A representative Nuclear Medicine Service in Spain has two or three gammacameras. It performs neurologic studies one or two days at week wich account 2,1% of total workload. Brain Perfusion SPECT, specially in cognitive disorders, is the most frequent application. Neurooncology has a lower but established relevance. Neuroreceptors imaging are increasing in the last months. Emission tomography is obtained using a double-headed camera fitted with high-resolution parallel hole collimators and a half an hour total acquisition time. Datasets are reconstructed by filtered backprojection with Butterworth or Metz filtres. Images are visually interpreted with comparison to MRI and/or CT findings.

Brain Neoplasms↗

PubMedDate not supplied

[Brain perfusion SPECT in the prognostic assessment of stroke].

PURPOSE: To compare the diagnostic yield of CT scan and perfusion SPECT on admission and its prognostic value in clinical outcome. METHODS: 25 ischemic stroke cases were studied on admission (<24 h) and at 30-60 days by CT scan, 99mTc-HMPAO-SPECT and neurological scales. Infarct size and severity on SPECT were assessed: visually "Total Weighted Score," added value in 22 areas, and by several semiquantitative count-based indices. RESULTS: Sensitivity: the first CT scan was positive in 24% patients, initial SPECT in 75% (73% of pure subcortical infarcts and 91% of those with cortical involvement). Localization: kappa: 0.725 between SPECT findings on admission and those in control-CT at 5 days. Extent and severity: correlations between count-based and visual indices (r: >0.719), the latter correlated slightly better with clinical scales. Both predicted similarly (Rho>0.739) infarct size in CT diagnostic scan. Early Outcome: There were statistical differences between deceased and survivors in SPECT (<24h) indices and CT-infarct size (mean 5 days), but not in neurological scores on admission. Long term Outcome: Correlation of initial SPECT indices with follow-up functional scores (SNSLP, Barthel index; mean 37 days) was only significant for visual SPECT indices (Rho:0.560 to 0.620). Nevertheless the best predictor of functional status on discharge was the Barthel Index on admission. CONCLUSIONS: 1) Early SPECT has good sensitivity and accurate infarct size prediction so it can be a useful tool for deciding thrombolytic therapy; 2) Visual scores perform as well as more complex indices; 3) Infarct volume seems to be a critical determinant in vital outcome; other factors (strategic localization, etc.) might influence long term functional status.

Aged↗

PubMedDate not supplied

[SPECT cerebral con (99m)TcHMPAO in a case of Steele-Richardson-Olszewski].

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Aged↗

PubMedDate not supplied

Thallium scintigraphy in human transplants: a way to detect myocardial damage.

An original index has been derived from thallium images to detect histopathologic changes in heart transplant patients. One hundred eighty-four static and end-diastolic images with thallium were recorded 5 minutes after injection in the left anterior oblique projection. Twenty patients and 14 healthy volunteers were studied. The epicardial and endocardial borders were determined, and the difference of these values was considered the myocardial area. The results in heart transplants were compared with the results of endomyocardial biopsies (N = 142). A significant decrease (p less than 0.01) was found in the index of the myocardial area between normal biopsy results and mild and moderate rejection. Differences were not detected between studies performed in several postoperative periods in the absence of rejection. The results in healthy volunteers prove that the index does not change between studies performed at different times in the same subject, although the value obtained from the end-diastolic image was more constant. On the basis of these results, it is possible to suggest that the decrease in the myocardial area during rejection is the result of a fall of thallium uptake by the myocardium. Capillary endothelial hyperplasia, perivascular infiltration, and myocytolysis can justify these changes, although the presence of other histologic findings, such as intramyocardial edema, could influence the value of this index. We conclude that the uptake of thallium decreases during acute rejection episodes; the results obtained from the images, in this work, are an expression of this event.

Adult↗

PubMedDate not supplied

Study of venous and lymphatic components in the production of edema following femoropopliteal by-pass. A comparative scintigraphy and radiologic study.

Fifteen consecutive patients who underwent femoro-popliteal reconstructions were examined comparatively by X-Ray and radionuclide lymphograms during the first postoperative week. The role of venous and lymphatic involvement and the significance of the surgical technique on the presence and extent of the postoperative edema was investigated. Patients were grouped according to the graft material (saphenous vein vs. PTFE), and the site of distal anastomosis. Edema developed in all but one patient, being more prominent in those with a saphenous graft with the popliteal anastomosis below the knee. Phlebography confirmed venous obstruction in one case. Contrast and scintigraphic lymphograms disclosed several degrees of lymphatic damage (disruption of the vessels and extravasation) in all instances, which correlated with the extent of surgical dissection and the development of postoperative edema. There was good agreement between the two lymphatic imaging techniques.

Aged↗