technetium-tc-99m-exametazime and Takayasu-Arteritis

Takayasu arteritis is a chronic inflammatory angiopathy involving the cerebral arteries. We performed upright and supine 99Tcm-HMPAO brain single photon emission tomography (SPET) to investigate the cerebral perfusion pattern in eight patients with Takayasu arteritis, and we compared the results with those acquired using 123I-IMP and acetazolamide in six patients. SPET images were evaluated visually and semi-quantitatively. Hypoperfusion was visually detected in all eight patients during the provocative upright test with 99Tcm-HMPAO, and in three of six tested using acetazolamide and 123I-IMP. Semiquantitative analysis revealed that the mean cortical-to-cerebellar ratio in the upright position was significantly changed compared to that in the supine position in the right frontal area (from 0.86 +/- 0.07 to 0.91 +/- 0.09; P < 0.05). Change was also seen in the left frontal area (from 0.85 +/- 0.08 to 0.91 +/- 0.08; P < 0.05). No significant change was seen in other cortical areas with the upright test or in any areas with the acetazolamide test. We postulate that reduced arterial compliance may cause frontal postural hypoperfusion in patients with Takayasu arteritis due to poor functioning of autoregulation and arterial stenosis or occlusion. We conclude that the provocative upright test with 99Tcm-HMPAO brain SPET can detect abnormal patterns of cerebral perfusion in patients with Takayasu arteritis that might be missed by brain SPET using 123I-IMP and acetazolamide.

Topics: Acetazolamide; Adolescent; Adult; Aged; Blood Pressure; Brain; Cerebellum; Cerebral Arteries; Cerebral Cortex; Diuretics; Epinephrine; Female; Humans; Hypotension, Orthostatic; Male; Middle Aged; Radiographic Image Interpretation, Computer-Assisted; Radiopharmaceuticals; Takayasu Arteritis; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A case of Takayasu's disease in a 22-year-old woman who complained of severe fainting attacks is presented. Bilateral obstruction of the cervical arteries was confirmed by digital subtraction angiography. Preoperative technetium-99m hexamethylpropylene amine oxime brain SPET in the sitting position showed bilateral hypoactivity in the temporoparietal areas. Subtraction brain SPET showed slightly increased activity in the lying position. The patient has had no fainting attacks since bypass surgery. Postoperative 99mTc-HMPAO brain SPET in the sitting position showed normal activity except in the right temporoparietal area. This area was filled in the lying position. 99mTc-HMPAO brain SPET is the only technique that can visualize the cerebral blood flow in any position, this capability deriving on the fact that the distribution of 99mTc-HMPAO in the brain is fixed in the first 2-3 min following injection. The use of both sitting and lying 99mTc-HMPAO brain SPET is very useful for detecting an abnormality (i.e. an inhomogeneous response due to the fall in perfusion pressure) that could not be seen if the cerebral blood flow were to be assessed only in the lying position.

Topics: Adult; Brain; Cerebrovascular Circulation; Female; Humans; Organotechnetium Compounds; Oximes; Posture; Syncope; Takayasu Arteritis; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon