monitoring prior to permanent ICA occlusion.. 24 patients with cervical metastasis (n = 18), cavernous meningiomas (n = 3) or inoperable cavernous aneurysms (n = 3) were examined. The test occlusion was monitored by EEG, neurological examinations and transcranial Doppler sonography of the ipsilateral middle cerebral artery with evaluation of the cerebrovascular reserve capacity. Additionally 99mTc-HMPAO-SPECT imaging was added showing the perfusion during test occlusion.. In one (4%) patient the test occlusion had to be interrupted previously due to an acute neurological deficit. This patient and two (8%) patients with highly pathological test results in SPECT and TCD were excluded from permanent carotid occlusion. In 6 (25%) patients quantitative TCD monitoring could improve the stroke risk assessment by differentiating the patients in a low and high risk group. 6 (25%) patients were definitely occluded without haemodynamic complications, but two patients suffered from embolic infarctions which cannot be predicted by this procedure.. The multimodal balloon test occlusion with enlarged haemodynamic monitoring allows haemodynamic stroke risk assessment prior to permanent occlusion of the ICA.

Topics: Adult; Aged; Aged, 80 and over; Brain; Carotid Artery Diseases; Carotid Artery, Internal; Catheterization; Cerebral Infarction; Cerebrovascular Disorders; Contrast Media; Embolization, Therapeutic; Female; Head and Neck Neoplasms; Hemodynamics; Humans; Intracranial Aneurysm; Intracranial Embolism and Thrombosis; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neurologic Examination; Organotechnetium Compounds; Oximes; Prognosis; Regional Blood Flow; Risk Factors; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A total of 17 patients with histologically proven diagnoses of low-grade astrocytoma (n = 4), high-grade astrocytoma (n = 8), lymphoma (n = 3), and meningioma (n = 2) were examined by using EPISTAR MR imaging. Meningiomas had the highest EPISTAR tumor/white matter contrast and low-grade astrocytomas and lymphomas the lowest. High-grade astrocytomas demonstrated elevated EPISTAR signal with marked regional heterogeneity. There was agreement between tumor vascularity by SPECT and EPISTAR in the five cases where both were done. Our results show that tumor vascularity can be assessed qualitatively by using EPISTAR without the need for contrast medium injection.

Topics: Adult; Aged; Astrocytoma; Brain Neoplasms; Cerebrovascular Circulation; Contrast Media; Echo-Planar Imaging; Female; Glioblastoma; Humans; Image Enhancement; Lymphoma; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Does the absolute value of the stump pressure (post-occlusion back pressure) become a useful index of a good collateral circulation? The authors continuously monitored the mean arterial pressure before, during and after 20-minute balloon test occlusion in 24 patients. The stump pressure was then compared with the results of 99mTc-hexa-methyl propyleneamine (99mTc-HMPAO) single photon emission computed tomography (SPECT) performed after 20 minutes of test occlusion. Patients who failed to tolerate even brief periods of carotid occlusion and showed asymmetric decreases in cerebral blood flow (CBF) on SPECT were divided into high and moderate risk groups. Those with no significant change in CBF on the occluded side formed the minimum risk group. Mean stump pressure was over 50 mmHg in three of a total of 13 patients in the high and moderate risk groups, and below 50 mmHg in two of the 11 patients in the minimum risk group. The ratios of the initial mean stump pressure to the pre-occlusion mean arterial pressure (%) and of the final mean stump pressure at the end of occlusion to the post-opening mean arterial pressure (%) did not exceed 58% in any patient in the high and moderate risk groups, and were at least 60% in all patients of the minimum risk group. Maintenance of a mean stump pressure of 60% or more of the mean systemic pressure during test occlusion may be a more useful index of a good collateral circulation than the absolute value of mean stump pressure.

Topics: Adult; Aged; Blood Pressure; Brain; Brain Ischemia; Carotid Artery Diseases; Carotid Artery, Internal; Catheterization; Cerebral Revascularization; Collateral Circulation; Dominance, Cerebral; Female; Humans; Intracranial Aneurysm; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Monitoring, Physiologic; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

To evaluate the possibility of preoperatively obtaining an index of aggressiveness for intracranial meningiomas, we prospectively studied 22 patients with computed tomographic or magnetic resonance imaging evidence of meningeal tumour, using single-photon emission tomography (SPET) of the brain and thallium-201 (201Tl). On a brain-dedicated SPET scanner, a rapid acquisition protocol with early, short scans was started simultaneously with the intravenous administration of 111 MBq 201Tl, covering the initial intratumoral distribution of the tracer. Twenty minutes post injection, a delayed SPET scan was also obtained. On the reconstructed and attenuation-corrected images we calculated the 201Tl concentration in tumour and normal contralateral brain tissue, and compared intratumoral tracer concentration in the initial and the final part of the rapid acquisition protocol. Benign and malignant meningiomas were classified as such based on histological examination. In malignant lesions, the ratio of the 201Tl concentration at 2-4 min post injection to that at 14-16 min was found to be significantly higher than in non-aggressive neoplasms (mean+/-1 SD: 1.14+/-0.31 and 0.56+/-0.13, respectively, P <0.01). Conversely, in the delayed scan, most lesions showed high tracer concentration, and the two groups could not be distinguished. In addition, three recurrent meningiomas displayed the same imaging behaviour as the malignant group, i.e. had similar 201Tl concentration values at 2-4 and at 14-16 min. Our findings suggest that the comparative assessment of intratumoral 201Tl concentration at 2-4 and at 14-16 min post injection could provide a fast, simple method to differentiate preoperatively intracranial meningiomas with different biological behaviour.

Topics: Female; Humans; Image Processing, Computer-Assisted; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Organotechnetium Compounds; Oximes; Prospective Studies; Technetium Tc 99m Exametazime; Thallium Radioisotopes; Time Factors; Tomography, Emission-Computed, Single-Photon

Technetium-99m-HMPAO and 99mTc-MIBI brain SPECT, MRI, CT and cerebral angiogram were studied in a patient with recurrent occipital meningioma. MRI and CT of the head showed right cerebral hemispheric tumor masses involving parasagittal, temporal and parietoccipital areas. The angiograms showed an intense vascular tumor blush in recurrent mass lesions supplied by the following arteries: the meningeal branch of the right external carotid artery, the right middle cerebral artery, the right anterior cerebral artery and the right posterior cerebral artery. Although demonstrable 99mTc-MIBI lesions mass exactly corresponded to CT and MRI (T-1) findings, mass lesions exhibited a mismatch between 99mTc-MIBI (increased uptake) and 99mTc-HMPAO (absent uptake) brain SPECT images. Technetium-99m-MIBI images, rather than 99mTc-HMPAO brain SPECT, resulted in the correct pathological diagnosis of recurrent meningioma.

Topics: Aged; Brain; Cerebral Angiography; Cerebrovascular Circulation; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

99mTc-ECD SPECT and 99mTc-HMPAO SPECT with or without Matas test were performed in a 62-year-old woman with meningioma in the left anterior cranial fossa. After injection of 740 MBq 99mTc-ECD or HMPAO, 64 projection images were collected with a rotating Gamma camera. Matas test was carried out by compressing the left common carotid artery for about one minute immediately after RI injection. Although 99mTc-ECD SPECT showed non-accumulation in the tumor, 99mTc-HMPAO SPECT demonstrated increased accumulation in it. This area of increased accumulation disappeared on 99mTc-HMPAO SPECT with Matas test which causes decrease in blood flow of the tumor. These findings suggest 99mTc-ECD and 99mTc-HMPAO have a different mechanisms of accumulation in the meningioma.

Topics: Cysteine; Female; Humans; Meningeal Neoplasms; Meningioma; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Technetium-d, HMPAO SPECT was performed in 70 patients suffering from intracerebral tumors of various histologic types (glioma n = 30, meningioma n = 19, metastases n = 10, angioma n = 3, neuroma n = 2, lymphoma n = 2, neurocytoma n = 1, epidermoid n = 1, gliosis n = 1, cholesteatoma n = 1). Tumor classification was histologically verified in all subjects except in two cases with inoperable angiomas. SPECT was performed under resting state conditions with a dual-head rotating camera (SIEMENS ZLC 37) following intravenous injection of 18-25 mCi 99mTc-d, 1-HMPAO. Regional tracer deposit was expressed in terms of a cerebellar index (CBI). Significantly higher regional HMPAO uptake was found in meningiomas when compared with gliomas of different malignancy (ANOVA p less than 0.05). Within gliomas, regional uptake increased with malignancy (n.s.). In 23 patients, a total of 32 tumor specimens were obtained for histochemical analysis of glutathione (GSH) content using high-pressure liquid chromatography. A significant correlation (least square method, p less than 0.001) between CBIs and GSH values was found, supporting the hypothesis that GSH is the predominant factor for the conversion of the lipophilic complex to hydrophilic derivates.

Topics: Adult; Aged; Aged, 80 and over; Brain Neoplasms; Cerebrovascular Circulation; Female; Glioma; Glutathione; Hemangioma; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Aged; Aged, 80 and over; Brain Neoplasms; Cerebrovascular Circulation; Female; Glioma; Humans; Iodobenzenes; Lymphoma; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Organotechnetium Compounds; Oximes; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Technetium-99m hexamethylpropyleneamine oxime ([99mTc]HM-PAO) has recently been introduced as an alternative to N-isopropyl-p-[123I]iodoamphetamine ([123I]IMP) for measurement of regional cerebral blood flow. This study compares dynamic SPECT studies using the two tracers in seven patients with meningiomas. Regions of interest were placed over the lesion and contralateral homologous presumed normal area. The counting-rate ratio for the lesion to the contralateral homologous area (L/N ratio) was then calculated in the first image. L/N ratios of [99mTc]HM-PAO single photon emission computed tomography (SPECT) were lower than those of [123I])IMP SPECT, particularly in hypervascular meningiomas. Furthermore, time-activity curves showed that the washout of [99mTc]HM-PAO in the tumors was very slow or incomplete, preventing an accurate assessment of vascularity of meningiomas with [99mTc]HM-PAO, as is generally possible with [123I]IMP.

Topics: Adult; Aged; Aged, 80 and over; Amphetamines; Female; Humans; Iodine Radioisotopes; Iofetamine; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Organometallic Compounds; Oximes; Technetium; Technetium Tc 99m Exametazime; Tomography, Emission-Computed

The cerebral uptake of 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO) as measured with the use of single photon emission computed tomography (SPECT) was studied in 66 patients with various types of brain tumours and quantified by tumour-to-cerebellum ratios. The uptake of 99Tcm-HMPAO by gliomas and meningiomas showed wide ranges of values. There were no significant differences among primary malignant gliomas (0.75 +/- 0.27, n = 25), recurrent malignant gliomas (0.81 +/- 0.25, n = 14) and benign gliomas (0.77 +/- 0.21, n = 9). Compared to gliomas, meningiomas exhibited a significantly higher 99Tcm-HMPAO uptake (1.14 +/- 0.31, n = 13, p less than 0.001) while the remaining four patients with tumours of various histopathology showed a low 99Tcm-HMPAO uptake. Three of the 66 patients were scanned immediately and again 2 h after injection and they revealed a decrease in tumour activity. No changes in the pattern of uptake were observed in two patients with gliomas which were studied before and after intra-arterial chemotherapy, but a decrease in tumour uptake was found in the glioma patient who was studied before and after radiotherapy. The results obtained with 99Tcm-HMPAO SPECT are in agreement with those on regional cerebral blood flow (rCBF) in brain tumours reported in the literature.

Topics: Brain Neoplasms; Glioma; Humans; Meningioma; Organometallic Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed

Topics: Adult; Aged; Amphetamines; Brain Neoplasms; Female; Glioblastoma; Hemangioma, Cavernous; Hemangiosarcoma; Humans; Iodine Radioisotopes; Iofetamine; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Organometallic Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed; Xenon Radioisotopes

Topics: Adult; Aged; Amphetamines; Astrocytoma; Brain Neoplasms; Female; Glioma; Humans; Iofetamine; Male; Meningioma; Organometallic Compounds; Oximes; Pentetic Acid; Technetium Tc 99m Exametazime; Technetium Tc 99m Pentetate; Tomography, Emission-Computed

The discrepancy between three methods for cerebral perfusion imagings in the case of a man with meningioma is presented. Imaging with N-isopropyl-P-[I-123] iodoamphetamine (IMP) showed no activity in the tumor. Imaging with Tc-99m hexamethylpropyleneamine oxime (HM-PAO) and the local cerebral blood flow (LCBF) image with Xe-133 inhalation showed high tumor activity. IMP is a more accurate method for imaging the brain tissue blood flow.

Topics: Amphetamines; Brain; Cerebrovascular Circulation; Humans; Iodine Radioisotopes; Iofetamine; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Organometallic Compounds; Oximes; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime; Xenon Radioisotopes