Single-Photon Emission Computed Tomography Image of Benzodiazepine Receptors in a Patient with Creutzfeldt-Jakob Disease.
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A 50-year-old woman presented with progressive visual disturbance, ataxia, and dementia. The cerebral cortex became atrophic, as the disease progressed, and electroencephalography showed periodic synchronous discharges. The patient's prion gene revealed a point mutation (232Met to Arg), and a diagnosis of Creutzfeldt-Jakob disease was made. lomazenil single-photon emission computed tomography (SPECT) was performed to assess neuronal degeneration. Accumulation of the tracer in the late images was severely decreased diffusely spread throughout the cerebral cortex. Our experience with this case suggests that iomazenil SPECT is useful for detecting neuronal degeneration in Creutzfeldt-Jakob disease.(Internal Medicine 37: 896-900, 1998)Keywords:
Emission computed tomography
We present two cases of primary progressive aphasia studied with neuropsychologic measures, computed tomography or magnetic resonance imaging, and single-photon emission computed tomography with technetium Tc99m-labeled hexamethylpropyleneamine oxime. Clinical and neuropsychologic observations revealed a marked, progressive loss of language functions over time with relative preservation of nonlanguage cognitive functions in both patients. The brain single-photon emission computed tomographic scan revealed marked left frontal and minimal left temporal and parietal hypoperfusion in case 1 and marked left posterior frontal and minimal left temporal hypoperfusion in case 2. The value of brain single-photon emission computed tomography in distinguishing primary progressive aphasia from Alzheimer's disease is described.
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The introduction of single photon emission computed tomography (SPECT) has markedly enhanced the study of brain function. The development of SPECT was the culmination of a series of investigations of cerebral blood flow (CBF) pioneered by Kety and Schmidt in the late 1940's combined with the introduction of transmission computed tomography (CT) in the early 1960's, in which three-dimensional images are derived from two-dimensional data. This chapter provides a review of the principles and basic techniques of SPECT, its present utility and application to clinical practice.
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D,L HM-PAO-99Tcm (PAO) is a lipophilic tracer complex which is avidly taken up by the brain. We have compared the regional distribution of PAO with regional cerebral blood flow (CBF). CBF was measured by single photon emission computed tomography (SPECT) by Tomomatic 64 after 133Xe inhalation in 41 patients. With the same SPECT the distribution of PAO was measured after intravenous injection. High resolution (HR) and low resolution (LR) studies were performed yielding a resolution of 6-10 mm (HR) and 15-20 mm (LR). PAO images showed close resemblance to 133Xe CBF tomograms. Only 20 per cent of the (decay corrected) brain counts were lost during 24 hours.
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청소년들의 뇌는 급속한 변화를 겪는다. 그동안 신경해부학적 특성과 일반지능(IQ)과의 관련성을 알아보기 위한 연구가 지속적으로 이뤄져 왔으나 대부분 단편적이었다. 본 연구는 단순히 대뇌 피질 두께를 한 번 측정한 것이 아니고, 대뇌 피질 두께의 변화를 추적하여 일반지능과 그 변화 간의 관련성을 추정하였다. 건강한 청소년 75명(M=16세 4개월)을 5단계의 지능범주별로 나눈 뒤 6개월의 간격을 두고 MRI 촬영을 두 번씩 하여 대뇌 피질 두께 변화를 알아냈다. 그 결과 일반지능 범주별로 대뇌 피질 두께 변화에 차이가 크게 나타났다. 일반지능이 120 이상인 세 그룹은 관찰 대상인 11개 뇌 영역의 대뇌 피질 두께가 모두 감소했으나, 그 이하의 두 개 그룹에서는 지능이 낮을수록 늘어나는 영역이 5~8개나 됐다. 이는 일반지능이 낮을수록 대뇌피질의 성숙이 늦어지는 것으로 추정할 수 있다. The brains of adolescents experience rapid changes, which has been studied to prove relatedness between neuroanatomical properties and IQ. But, most previous studies infer the relatedness from purely cross-sectional data. This study not only measured the thickness of the cerebral cortex once, but traced its variability and the relatedness between IQ and this variability, which was presumed to be 75. Healthy adolescents (M=16yr. and 4month) were divided into 5-stage categories based on their intellectual ability and MRI scan was made twice every 6 months to measure the variablity of their cerebral cortex. As a result, a big difference in the variability of the cerebral cortex was shown based on their IQ. Three groups with an IQ of more than 120 showed a decrease in the thickness of the cerebral cortex in 11 brain regions, while two groups with an IQ lower than 120 showed an increase in the cerebral cortex thickness in 5 to 8 regions. It is presumed that the lower the IQ, the slower the maturation of the cerebral cortex.
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In quantitative neuroanatomy and neuropathology, large neuronal systems are frequently analyzed on the basis of small tissue blocks thus assuming that the volume changes of the various compartments of the tissue block can be corrected by an overall factor. 228 blocks of cerebral cortex and white matter of the frontal lobe, thalamus, and striatum were prepared from 13 human brains and embedded in paraffin. The mean shrinkage in the paraffin sections was found to be 51% for the cerebral cortex and 42% for the white matter. Therefore, an overall correction factor tissue blocks both with cerebral cortex and white matter results in an underestimation of cerebral cortex and an overestimation of white matter.
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Single-photon emission computed tomography has received increasing attention as radiopharmaceuticals that reflect perfusion, metabolism, and receptor and cellular function have become widely available. Perfusion single-photon emission computed tomography of the brain provides functional information useful for the diagnosis and management of stroke, dementia, and epilepsy. Single-photon emission computed tomography has been applied to myocardial, skeletal, hepatic, and tumor scintigraphy, resulting in increased diagnostic accuracy over planar imaging because background activity and overlapping tissues interfere far less with activity from the target structure when tomographic techniques are used. Single-photon emission computed tomography is substantially less expensive and far more accessible than positron emission tomography and will become an increasingly attractive alternative for transferring the positron emission tomography technology to routine clinical use. In addition, singlephoton emission computed tomography has unique applications that are increasingly finding their way into the routine practice of clinical nuclear medicine. (JAMA. 1990;263:561-564)
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The scintigraphic investigation of neuroendocrine tumours such as carcinoids has depended on standard techniques such as I-metaiodobenzylguanidine and In-pentetreotide imaging. More recently, the use of PET techniques such as Ga-DOTATATE has been advocated. An alternative improved modality is high-quality single photon emission computed tomography/computed tomography (SPECT/CT), which has the advantages of better sensitivity and specificity and has shown improved localization in up to 60% of cases. These advantages are especially true for pancreatic and lymph node lesions. Overall, SPECT/CT can result in a change in clinical management in 25% of patients. Although it is possible to combine SPECT and CT performed at different time points, there is better anatomical localization and improved reporter confidence when SPECT and CT are performed simultaneously.
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