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The role of Tc-99m HMPAO functional brain imaging in detection of cerebral radionecrosis.

BACKGROUND: Cerebral radionecrosis is a possible complication of brain radiation therapy in patients with primary or metastatic tumors. This retrospective study evaluated the role of Tc-99m hexamethyl propyleneamine oxime (HMPAO) scintigraphy in monitoring the effects of radiation on the brain. METHODS: Ninety-eight patients (41 female, 57 male) with a mean age of 51 years (range, 16-82 years) underwent 128 sets of single-photon emission computed tomography studies. TI-201 and Tc-99m HMPAO single-photon emission computed tomography studies were performed for tumor localization and evaluation of the effect of radiation on the cerebral cortex. Thirty concomitant neuropsychological tests and 96 anatomic imaging (computed tomography/magnetic resonance imaging) were performed. The average radiation dose was 52 Gy delivered as 1.8 to 2 Gy/fraction. Thirty-two patients received an average dose of 160 mCi of I-125 EGFr concomitantly. The average follow-up period was 34 months. Abnormalities away from the tumor site were interpreted as positive on HMPAO studies, neuropsychological testing, or anatomic imaging; otherwise, they were classified as negative. RESULTS: There were 10/45 (22%) and 75/83 (90%) abnormal HMPAO study results before and after radiation therapy. The HMPAO studies compared with neuropsychological testing showed 3/13 (23%) and 14/17 (82%) concordant abnormalities in addition to tumor site in patients pre- versus postradiation therapy. There was better concordance of HMPAO and anatomic imaging in 22/30 (76%) patients versus 24/67 (36%) patients before radiation therapy. HMPAO imaging after radiation therapy revealed significantly more perfusion abnormalities. There were significant differences between all of the aforementioned parameters. CONCLUSION Tc-99m HMPAO imaging is useful in the evaluation of the effects of radiation therapy on the brain and is highly concordant with neuropsychological testing. It is superior to anatomic studies in identifying radiation-induced changes.

Adolescent↗
PubMed1999

David Ferrier and Luigi Luciani on the localization of brain functions.

Cerebral localizations discovered by Luciani will be compared with those observed by Ferrier, the 'father' of cerebral cartography. The two neurophysiologists' different experimental results will be analyzed from an epistemological point of view, in the light of their respective methodologies, models and theoretical assumptions. Luciani was always profoundly aware of the importance of theoretical assumptions and their impact both on methodological approaches and on how to interpret the results of experiments (results which were often the same as those obtained by Goltz, even though they were interpreted in quite dissimilar ways because they were based on different models). Agreement or disagreement with Ferrier's interpretation of cerebral functioning, and the two men's conception on the functional differentiation of well-identified cortical areas will be interpreted on epistemological ground. Reference will be made, on the one hand, to the theoretical model behind Luciani's experiments, on the other hand, to methods and procedures which allowed him to observe his experimental subjects for a longer period of time after the operation because of their longer survival rates. He was, consequently, able to carry out a more detailed analysis of the effects of experimentation on animal behavior. In this sense the time factor acquired a fundamental importance in the development of notions such as compensation and functional recovery. From Luciani's vast amount of activity in the field of physiology at the turn of the century, we shall take a look at the results of his investigations into cerebral localization in order to highlight the state of Italian neurophysiology in relation to the situation in contemporary Europe and, in particular, to the situation in Great Britain.

Cerebellum↗