technetium-tc-99m-exametazime and Substance-Related-Disorders

1. Cerebral blood flow of nine methamphetamine abusers with technetium-99m-hexamethylpropyleneamine oxime (HMPAO) and single photon emission computed tomography (SPECT) as well as morphological examination with magnetic resonance imaging (MRI) were investigated. 2. Six of these subjects exhibited multiple focal perfusion deficits in cerebral cortices without abnormalities in MRI including cerebral atrophy and/or infarctions. 3. Cerebral perfusion deficits were detected in methamphetamine abusers even after a long abstinence period, suggesting that vascular changes were irreversible to some degree. 4. HMPAO SPECT study appeared to be sensitive to the detection of cerebral perfusion abnormalities in drug abusers.

Topics: Adolescent; Adult; Cerebrovascular Circulation; Female; Humans; Magnetic Resonance Imaging; Male; Methamphetamine; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Chronic cocaine and polydrug abuse have been associated with regional abnormalities in cerebral perfusion. The authors have previously demonstrated that these abnormalities are partially reversible after drug addiction treatment with buprenorphine. This study was designed to separate the effect on cerebral perfusion of abstinence from drug use from that of buprenorphine directly.. Fifteen cocaine- and heroin-dependent men were studied with 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain SPECT. The men, all part of an inpatient drug abuse treatment research program, were randomly assigned after detoxification to receive placebo or either 6 or 12 mg daily buprenorphine treatment. SPECT studies were performed at baseline, after maximum dosage was reached and after tapering off the study drug. Studies were compared visually with regard to the number and location of perfusion defects by reviewers blinded to treatment assignment.. Subjects receiving buprenorphine had a significant reduction in the number of defects per study between baseline and maximum buprenorphine dose as compared with those receiving placebo (decrease of 4 +/- 5.4 versus increase of 4.8 +/- 4.7, p = 0.006). These differences were dose-related. Improvement with buprenorphine was temporary, with return to baseline after tapering off.. Buprenorphine treatment, and not abstinence from drug use alone, leads to improvement in regional cerebral perfusion abnormalities in chronic cocaine- and heroin-dependent men.

Topics: Adult; Brain; Buprenorphine; Cerebrovascular Circulation; Cocaine; Double-Blind Method; Heroin Dependence; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Cocaine abuse continues to be a major public health concern, with a variety of medical and neurologic sequelae. Previous studies have demonstrated abnormalities in cerebral perfusion in chronic cocaine abusers and after acute administration of cocaine. Although women are becoming increasingly represented among drug abusers, few studies have included women. To the authors' knowledge, none has compared cerebral perfusion in asymptomatic women with that in men.. The cerebral perfusion of 13 cocaine-dependent women, 4 of whom were also heroin dependent, was studied with 99mTc hexamethylpropyleneamine oxime (HMPAO) SPECT. These women were compared with 13 cocaine-dependent men and 26 healthy control subjects. Structural brain lesions and neurologic abnormalities were excluded by MRI and neurologic evaluation. Perfusion studies were interpreted in a standardized fashion by reviewers blinded to clinical information.. It was found that cocaine-dependent women were much less likely to have abnormal study findings than cocaine-dependent men (p = 0.003) and were indistinguishable from normal women (p = 1.0). However, the results in both women and men who concurrently used heroin plus cocaine were all abnormal. Perfusion abnormalities tended to be located in anterior brain structures, such as the frontal and temporal cortex and the basal ganglia.. These data suggest that cocaine-dependent women have fewer abnormalities in cerebral perfusion than cocaine-dependent men, but that concurrent abuse of heroin and cocaine is associated with more perfusion abnormalities in both sexes.

Topics: Adult; Cerebrovascular Circulation; Cocaine; Female; Humans; Male; Organotechnetium Compounds; Oximes; Perfusion; Reference Values; Sex Characteristics; Sex Factors; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Women

Brain SPECT imaging (BSI) with statistical parametric mapping (SPM) offers a clear and accurate vision of perfusion changes.. To study brain perfusion abnormalities in adolescents' dependent of multiple drugs.. Sixteen male patients (15.1 + or - 2.1 years) were submitted to (99m)Tc-HMPAO BSI with SPM.. Cortical hypoperfusion occurred in 7/16 patients (44%). There was a significant inverse correlation between the number of hypoperfused regions and the patient's age (p= -0.6737; p=0.004) and with the age when the drug dependence began (p= -0.5616; p=0.023). There was also a tendency towards an inverse correlation between regions of hypoperfusion and the duration of the drug dependence.. BSI with SPM can help detect hypoperfusion in adolescents dependent on multiple drugs. The younger the patients, the more regions of hypoperfusion are noted. Probably, the neuronal plasticity has an important role in this phenomenon because the highest neural activity occurs in childhood.

Topics: Adolescent; Age Factors; Brain; Brain Mapping; Child; Humans; Male; Radiopharmaceuticals; Substance-Related Disorders; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon

Although abuse of cocaine or methamphetamine usually takes place in the context of heavy drinking, there is little information on the effects of such substance use comorbidity on brain perfusion. We explored similarities and differences in the effects of these two drugs in combination with alcohol on brain function using SPECT. Global and regional cerebral blood flow (CBF) were examined in 7 abstinent cocaine-dependent alcoholics (CDA; mean age = 39.2 yr, S.D. = 9.2 yr), 7 abstinent methamphetamine-dependent alcoholics (MDA; mean age = 36.8 yr, S.D. = 5.0 yr), and 7 non-alcoholic/non-stimulant abusing controls (NAC; mean age = 37.3 yr, S.D. = 9.6 yr). MDA had significantly lower global CBF than CDA who, in turn, were significantly lower than NAC. In addition, CDA had abnormal perfusion in the superior posterior frontal region compared to NAC; while MDA did not display specific regional deficits. Therefore, it appears that cocaine alters the relationship between global and regional CBF in alcoholics, while methamphetamine does not.

Topics: Adult; Alcoholism; Cerebral Cortex; Cerebrovascular Circulation; Cocaine-Related Disorders; Female; Humans; Image Interpretation, Computer-Assisted; Male; Methamphetamine; Middle Aged; Radiopharmaceuticals; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Adolescent; Adult; Alzheimer Disease; Bipolar Disorder; Cerebral Cortex; Cerebrovascular Circulation; Depressive Disorder; Diagnosis, Differential; Female; Humans; Male; Radiopharmaceuticals; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Humans; Lung; Male; Marijuana Smoking; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Smoking; Substance-Related Disorders; Technetium Tc 99m Exametazime

Chronic alcohol abuse is responsible for several organic brain disorders. However, even the most characteristic of them are largely underdiagnosed by routine procedures. Therefore, there is need for sensitive, noninvasive and low-cost diagnostic procedures. 99m-Tc-HMPAO-SPECT could be an interesting candidate in this indication, because it estimates the distribution of the cerebral blood flow and the metabolic activity of the brain with a good resolution. We used this technique in 17 healthy volunteers and in a sample of 50 patients dependent on alcohol, without other major physical or mental disorder. SPECT was performed during the attendance of these patients in an inpatient detoxification program. We observed abnormal SPECT in 34 patients, but only in 2 volunteers (p < 0.001). The main abnormality was heterogeneity of the distribution of the tracer. SPECT abnormalities appear to be due nor to withdrawal syndrome, nor to medication. On the contrary, they are correlated with stigmata of heavy alcoholism. Furthermore, a genetic vulnerability to alcohol was suspected because SPECT abnormalities are more frequent in patients with an history of drinking problems in their relatives.

Topics: Adult; Alcoholism; Cerebrovascular Circulation; Female; Humans; Inactivation, Metabolic; Male; Middle Aged; Organotechnetium Compounds; Oximes; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The objective of this study was to characterize the cognitive status of a population of asymptomatic HIV-positive drug addicts (patient group) to document the relationship between neuropsychological results and cerebral blood flow defects as measured by single photon emission computed tomography. As a control group we employed an age-matched population of HIV-seronegative drug addicts. Some neuropsychological differences were found between patients and controls and between drug addicts and normal population. We could not detect any difference in cerebral blood flow rates among HIV-1-positive and -negative drug addicts.

Topics: AIDS Dementia Complex; Brain; Cerebral Cortex; Diagnosis, Differential; Dominance, Cerebral; HIV Seronegativity; HIV Seropositivity; HIV-1; Humans; Neuropsychological Tests; Organotechnetium Compounds; Oximes; Regional Blood Flow; Substance Abuse, Intravenous; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The aim of this study was to describe the effectiveness of 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO) brain single photon emission computed tomography (SPECT) in the assessment of the regional cerebral blood flow (rCBF) in amphetamine abusers. Twenty-one amphetamine abusers were included and 99Tcm-HMPAO brain SPECT performed to evaluate rCBF. The drug-using periods ranged from 1 month to several years. The demonstrated neuropsychogenic symptoms and signs of the abusers were from normal presentation to various neurologic complications. The brain SPECT scans were interpreted visually as either normal or abnormal. The degree of abnormality was classified into mild or severe. The results revealed that (a) most SPECT studies in abusers show small defects (95%, 20/21 cases); 71% (15/21) of cases revealed multiple defects over both hemispheres (classified as severe); 24% (5/21) of the cases had focal defects (classified as mild); and only one case (5%, 1/21) demonstrated a normal SPECT finding; (b) the degree of abnormality on SPECT scans was not related to the dose and duration of drug use or the severity of the neuropsychiatric symptoms and signs. In conclusion, 99Tcm-HMPAO brain SPECT is a sensitive but not specific test for neuropsychogenic abnormalities associated with amphetamine abuse.

Topics: Adolescent; Adult; Amphetamine; Brain; Cerebrovascular Circulation; Female; Humans; Male; Organotechnetium Compounds; Oximes; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Artificial neural networks have been applied to a variety of pattern recognition tasks in medical imaging and have been shown to be a powerful classification tool. The potential usefulness to discriminate normal from abnormal cerebral perfusion patterns was investigated.. Cerebral perfusion imaging with 99mTc-labeled hexamethylpropyleneimine oxime was performed on 52 normal control subjects, 29 patients with clinically diagnosed Alzheimer's disease (AD) and 25 patients with chronic cocaine polydrug abuse. Each study was registered and scaled to a common anatomic coordinate system, yielding 120 standardized cortical regions. A back-propagation neural network classifier based on regional perfusion was used to classify normal and abnormal perfusion patterns. The neural network was trained to discriminate patients with AD from age-matched normal controls and cocaine polydrug abuse patients from normal controls. The performance of the neural network in these two tasks was evaluated quantitatively by receiver operating characteristic (ROC) analysis using cross-validation.. For patients with AD, the area under the ROC curve was 0.93 +/- 0.04. When testing with the cocaine polydrug abuser data, the area under the ROC curve was 0.89 +/- 0.04.. Neural networks provide a potentially useful tool in the decision-making task to discriminate patients with AD and cocaine abuse from normal controls.

Topics: Adult; Aged; Aged, 80 and over; Alzheimer Disease; Brain; Cocaine; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Neural Networks, Computer; Organotechnetium Compounds; Oximes; Radionuclide Imaging; ROC Curve; Substance-Related Disorders; Technetium Tc 99m Exametazime

Brain perfusion is abnormal in chronic cocaine users. To determine whether these perfusion abnormalities are reversible following treatment, we studied 10 cocaine-dependent polydrug users with 99mTc-HMPAO SPECT 2 to 3 days after admission to an inpatient treatment facility and at 7 to 8 days and 17 to 29 days after abstinence from drugs. The patients also received buprenorphine, an opioid mixed agonist-antagonist, beginning 10 days after admission and continuing to the end of the study. Imaging began 10-15 min after injection of 99mTc-HMPAO (20 mCi) using an annular gamma camera system. MRI was performed during hospitalization using a 1.5 Tesla system. SPECT and MRI were merged and five axial SPECT slices centered at the level of the basal ganglia were selected for analysis. Activity ratios were derived for cortical regions relative to cerebellar activity and were corrected for linearity with respect to regional cerebral blood flow. The cortical regions were classified as abnormal (activity ratio < 0.6), borderline (0.6-0.72) and normal (> 0.72) based on the results of the first SPECT study. In abnormal zones, regional cerebral blood flow (rCBF) increased 11.0% +/- 9.0% at 7 to 8 days and 23.8% +/- 9.4% at 17 to 29 days after initiation of treatment. The increase in rCBF was 4.8% +/- 7.1% (7 to 8 days) and 11.1% +/- 8.0% (17 to 29 days) in borderline cortex and decreased 2.9% +/- 6.3% (7 to 8 days) and increased only 2.7% +/- 13.4% (17 to 29 days) in normal cortex. The increase in rCBF did not vary significantly by location. The perfusion defects observed in chronic cocaine polydrug users are partially reversible with short-term abstinence and buprenorphine treatment.

Topics: Adult; Buprenorphine; Cerebrovascular Circulation; Cocaine; Heroin; Humans; Magnetic Resonance Imaging; Male; Organotechnetium Compounds; Oximes; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Intravenous drug use is a major risk factor for HIV-1 infection. Since both AIDS dementia complex (ADC) and cocaine have been associated with abnormal brain perfusion imaging, we compared the scintigraphic patterns of ADC patients and cocaine polydrug users with normal control subjects using 99mTc-HMPAO SPECT. We found a high incidence of cortical defects in both ADC (100%) and cocaine-dependent (90%) subjects. In the cocaine and ADC patients, cortical defects were most frequent in the frontal, temporal and parietal lobes and occurred with similar frequency in the two populations. In both groups, the number of cortical defects per subject was higher than normal subjects (10.0 +/- 5.0 for ADC, 10.1 +/- 5.2 for cocaine and 0.7 +/- 1.5 for normal), background activity was high (a 65% and 60% incidence for ADC and cocaine, respectively), and basal ganglia involvement was frequent (40% and 65% for ADC and cocaine). We conclude that the brain perfusion pattern, while a sensitive indicator of ADC, cannot be distinguished from chronic cocaine polydrug use and caution should therefore be applied before entertaining a specific diagnosis.

Topics: Adult; AIDS Dementia Complex; Brain; Cocaine; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A 32-year old woman presented with serious memory impairment and a mental syndrome named loss of psychic auto-activation or psychic akinesia following carbon monoxide poisoning. The MRI findings were bilateral pallidal lesions probably associated with thalamic lesions. The evolution was favourable.

Topics: Adult; Brain; Carbon Monoxide Poisoning; Electroencephalography; Female; Humans; Magnetic Resonance Imaging; Memory Disorders; Neuropsychological Tests; Organotechnetium Compounds; Oximes; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed

Cocaine abuse is widespread and has been associated with serious neurovascular complications. We studied a group of cocaine-dependent polydrug users with 99mTc-HMPAO and high-resolution SPECT and compared their perfusion pattern to cerebral perfusion in a group of older control subjects. Sixteen of 18 cocaine-dependent polydrug users had abnormal perfusion characterized primarily as small focal defects involving inferoparietal, temporal, and anterofrontal cortex and basal ganglia. Psychometric testing was abnormal in all 18 cocaine-dependent subjects. No relation was found between the severity of SPECT abnormalities and mode of administration or frequency or length of cocaine use. All 15 older normal subjects had normal cerebral perfusion. While the focal perfusion abnormalities to the cortex and basal ganglia could be explained by the profound vasoconstrictor effects of cocaine, the combinational use of multiple substances including cannabis and alcohol may play a contributory role. This study documents the high incidence of functional brain abnormalities in cocaine-dependent chronic polydrug users without corresponding abnormalities on imaging studies of cerebral anatomy and morphology.

Topics: Adult; Brain; Cerebrovascular Circulation; Cocaine; Humans; Male; Organotechnetium Compounds; Oximes; Substance-Related Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon