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Background To describe interictal brain structural and metabolic differences between patients with episodic migraine (EM), chronic migraine (CM) and healthy controls (HC). Methods This is an exploratory study including right-handed age-matched women with EM, CM and HC. On the same day, a sequential interictal scan was performed with 18FDG-PET and MRI. 3D T1-weighted images were segmented with FreeSurfer, normalized to a reference atlas and the mean values of metabolism, cortical thickness (CTh) and local gyrification index (IGI) were determined. Groups were compared using age-adjusted linear models, corrected for multiple comparisons. 18FDG-PET measurements between groups were also analysed adjusting by patient’s age, CTh and lGI. The variables independently associated with diagnosis were obtained using a logistic regression analysis. Results Fifteen patients (8 EM, 7 CM) and 11 HC were included. Morphometric data showed an increased CTh in 6 frontal areas (L/R-Caudal Middle Frontal, L/R-Rostral Middle Frontal, L-Medial Orbitofrontal and L-Superior Frontal) in CM patients compared to HC without differences for IGI. The structural adjusted analysis in CM showed a statistically significantly hypometabolism in 9 frontal areas (L-Lateral Orbitofrontal, L/R-Medial Orbitofrontal, L-Frontal Superior, R-Frontal pole, R-Parts Triangularis, L/R-Paracentral and R-Precentral) and 7 temporal areas (L/R-Insula, L/R-Inferior temporal, L/R-Temporal pole and R-Banks superior temporal sulcus) compared to HC. EM patients presented intermediate metabolic values ​​between EM and HC (non-significant). Conclusions CM patients showed frontotemporal hypometabolism and increased frontal cortical thickness when compared to HC that may explain some cognitive and behavioural pain-processing and sensory integration alterations in CM patients. Combined information from sequential or simultaneous PET and MRI could optimize the study of complex functional neurological disorders such as migraine.

Objectives The aims were to analyze the clinical features, response to treatment, prognostic factors and long-term follow-up of children and adolescents with differentiated thyroid carcinoma (DTC). Methods Eighty patients with DTC were studied retrospectively. All underwent total or near-total thyroidectomy, and in 75 cases, ablative iodine therapy was recommended. Patients were assessed periodically by tests for serum thyroglobulin levels and whole-body iodine scans. Age, gender, initial clinical presentation, histology, tumor stage, postoperative complications, radioiodine treatment protocol, treatment response, thyroglobulin (Tg), recurrence and long-term disease progression were evaluated. Results Seventy patients completed >2 years of follow-up (23 males, 47 females; median age: 14 years; range: 3–18 years). Sixty-two patients showed papillary DTC and eight, follicular DTC. Sixty-five percent presented nodal metastasis and 16%, pulmonary metastasis at diagnosis. Six months after first radioiodine treatment, 36.2% of patients were free of disease. Seven recurrences were documented. At the end of follow-up, overall survival was 100%, and 87.2% of patients were in complete remission. Nine patients had persistent disease. We found a significant association between stage 4 and persistent disease. Hundred percent of patients with negative Tg values at 6 months posttreatment were documented free of disease at the end of the follow-up. The analysis of disease-free survival based on radioiodine treatment protocols used showed no statistically significant differences. Conclusions DTC in children and adolescents is frequently associated with presence of advanced disease at diagnosis. Despite this, complete remission was documented after treatment in most cases, with a good prognosis in the long-term follow-up. Negative posttreatment thyroglobulin and stage 4 at diagnosis were significant prognostic variables.

Amyloidosis comprises a group of heterogeneous conditions. To ascertain the burden of disease is important because it can determine the treatment as well as the evolution of the disease. Recent reports have shown good results in diagnosing cardiac amyloidosis using 18F-florbetapir. We hypothesize that combining whole body PET/CT with 18F-Florbetapir can be useful to characterize the burden of the disease. We included 25 patients, 13 of them with different types of amyloidosis, and 12 with Alzheimer's disease as controls. Target-to-background ratio was computed for multiple organ using maximum standardized uptake values. Organ involvement was described (standardized techniques versus PET) according to different kinds of amyloidosis showing promising results in AA and AL types. Heart involvement showed poorer results when compared to tongue, lung or thyroid gland. Multiple organ involvement in patients previously labelled as having negative organ affectation could be identified. This is the first study to evaluate the utility of 18F-florbetapir in the assessment of the global extension of disease. Our results show that this technique is useful for its diagnosis.

Amyloidosis comprises a group of heterogeneous conditions. To ascertain the burden of disease is important because it can determine the treatment as well as the evolution of the disease. Recent reports have shown good results in diagnosing cardiac amyloidosis using

Objective [11C] methionine (MET) positron-emission tomography (PET) is a useful diagnostic and therapeutic tool in neuro-oncology. The aim of this study was to evaluate the relationship between MET uptake and the histopathological grade in both primary brain tumours and brain metastases. A secondary goal was to assess the relationship between MET uptake and patients’ survival after surgery. Methods We reviewed a consecutive series of 43 PET studies performed at our institution. Out of the 43 patients studied, 35 harboured primary brain tumours (3 grade I, 12 grade II, 7 grade III and 13 grade IV) and 8 patients had brain metastases. We measured the tumour/cortex ratio (T/C ratio) on each PET study and we investigated the correlations among the tracer uptake, tumour grade, tumour type, MRI parameters and outcome. Results The mean T/C ratio was 1.8 ± 0.9 for benign lesions and low grade gliomas (grade I and II) and 2.7 ± 1 for high grade gliomas (grade III and IV). In brain metastases it was 2.5 ± 0.7, with a significant difference in MET uptake between low and high grades gliomas (P = 0.03). There was no statistically significant difference among all different histologic types. We found that both contrast enhancement and perfusion studies correlate with MET uptake in brain tumours. Moreover, in Kaplan–Meier curves, the T/C ratio adversely affects long term survival in patients with brain tumours (P = 0.01). Conclusions MET PET appears to be useful in diagnosis and evaluation of potential malignancy in brain tumours. MET uptake is also related with the overall survival in patients with brain tumours. Nevertheless, further studies are needed in order to define its possible clinical implications in identifying patients at high risk of tumour progression or resistance to therapy.

To assess different warranty periods following a normal myocardial perfusion SPECT based on patients' clinical characteristics and the type of stress performed.A study was done of 2,922 consecutive patients (62.9 ± 13 years; 53.4% women) with a normal stress-rest SPECT. The warranty period was defined as the period during which patients remained at a low risk (1% events/year) of total mortality (TM), or hard events (HE) (cardiac death or non-fatal myocardial infarction). Of these patients, 2,051 were given an exercise myocardial perfusion imaging (Ex-MPI); 461 submaximal exercise plus dipyridamole (Ex+Dipy-MPI); and 410 dipyridamole (Dipy-MPI). During a mean follow-up of 5 ± 3.3 years, a significant reduction (P.05) of the warranty period for TM (13.5, 9.6 and 8 months) and HE (34.8, 20.5 and 8.2 months) was observed, for Ex-MPI, Ex+Dipy-MPI and Dipy-MPI, respectively. Other warranty period determinants were the clinical variables of age, sex, diabetes and known coronary artery disease. An abnormal left ventricular ejection fraction on gated-SPECT also significantly shortened the warranty period for HE in patients undergoing Ex+Dipy-MPI (P = .001) or Dipy-MPI alone (P = .007).The warranty period for a normal stress-rest SPECT is highly variable since it is primarily determined by the type of stress, the patient's clinical characteristics and LVEF.

Resumen Objetivo El objetivo de este estudio fue investigar que variables en el momento de la practica de una gated-SPECT de perfusion miocardica normal son predictoras de la indicacion de una segunda gated-SPECT. Material y metodos Estudio unicentrico, prospectivo de cohorte. Se incluyeron consecutivamente 2.326 pacientes (edad 63,6 ± 13 anos, 57,3% mujeres) sin defectos de perfusion y con una fraccion de eyeccion del ventriculo izquierdo normal en una gated-SPECT de perfusion miocardica estres-reposo. Se estudiaron variables clinicas y ergometricas predictoras de la indicacion de una nueva gated-SPECT y de la presencia de defectos reversibles de perfusion en esta ultima. Resultados Durante un seguimiento medio de 3,6 ± 2 anos despues de una gated-SPECT normal se practico una segunda gated-SPECT en 286 pacientes (12,3%). Las variables predictoras independientes que influyeron en la indicacion de una segunda gated-SPECT fueron la presencia de 3 o mas factores de riesgo cardiovascular (χ2: 5.501; HR: 1,4; p = 0,019), el antecedente de infarto agudo de miocardio (χ2: 3.862; HR: 1,4; p = 0,049), la revascularizacion coronaria previa (χ2: 41.063; HR: 2,5; p 2 : 4.322; HR: 1,9; p = 0,038) que realizaron una primera gated-SPECT farmacologica pura (χ 2 : 7.182; HR: 2,6; p = 0,007). Conclusiones En los pacientes con una gated-SPECT de perfusion miocardica normal diversos factores clinicos y variables derivadas de la prueba de estres influyen en la indicacion de una segunda gated-SPECT y en la presencia de isquemia en esta ultima.

The objective of this study was to investigate predictor variables at the moment of normal stress-rest myocardial perfusion gated SPECT for indication of a second gated SPECT.A prospective, single center cohort study was conducted. We evaluated 2326 consecutive patients (age 63.6 ± 13 years, 57.3% females) without perfusion defects and with normal left ventricular ejection fraction on a myocardial perfusion gated SPECT. Clinical and stress test variables were studied to predict indication of a second gated SPECT and presence of reversible perfusion defects in the second gated SPECT.During a mean follow-up of 3.6 ± 2 years a second gated SPECT was performed in 286 patients (12.3%). Independent predictor variables of a second gated SPECT were presence of three or more cardiovascular risk factors (χ(2): 5.510; HR: 1.4; p=0.019), previous acute myocardial infarction (χ(2): 3.867; HR: 1.4; p=0.049), previous coronary revascularization (χ(2): 41.081; HR: 2.5; p0.001), and a positive stress test (χ(2): 8.713; HR: 1.5; p=0.003). Observation of perfusion defects in the 280 patients in whom a second stress-rest gated SPECT was performed was more likely in male patients (χ(2): 4.322; HR: 1.9; p=0.038) who had a first pure pharmacological gated-SPECT (χ(2): 7.182; HR: 2.6; p=0.007).In patients with a first normal myocardial perfusion gated SPECT, various clinical factors and variables derived from the stress test affect the indication of a second gated SPECT and the presence of ischemia in the latter.

Resumen Introduccion y objetivos El objetivo de este estudio es comparar los resultados de la resonancia magnetica y la gated- SPECT de perfusion miocardica en la valoracion de la funcion ventricular y la viabilidad en pacientes con infarto de miocardio en fase cronica. Metodos Se estudio con resonancia magnetica y gated- SPECT a 104 pacientes (media de edad, 61 ± 12 anos; el 87,5% varones) con infarto previo. Se correlacionaron los volumenes y la fraccion de eyeccion del ventriculo izquierdo y los criterios clasicos de viabilidad con realce tardio con gadolino ( 50%) en los 17 segmentos del ventriculo izquierdo. Se valoro la motilidad, el engrosamiento y la isquemia en la gated- SPECT de los segmentos no viables o con criterios dudosos con el realce (un 50-75% de transmuralidad). Resultados Se observo buena correlacion entre ambas exploraciones para los volumenes y la fraccion de eyeccion (p 75%, 82 (31%) tenian captacion > 50% en la SPECT. De los 106 segmentos con criterios dudosos de viabilidad (un 50-75% de realce) en la resonancia magnetica, en la SPECT 68 (64%) tenian una captacion > 50%; 41 (38,7%), motilidad conservada; 46 (43,4%), engrosamiento conservado, y 17 (16%), criterios de isquemia. Conclusiones Una tercera parte de los segmentos considerados no viables en la resonancia magnetica muestran captacion > 50% en la SPECT. El analisis de la motilidad, engrosamiento y presencia de isquemia en la gated- SPECT es de utilidad en los segmentos de dudosa viabilidad en la resonancia magnetica.

The arterial switch operation (ASO) is the preferred technique for correcting transposition of the great arteries, but translocation and reimplantation of the coronary arteries can produce myocardial ischemia. This report aims to describe the authors' experience with exercise single-photon emission computed tomography (SPECT) used to evaluate myocardial perfusion. Exercise-rest gated-myocardial perfusion SPECT was performed for 69 patients (49 boys; median age, 9 years; 5th percentile [6.4 years] to 95th percentile [15.6 years]), 64 of whom were asymptomatic 9.98 ± 3.20 years after ASO. During exercise testing, the patients reached 9.85 ± 3.05 metabolic equivalents (METs) and a median heart rate of 160 beats per minute (bpm), 5th percentile (106 bpm) to 95th percentile (196 bpm). Whereas 61 patients (88.41 %) had normal myocardial perfusion, 2 patients (2.9 %) had reversible defects, and 6 patients (8.7 %) had fixed defects. All the patients with perioperative ischemic complications (4/4, 100 %) had myocardial perfusion defects, whereas four patients (4/65, 6.15 %) without ischemic complications had abnormal perfusion (p = 0.0005). Age at the time of surgery did not differ significantly (p = 0.234) between the patients with perfusion defects and those with normal study results. No significant difference was observed between the patients who had an A coronary pattern (left coronary artery originating from the left sinus and the right coronary artery originating from the right sinus, n = 47) and those who had a non-A coronary pattern (n = 22) (p = 1). The high rate for normality of exercise myocardial perfusion in our study suggests that myocardial perfusion gated-SPECT should be reserved for patients who have experienced perioperative ischemic complications or those with symptoms, at least during the first 10 years after the surgery.

Background— The incremental prognostic value of myocardial perfusion–gated single photon emission computed tomography (MPGS) compared with exercise test has not yet been properly evaluated. Methods and Results— Five thousand six hundred seventy-two consecutive patients with known or suspected coronary disease undergoing exercise MPGS between 1997 and 2007 were included. Three-year predictive models for total death and death from cardiovascular causes or acute myocardial infarction (ie, major cardiovascular events [MCE]) were built using Cox-regression modeling, including only the clinical information. Then the exercise and MPGS information was sequentially added. The added discriminative ability of exercise test information and MPGS was assessed by net reclassification improvement and integrated discrimination improvement. The increase in predictive ability of exercise information for death and MCE was high as assessed by net reclassification improvement (0.199 and 0.263) and integrated discrimination improvement (0.042 and 0.021). The only variable of MPGS associated with total death was ejection fraction (hazard ratio, 0.84; 95% confidence interval, 0.79–0.89; P P =0.007). Adding MPGS information barely improved the prognostic value for total death (net reclassification improvement, 0.017; integrated discrimination improvement, 0.013), but it increased for MCE (net reclassification improvement, 0.122; integrated discrimination improvement, 0.033). Conclusions— Adding MPGS information to exercise information does not improve prediction of total death, although it allows a more accurate prediction of MCE.

Objective To evaluate the evolutive changes in diastolic function after percutaneous coronary revascularization (PCR) in acute myocardial infarction (AMI), using myocardial perfusion gated SPECT. Methods Thirty-two patients (mean 61.9 ± 9.7 years, 7 women) were studied by two at rest gated SPECT: the first gated-SPECT-1 was performed with an injection of a dose of 99mTc-tetrofosmin prior to PCR and the second gated-SPECT-2 between the fourth and fifth weeks after AMI. Changes of peak filling rate (PFR) and the time to peak filling rate (TTPF) were assessed between both studies, and were related to the extent of salvaged myocardium (SM), end-diastolic (EDV) and end-systolic (ESV) volumes, and left ventricular ejection fraction (LVEF) changes. Results An improvement was observed in diastolic function parameters gated-SPECT-2: PFR increased significantly (p = 0.011) while the TTPF decreased without reaching statistical significance (p = 0.288). In multivariate analysis, adjusted by clinical and coronary variables, improvement of PFR was significantly associated with percentage of SM (p = 0.030), increase in LVEF (p = 0.004) and with ESV volume reduction (p = 0.005). Improvement of TTPF was only related significantly to the percentage of SM (p = 0.046). PFR increased by 0.01 EDV/s. and TTPF decreased by 1.14 ms for each cm2 increase of the area of SM. Conclusions After PCR in AMI, the myocardial perfusion gated SPECT makes it possible to assess the significant improvement in diastolic function mainly related to the amount of MS.

Resumen Objetivo Valorar mediante gated-SPECT de perfusion miocardica los cambios evolutivos de la funcion diastolica despues de la revascularizacion coronaria percutanea (RCP) de un infarto agudo de miocardio (IAM). Material y metodos Se estudiaron consecutivamente 32 pacientes (media 61,9 ± 9,7 anos; 7 mujeres) mediante 2 gated-SPECT de perfusion miocardica en reposo: la primera gated-SPECT-1 con inyeccion de una dosis de 99mTc-tetrofosmina previa a la RCP y la segunda gated-SPECT-2 entre la cuarta y quinta semana despues del IAM. Se valoraron los cambios de la velocidad maxima de llenado (Vmax) y del tiempo a la velocidad maxima de llenado (TVmax) entre ambos estudios, relacionandolos con la extension del miocardio salvado (MS) y con los cambios observados en los volumenes telediastolico (VTD) y telesistolico (VTS) y en la fraccion de eyeccion del ventriculo izquierdo (FEVI). Resultados En la gated-SPECT-2 se observo una mejoria de los parametros de la funcion diastolica: la Vmax aumento significativamente (p = 0,011) mientras que el TVmax disminuyo sin alcanzar significacion estadistica (p = 0,288). En el analisis multivariante, ajustado por variables clinicas y coronariograficas, el aumento de la Vmax se relaciono significativamente con el porcentaje de MS (p = 0,030), el aumento de la FEVI (p = 0,004) y la reduccion del VTS (p = 0,005). La mejoria del TVmax solo se relaciono significativamente con el porcentaje de MS (p = 0,046). Por cada cm2 de aumento del area del MS la Vmax aumento 0,01 VTD/s y la TVmax disminuyo 1,14 ms. Conclusiones Tras la RCP en el IAM, la gated-SPECT de perfusion miocardica permite valorar la mejoria significativa de la funcion diastolica que se relaciona fundamentalmente con la cantidad de MS.

The 15-Objects Test (15-OT) provides useful gradation of visuoperceptual impairment from normal aging through Alzheimer's disease (AD) and correlates with temporo-parietal perfusion. The objectives of this study were to analyze progression of 15-OT performance in mild cognitive impairment (MCI) and AD, and its correlates with cognition and single photon emission computerized tomography (SPECT), as well as to examine neuropsychological and SPECT differences between the MCI patients who developed AD and those who did not. From the initial 126 participants (42/group), 38 AD, 39 MCI, and 38 elderly controls (EC) were reassessed (SPECT: 35 AD, 33 MCI, 35 EC) after two years. The progression of cognitive and SPECT scores during this period was compared between groups, and baseline data between converters and non-converters. The 15-OT was the only measure of progression that differed between the three groups; worsening scores on 15-OT were associated with worsening in verbal and visual retention, and decreased perfusion on left postsubicular area. In the MCI patients, cerebral perfusion fell over the two years in medial-posterior cingulate and fronto-temporo-parietal regions; AD showed extensive changes involving almost all cerebral regions. No SPECT changes were detected in controls. At baseline, the MCI patients who developed AD differed from non-converters in verbal recognition memory, but not in SPECT perfusion. In conclusion, SPECT and 15-OT appear to provide a potential measure to differentiate between normal aging, MCI, and AD. Worsening on 15-OT was related to decreased perfusion in postsubicular area; but further longitudinal studies are needed to determine the contribution of 15-OT as a predictor of AD from MCI.

Objectives To assess the significance of a paradoxical pattern (PP) (greater tracer uptake during stress than at rest) on gated myocardial perfusion SPECT in myocardial regions with myocardial necrosis.

Aim The aim of this study was to quantitatively evaluate the striatal uptake in 3 groups of patients: essential tremor (ET), drug-induced parkinsonism (DIP), and Parkinson disease (PD), using a voxel-based methodology and volumes of interests (VOIs) analysis. Patients and method Sixty patients from the Neurology Department Movement Disorders outpatient clinic in a tertiary hospital with I-123-FP-CIT SPECT were selected. After a clinical follow-up period of 2 years, a final clinical diagnosis of DIP was established for 20 patients (first group); 20 patients were diagnosed with ET (second group), and the third group was made up of 20 patients with a qualitatively pathologic SPECT who were diagnosed with PD.Once processed, DIP studies were spatially normalized to Montreal Neurologic Institute space and an average image was computed to create an I-123-FP-CIT SPECT template using statistical parametric mapping (SPM). Then all the I-123-FP-CIT images from all groups (DIP, ET, and PD) were registered to the new template. VOIs were defined in a digital atlas in Montreal Neurologic Institute space (caudate nucleus, putamen, and occipital cortex). Finally, mean counts were extracted from all VOIs and putamen-occipital and caudate-occipital ratios were computed. Analysis of variance tests were performed with all ratios.A SPM study of patterns evaluated the efficacy of the automated technique to determine whether the significant differences among groups corresponded to the same regions that the method purported to evaluate. Results The analysis of variance test revealed significant differences between DIP and ET as compared with PD, both in the putamen and in the caudate nucleus. There were significant differences between DIP and ET populations only in the putamen but not in the caudate.The SPM found a lower uptake in the PD group in comparison with the ET and DIP groups. Therefore, in the organic parkinsonism cases, the most significant changes in uptake decrease were found in the putamen nuclei when compared with the DIP and the ET cases. No significant changes were observed between the ET and DIP groups. Conclusions This study provides a fairly simple, reproducible, and useful methodology to be applied in everyday practice to quantify the studies of dopamine transporters using FP-CIT.We present the different ratios for putamen and caudate nucleus for 3 different groups with FP-CIT images. We obtained an optimal discrimination threshold value between the reference population and the pathologic population for the putamen ratio.

The aim of this study was to evaluate the diagnostic efficacy of bone scintigraphy (BS) and radiolabeled white blood cell scintigraphy (WBCS) in detecting septic activity in the flat bones of the jaw. A retrospective analysis was conducted using 38 studies of combined BS plus WBCS: 33 of them 3-phase BS and 36 of them 2-phase WBCS. These studies were performed on 34 patients, 19 women and 15 men with a mean age of 56 years (22-79), who presented with suspected mandibular osteomyelitis, either acute or chronic exacerbation. The results were compared with histologic findings (55%) or with a minimum clinical/radiologic follow-up of 6 months (average, 21 months), when biopsy results were not available. BS showed a sensitivity of 100%, a specificity of 6.7%, a positive predictive value of 62%, and a negative predictive value of 100%. For WBCS, the corresponding values were as follows: 73.7%, 78.6%, 82%, and 69%. Accuracy was 63.2% for BS and 94.7% for WBCS. WBCS has proven to be a useful test for detecting septic activity in the jaw bone, being more effective than BS alone, which under certain circumstances, can return a very high false-positive rate.

Introduccion y objetivos El objetivo de este estudio es evaluar la eficacia diagnostica de la tomografia computarizada por emision monofotonica (SPECT) de perfusion miocardica con la administracion de atropina intravenosa al final de una prueba de esfuerzo con insuficiente taquicardizacion. Metodos A 172 pacientes que, a pesar de realizar una prueba ergometrica limitada por sintomas, no alcanzaron un 80% de taquicardizacion, sin presentar angina ni descenso del segmento ST ≥ 1 mm, se les administro 1 mg de atropina intravenosa al final del esfuerzo. A 23 de estos pacientes con criterios de isquemia gammagrafica en la SPECT con atropina, y en el curso de 1 semana, se les practico una segunda SPECT sin la administracion de atropina con la finalidad de comparar la presencia y la gravedad de la isquemia gammagrafica entre los dos estudios (suma puntuacion diferencial [SPD]). Resultados De los 172 pacientes, 75 (43,6%) presentaron angina (n = 56) o descenso del segmento ST (n = 30) con la administracion de atropina. De los 23 pacientes en los que se hicieron ambas pruebas, 8 (35%) tuvieron isquemia (SPD ≥ 2) unicamente en la prueba con atropina. Ademas, la SPD fue significativamente superior en las imagenes de SPECT con atropina (5,6 ± 4,5 frente a 3,1 ± 2,8; p = 0,0001). Conclusiones La administracion de atropina al final de una prueba de esfuerzo insuficiente permite obtener criterios gammagraficos de isquemia en una tercera parte de los casos en que no se habria obtenido sin la administracion del farmaco.

Resumen Introduccion y objetivos El objetivo de este estudio ha sido crear una base de datos espanola (BDE) de normalidad de la SPECT (single photon emission computed tomography) de perfusion miocardica y compararla con una base de datos de normalidad de poblacion norteamericana. Metodos Se selecciono a 104 voluntarios sanos (45 mujeres, media de edad, 42 ± 14 anos) a los que se practico una SPECT de estres y reposo, procesandose los estudios en el programa comercial 4DM-SPECT. La BDE de normalidad generada para varones y mujeres se comparo con la base de datos de la poblacion norteamericana (70 varones y 60 mujeres) que proporciona el programa 4DM-SPECT. Resultados En la BDE el mayor porcentaje de captacion correspondio a la region lateral-medial, y el menor, a la region septal-basal, tanto en estres como en reposo. En las mujeres el porcentaje de captacion de la region anterior-medial fue significativamente mas bajo que en los varones, mientras que en estos se observo una menor captacion en las regiones inferiores, septal medial y apical con respecto a las mujeres. Los valores de la BDE fueron significativamente mas bajos que los de la 4DMSPECT en la mayoria de las regiones. Conclusiones Se ha creado una base de datos de normalidad espanola para mujeres y varones por separado de la SPECT de perfusion miocardica, y se ha observado que hay diferencias significativas con una base de datos comercial de origen norteamericano que suele utilizarse en estudios semicuantitativos.

Resumen Objetivo Analizar la funcion sistolica ventricular izquierda y la perfusion miocardica entre los protocolos corto esfuerzo reposo en un solo dia y largo en 2 dias de la gated-SPECT (Single Photon Emision Computed Tomography) de perfusion miocardica en pacientes con miocardiopatia isquemica. Metodos Estudio prospectivo de 40 pacientes (59,6±8,9 anos, 3 mujeres) con miocardiopatia isquemica (fraccion de eyeccion (FE) ventricular izquierda ≤40%) estudiados mediante gated-SPECT. Entre 5–10 dias despues de realizar el protocolo corto esfuerzo reposo (gated-SPECT-1) los pacientes fueron recitados para un segundo estudio de reposo (gated-SPECT-2) para comparar los resultados de la FE y de las diferencias de la suma de puntuacion de perfusion en reposo (ΔSPR=SPR1–SPR2) y de la suma de puntuacion de perfusion diferencial (ΔSPD=SPD1–SPD2) entre ambos protocolos. Resultados En 26 pacientes (65%) la FE de la gated-SPECT-2 fue superior (37 vs 34%, p=0,008) a la de la gated-SPECT-1 y en 11 pacientes (27,5%) el incremento fue ≥5%. No hubo diferencias clinicas ni coronariograficas significativas entre los pacientes con y sin aumento de la fraccion de eyeccion ≥5%. En el analisis multivariante ΔSPR (IC95%: −1,1 a −29,2) y ΔSPD (0,179–1,236) fueron predictoras del incremento de la FE ≥5% entre ambos estudios. Conclusiones En los pacientes con miocardiopatia isquemica la practica de un protocolo corto esfuerzo reposo puede infravalorar la FE del ventriculo izquierdo. El aturdimiento miocardico postestres y la posible contaminacion de las imagenes de reposo con las del esfuerzo previo en el protocolo corto permitirian explicar en parte estos resultados.

The aim of this study was to assess interassay reproducibility of myocardial perfusion gated-SPECT for calculation of end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular ejection fraction (LVEF) in patients with atrial fibrillation (AF).One hundred and fifteen consecutive patients with AF from three participating hospitals (mean age 68.9 years, 39 women) were included in the study. All patients underwent two image gated acquisitions at rest with a 30 minute interval between them. Quantitative data were obtained using the QGS and ECT software algorithms.Heart rate was similar in both studies: 74.94 +/- 15.2 vs 73.03 +/- 15.57. QGS yielded an LVEF of 54.4%/53.8%, an EDV of 100 mL/101.5 mL, and an ESV of 51 mL/52.3 mL; and ECT showed an LVEF of 63.6%/62.9%, an EDV of 125.8 mL/127.4 mL and ESV of 54.1 mL/56.3 mL. Correlation between the two acquisitions was high (0.948) for both methods for LVEF, EDV and ESV. Regression and Bland-Altman graphics showed a good agreement between all parameters. Interassay variation coefficients for each method (QGS/ECT) were 5.29% vs 4.83% for LVEF, 4.94% vs 5.17% for EDV, and 9.94% vs 12.78% for ESV.Interassay reproducibility of LVEF and EDV with gated-SPECT in patients with AF is good, whereas for ESV it is suboptimal, particularly when ESV is small.

The proven efficacy and safety of medical ozone therapy remains controversial [1–6]. In rats, ozone inhalation was shown to promote neuronal activation in stress-responsive regions of the central nervous system (CNS) [7], electrical activity alterations and changes in brain major neurotransmitter systems [8, 9]. We here describe two patients who developed cortical blindness and seizures shortly after intraarticular ozone infiltrations. There is only a prior report of top of the basilar stroke and Anton syndrome following ozone therapy [10]. A 75-year-old man complained of dizziness, slurred speech, tingling in the left extremities and visual loss, which developed 10 min after receiving a paravertebral ozone therapy session and autohemotherapy for spondylarthrosis. On admission he was fully aware with left neglect, cortical blindness, left central facial paralysis, and numbness and mild weakness of the left extremities. A brain magnetic resonance imaging (MRI) scan showed subcortical/juxtacortical white matter chronic ischemic lesions in the right cerebral hemisphere without evidence of acute lesions (Fig. 1a). Stenosis of the distal branch of the left cerebral posterior artery and a severe stenosis of the right carotid artery on MR angiograms were found. An EEG showed an alpha rhythm (8 Hz) predominantly in the left posterior region and a slow attenuated delta rhythm in the right hemisphere. A Tc-ECD brain SPECT showed bilateral hypoperfusion areas particularly in the left occipitotemporal region (Fig. 2). Twenty-four hours later, the patient presented visual hallucinations, various episodes of forced oculocephalic deviation to the left, clonus on left extremities and a tonic–clonic seizure. He was successfully treated with valproic acid and levetiracetam. A brain MRI performed 7 days later showed one small juxtacortical subacute ischemic lesion in the right occipital lobe (Fig. 1b). A 60-year-old woman presented with posterior cortical blindness and history of a tonic–clonic seizure, which developed shortly after intraarticular infiltration of ozone and procaine for the treatment of a left shoulder joint disease. On admission she was disoriented with repetitive speech, anterograde memory impairment and cortical blindness. The brain MRI showed a right acute ischemic cerebellar lesion (Fig. 1c). The EEG showed slowed brain D. V. Rolan (&) J. L. B. Cunat J. V. Hervas D. Escudero Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Carretera de Canyet s/n, 080916 Badalona, Barcelona, Spain e-mail: doloviro@hotmail.com

Background: There is a range of factors that predict the development of Alzheimer’s disease (AD) dementia among patients with amnestic mild cognitive impairment (MCI). Objectives: To identify the neuropsychological, genetic, and functional brain imaging data that best predict conversion to AD dementia in patients with amnestic MCI. Methods: From an initial group of 42 amnestic MCI patients assessed with neurological, neuropsychological, and brain SPECT, 39 (25 converters, 14 non-converters) were followed for 4 years, and 36 had APOE e4 genotyping. Baseline neuropsychological data and brain SPECT data were used to predict which of the MCI patients would develop dementia by the end of the 4 years of observation. Results: The MCI patients who had converted to AD dementia had poorer performance on long-term visual memory and Semantic Fluency tests. The MCI subjects who developed dementia were more likely to carry at least one copy of the APOE e4 allele (Hazard Risk = 4.22). There was lower brain perfusion in converters than non-converters, mainly in postcentral gyrus. An additional analysis of the SPECT data found differences between the MCI subjects and controls in the posterior cingulate gyrus and the basal forebrain. When the brain imaging and neuropsychological test data were combined in the same Cox regression model, only the neuropsychological test data were significantly associated with time to dementia. Conclusion: Although the presence of reduced brain perfusion in postcentral gyrus and basal forebrain indicated an at-risk condition, it was the extent of memory impairment that was linked to the speed of decline from MCI to AD.

The aim of this study was to compare magnetic resonance and gated-SPECT myocardial perfusion imaging in patients with chronic myocardial infarction.Magnetic resonance imaging and gated-SPECT were performed in 104 patients (mean age, 61 [12] years; 87.5% male) with a previous infarction. Left ventricular volumes and ejection fraction and classic late gadolinium enhancement viability criteria (75% transmurality) were correlated with those of gated-SPECT (uptake50%) in the 17 segments of the left ventricle. Motion, thickening, and ischemia on SPECT were analyzed in segments showing nonviable tissue or equivocal enhancement features (50%-75% transmurality).A good correlation was observed between the 2 techniques for volumes, ejection fraction (P.05), and estimated necrotic mass (P.01). In total, 82 of 264 segments (31%) with75% enhancement had50% single SPECT uptake. Of the 106 equivocal segments on magnetic resonance imaging, 68 (64%) had50% uptake, 41 (38.7%) had normal motion, 46 (43.4%) had normal thickening, and 17 (16%) had ischemic criteria on SPECT.A third of nonviable segments on magnetic resonance imaging showed50% uptake on SPECT. Gated-SPECT can be useful in the analysis of motion, thickening, and ischemic criteria in segments with questionable viability on magnetic resonance imaging.

The objective of this study was to investigate the impact of clinical, electrocardiographic and stress testing variables in predicting hard cardiac events (HE) and coronary revascularization (CR) in patients with normal stress-rest gated SPECT.Included in the study were 2,004 patients (63.5 ± 12.5 years, 41.6% men) with normal myocardial perfusion and left ventricular ejection fraction (LVEF)50% on gated SPECT who were followed for HE (cardiovascular death or acute myocardial infarction) and CR.During a follow-up of 4.3 ± 2.4 years, 33 patients (1.6 %; 0.4%/year) had HE and 50 patients (2.5%; 0.6%/year) underwent CR. In a univariate analysis, age ≥65 years, insulin-dependent diabetes mellitus (IDDM), left bundle branch block (LBBB), and pharmacological stress were associated with HE. Independent predictors of HE were age ≥65 years (p0.001; HR 6.9), IDDM (p = 0.014; HR 3.4), and LBBB (p = 0.002; HR 4.6). In the univariate analysis, male gender, LVEF, known coronary artery disease (CAD), LBBB, and a positive stress test were associated with CR. Independent predictors of CR were known CAD (p = 0.016; HR 2.1), and a positive stress test (p = 0.006; HR 2.3).Age ≥65 years, IDDM, and LBBB are HE-independent predictors in patients with normal myocardial perfusion and normal LVEF on gated SPECT. The presence of known CAD or a positive stress test significantly increases the probability of CR during follow-up.

To assess the significance of a paradoxical pattern (PP) (greater tracer uptake during stress than at rest) on gated myocardial perfusion SPECT in myocardial regions with myocardial necrosis.A review of 1,764 consecutive stress-rest myocardial perfusion SPECT studies in patients with prior myocardial infarction (MI) was conducted. Of these, 117 patients (6.6%) with a PP corresponding to a region with myocardial necrosis were identified. An assessment of perfusion, contractility, wall thickening, scintigraphic criteria for viability, and the characteristics of the culprit artery in regions with a PP was performed.Of the 160 regions with necrosis, 125 (75%) had a PP: 67 in the anterior region and 58 in the inferior-lateral region. In the PP group, the average tracer activity of defects during stress was significantly higher than at rest (P.0001). Ninety-three (86.6%) out of 110 PP segments without scintigraphic criteria of viability at rest met viability criteria on stress imaging. The artery supplying regions with a PP was patent in 88% of cases. In the remaining patients it was occluded, although collateral circulation was always present.In scintigraphic segments corresponding to regions with infarction and PP, a mixture of viable and well perfused myocardium was observed. In most cases, the vessel that supplied the region with PP was either patent, or when the artery was occluded, there was evident collateral circulation.

Introduction and objectives The aim of this study was to determine the diagnostic value of using myocardial perfusion single-photon emission computed tomography (SPECT) with intravenous atropine administration at the end of submaximal exercise testing. Methods One milligram of atropine was administered intravenously at the end of exercise testing to 172 patients who underwent a symptom-limited ergometric test but did not reach 80% of their peak heart rate without exhibiting angina or an ST-segment depression ≥1 mm. Within 1 week, 23 patients who satisfied scintigraphic criteria for ischemia during SPECT with atropine underwent SPECT for a second time without atropine administration with the aim of comparing the presence and severity of scintigraphic ischemia between the two studies (SDS: summed difference score). Results Of the 172 patients, 75 (43.6%) developed angina (n=56) or ST-segment depression (n=30) during atropine administration. Eight of the 23 patients (35%) who underwent two tests exhibited scintigraphic ischemia (SDS ≥2) on only the test with atropine. Furthermore, the SDS was significantly greater on SPECT imaging with atropine (5.6 [4.5] vs. 3.1 [2.8]; P =.0001). Conclusions One-third of patients who met scintigraphic criteria for ischemia at the end of submaximal exercise testing and after atropine administration would not have met those criteria without administration of the drug.

Introduction and objectives The aims of this study were to create a Spanish database of normal myocardial perfusion SPECT (single-photon emission computed tomography) data, termed the normal Spanish database, and to compare it with a database of normal data from the North American population. Methods We selected 104 healthy volunteers (45 female, mean age 42±14 years) who underwent SPECT during stress and at rest. The findings were analyzed using the 4DM-SPECT commercial software package. The resulting normal Spanish database for males and females was compared with the North American population database (from 70 men and 60 women) provided with the 4DM-SPECT software. Results In the Spanish database, the highest percentage uptake during both stress and rest was observed in the medial–lateral region and the lowest, in the basal–septal region. The percentage uptake in the anterior–medial region was significantly lower in women than men, while uptake in the inferior, medial–septal and apical regions was lower in men than women. Data values in the Spanish database were significantly lower for the majority of heart regions than those in the database with the 4DM-SPECT software. Conclusions A Spanish database of normal myocardial perfusion SPECT data was created and included separate data for men and women. Significant differences were observed between this database and a commercial North American database that is commonly used in semiquantitative studies.

Objective The purpose of this study was to analyze left systolic ventricular function and myocardial perfusion characteristics between short one day exercise-rest and long two days gated SPECT (Single Photon Emission Computed Tomography) protocols in patients with ischemic cardiomyopathy (ICM). Methods A prospective study of 40 patients (59.6 ± 8.9 years, 3 women) with IHD (left ventricular ejection fraction (EF) ≤ 40%) was performed with myocardial perfusion gated SPECT. From 5 to 10 days after a one-day exercise-rest study (gated SPECT-1), patients were called back for a second rest study (gated SPECT-2) in order to compare EF and differences in perfusion summed rest score (ΔSRS=SRS1-SRS2) and summed difference score (ΔSDS=SDS1-SDS2) between both protocols. Results Between rest-gated SPECT-1 (short protocol) and rest-gated SPECT-2 (long protocol) EF increased (34% vs 37%, P = 0.008) in 26 patients (65%), and in 11 patients (27.5%) the increase was ≥ 5%. There were no significant differences in clinical and coronary angiography variables between patients with and without increase of the EF ≥ 5%. In the multivariate analysis, ΔSRS (95% CI: −1.1 to −29.2) and ΔSDS (0.179–1.236) were predictors for this EF increase between both studies. Conclusions Exercise-rest short protocol can underestimate EF in patients with ICM. Stunning but also contamination of rest images by previous exercise images in a short protocol could explain these results.

Objective To evaluate the usefulness of SPECT in assessing damage to the pre-synaptic dopaminergic system in Huntington's disease (HD) using [ 123 I]-FP-CIT (DaTSCAN), a selective radioligand with regulatory approval as the diagnostic test for investigating functional dopaminergic neuron loss in the striatum in Parkinson's disease. Methods We studied twelve symptomatic HD patients using DaTSCAN/SPECT imaging. [ 123 I]-FP-CIT caudate and putamen uptake levels were qualitatively and semi-quantitatively analyzed to assess pre-synaptic damage in the striatal dopamine system. Possible correlations were analyzed between HD severity on the Unified Huntington's Disease Rating Scale (UHDRS), duration of clinical symptoms, and [ 123 I]-FP-CIT/SPECT striatal uptake. Results DaTSCAN/SPECT qualitative analysis showed reduced striatal uptake in eight patients. Semi-quantitative analysis revealed a significant reduction in four. Of these four, uptake reduction was at putamen level in all, and also at caudate level in one. Although we observed no linear correlation between HD severity and reduced striatal [ 123 I]-FP-CIT uptake, the patients with the worst UHDRS scores had more severe reductions in radioligand uptake. Conclusion This is the first study to use in vivo [ 123 I]-FP-CIT/SPECT imaging to confirm prior descriptions using PET of a pre-synaptic dopaminergic system defect in HD.

To illustrate the potential of [I]-FP-CIT SPECT DaTSCAN® in investigating the progression of presynaptic dopaminergic degeneration in Huntington disease (HD), we performed a 2-year follow-up [I]-FP-CIT study on 4 HD patients, evaluating the SPECT imaging based on qualitative and semiquantitative analysis. The mean annual decline in [I]-FP-CIT uptake in caudate and putamen after 2 years of follow-up was 5.8% and 9.6%, respectively. Our findings suggest that [I]-FP-CIT SPECT is useful in investigating the progression of presynaptic dopaminergic degeneration in HD, and may be useful as a disease biomarker, providing an objective method for measuring the effectiveness of future neuroprotective therapies.

Cerebrotendinous xanthomatosis is a rare recessive autosomal disease caused by mutations of the sterol 27-hydroxylase gene (CYP27), which leads to reduced synthesis of bile acids, particularly chenodeoxycholic acid (Cali et al, J Biol Chem. 1991;266:7779-7783; Gallus et al, Neurol Sci. 2006;27:143-149). The disease is characterized by progressive neurologic dysfunction due to accumulation of cholestanol in neurologic tissues (Moghadasian et al, Arch Neurol. 2002;59:527-529; Selva-O'Callaghan et al, Rheumatology. 2007;46:1212-1213). Long-term treatment with chenodeoxycholic acid can arrest or even reverse progression of the disease (Pierre et al, J Inherit Metab Dis. In press).Brain SPECT with 740 MBq of Tc-99m ethyl cysteinate dimmer, using a double-head gamma camera (Siemens E.cam) with high-resolution, low-energy parallel collimators was performed in our patient at onset and 2 years after starting chenodeoxycholic acid treatment. SPECT acquisitions were performed using a 360-degree orbit, 1 image/30 seg/3 degree, and 128 × 128 matrix. Reconstruction was by means of filtered back-projection, Butterworth 5/0.25, without attenuation correction. Pre- and post-SPECT dicom images were reoriented into Talairach space using NeuroGam (Segami Corporation). To visually identify abnormal perfusion regions, volume render brain image was computed, where abnormal perfusion regions were found by comparing with age-matched normal database, and Brodmann areas (BA) were quantified. Pre- versus post-treatment changes were computed by means of relative percentage between counts. Post-treatment SPECT showed better perfusion than pretreatment SPECT with an increase between 5% and 10% in frontal cortex (BA 9, BA 24, BA 32, BA 46, BA 47), parietal cortex (BA 5, BA 31), and temporal cortex (BA 20, BA 22, BA 28, BA 36, BA 37, BA 38), and with an increase of more than 10% in frontal cortex (BA 45) and parietal cortex (BA 23). This case illustrates the benefit of bile acid therapy for halting and even reversing neurologic retardation in this condition.

Introduccion. Con el objetivo de estudiar los cambios funcionales cerebrales en pacientes con enfermedad de Alzheimer sometidos a plasmaferesis con recambio plasmatico con Albumina Humana Grifols® 5%, se han realizado prospectivamente y a doble ciego estudios secuenciales de tomografia computarizada por emision de foton unico (SPECT) y resonancia magnetica cerebrales a pacientes sometidos o no a esta terapia. Materiales y metodos. Los SPECT cerebrales (99mTc-ECD) se obtuvieron en condiciones basales (gamma-camara doble detector Ecam, LE-HR, 30 sec/image/3o, 128 × 128). Estos estudios se cuantificaron mediante SPM (Statistical Parametric Mapping) y Neurogam para valorar los cambios entre el estudio basal y el seguimiento tras la plasmaferesis. Todos los estudios, referenciados con una base de datos normal para la edad, se han comparado de forma individual y por grupos: tratados/no tratados con plasmaferesis y estudios pretratamiento/postratamiento en diferentes tiempos. Resultados y conclusiones. Se presentan los resultados de las areas de Brodmann en las que se han detectado diferencias significativas entre los grupos tratado y control y entre los controles evolutivos, y las variaciones evolutivas en la captacion del hipocampo en los grupos control y tratados. Junto con los hallazgos clinicos, estos resultados preliminares aportan evidencia biologica a la hipotesis de que el recambio plasmatico con Albumina Humana Grifols® 5% puede desempenar un papel en el tratamiento de la enfermedad de Alzheimer.

Introduccion. La angiopatia amiloide cerebral es una causa frecuente de enfermedad cerebrovascular hemorragica en mayores de 65 anos y, en ocasiones, la sintomatologia inicial puede ser de tipo epileptico. Caso clinico. Mujer de 62 anos de edad sin antecedentes de interes que ingresa por estado de mal no convulsivo con sintomatologia de desconexion del medio, alucinaciones auditivas y apraxia ideomotora, con aparicion de descargas periodicas lateralizadas epileptiformes en la region parietooccipital derecha en el electroencefalograma. La resonancia con secuencia de susceptibilidad magnetica mostro una hemorragia subaracnoidea focal subaguda en la region parietotemporal derecha y microsangrados corticosubcorticales en distintos estadios evolutivos compatibles con angiopatia amiloide cerebral. Se realizo una tomografia computarizada por emision de foton unico critica que mostro una area de hiperperfusion en la misma region. Se inicio tratamiento antiepileptico con resolucion clinica, neurofisiologica y gammagrafica. Conclusion. Se presenta un caso clinico con estado de mal no convulsivo como manifestacion inicial de angiopatia amiloide cerebral, se senala la utilidad de las secuencias de susceptibilidad magnetica de la resonancia y se discute la fisiopatogenia de las descargas periodicas lateralizadas epileptiformes como elemento de actividad epileptica.