(123)I-FP-CIT SPECT imaging in early diagnosis of dementia in patients with and without a vascular component.

Alzheimer's disease (AD) and vascular dementia (VaD) are the most common cause of dementia. Cerebral ischemia is a major risk factor for development of dementia. (123)I-FP-CIT SPECT (DaTScan) is a complementary tool in the differential diagnoses of patients with incomplete or uncertain Parkinsonism. Additional application of DaTScan enables the categorization of Parkinsonian disease with dementia (PDD), and its differentiation from pure AD, and may further contribute to change the therapeutic decision. The aim of this study was to analyze the vascular contribution towards dementia and mild cognitive impairment (MCI). We evaluated the utility of DaTScan for the early diagnosis of dementia in patients with and without a clinical vascular component, and the association between neuropsychological function, vascular component and dopaminergic function on DaTScan. One-hundred and five patients with MCI or the initial phases of dementia were studied prospectively. We developed an initial assessment using neurologic examination, blood tests, cognitive function tests, structural neuroimaging and DaTScan. The vascular component was later quantified in two ways: clinically, according to the Framingham Risk Score (FRS) and by structural neuroimaging using Wahlund Scale Total Score (WSTS). Early diagnosis of dementia was associated with an abnormal DaTScan. A significant association was found between a high WSTS and an abnormal DaTScan (p < 0.01). Mixed AD was the group with the highest vascular component, followed by the VaD group, while MCI and pure AD showed similar WSTS. No significant associations were found between neuropsychological impairment and DaTScan independently of associated vascular component. DaTScan seems to be a good tool to discriminate, in a first clinical assessment, patients with MCI from those with established dementia. There was bigger general vascular affectation observable in MRI or CT in patients with abnormal dopaminergic uptake seen on DaTScan.

Assessment of left ventricular contractile reserve by means of myocardial perfusion-gated SPECT in patients with early systolic dysfunction after acute myocardial infarction and in patients with chronic ischemic cardiomyopathy.

OBJECTIVES: In patients with depressed systolic function after recent acute myocardial infarction (AMI), improvement of global left ventricular (LV) systolic function using low-dose dobutamine (LDD) may be influenced by factors different from those observed in patients with chronic ischemic cardiomyopathy (CIC). The aim of this study was to analyze, by means of myocardial perfusion-gated single photon emission computed tomography, segmental thickening (STh), LV volumes and ejection fraction (EF), at baseline and during LDD infusion in patients with systolic dysfunction early after AMI, and compare these results with those in patients with CIC. METHODS: Prospective, multicenter study. Eighty-nine patients {mean 60.7 years [standard deviation (SD)=12.9]} with coronary artery disease and LVEF less than or equal to 40% were investigated with resting gated single photon emission computed tomography with LDD, 41 patients between 5 and 8 days post-AMI, and 48 patients with CIC. RESULTS: Post-AMI the patients had lower LVEF, worse STh scores, and a greater number of segments with severely diminished thickening than patients with CIC. In post-AMI patients, contractile reserve in segments with severely impaired baseline thickening was predictive of a more than or equal to 5% increase in LVEF [odds ratio (OR): 3.77], whereas in patients with CIC the predictors were global contractile reserve (OR: 2.45) and a lower resting end-diastolic volume (OR: 0.98). CONCLUSION: Improvement of LVEF with LDD in patients with systolic dysfunction early after AMI depended essentially on contractile reserve in segments with severely impaired baseline thickening, whereas in patients with CIC it depended on overall LV contractile reserve and the presence of less ventricular remodeling.

Estudio mediante linfogammagrafía isotópica del edema postquirúrgico tras cirugía del sector fémoro-poplíteo / Lymphoscintigraphy study of oedema after femoropopliteal segment surgery

Introducción: El edema postcirugía del sector femoropoplíteo es una complicación frecuente, no relacionada con la gravedad de los síntomas previos ni con los cambios en la PA distal posterior. El objetivo del estudio es evaluar si el edema observado en los pacientes intervenidos de bypass femoropoplíteo es de causa linfática, y la posible influencia del tipo de prótesis utilizada y del tipo de intervención. Pacientes y métodos: Estudio analítico observacional de casos control con 30 pacientes intervenidos de bypass femoropoplíteo. Se ha realizado linfogammagrafía isotópica del sistema linfático superficial y profundo de ambas extremidades en todos los pacientes seleccionados para el estudio. Resultados: Se utilizó vena safena en 19 pacientes y PTFE en 11. Quince pacientes fueron controles (sin edema) y 15 casos (con edema). Tipo de cirugía: 9 reconstrucciones a primera porción de poplítea (1.a p.p.), 18 a tercera porción de poplítea (3.a p.p.) y 3 a ramas distales. Hallazgos gammagráficos: en las 30 exploraciones se observó asimetría del drenaje linfático entre las 2 extremidades, excepto en 1 caso (que no presentó edema). En 5 no había drenaje linfático (uno desarrolló edema). Se compararon casos con controles y pacientes con injerto autólogo y sintético, así como derivaciones por encima y por debajo de la rodilla. La única significación estadística que se obtuvo fue que estos últimos desarrollaron edema con mayor frecuencia que los practicados proximalmente a la rodilla. Conclusión: Por tanto los hallazgos linfogammagráficos no apuntan al daño linfático como causa del edema postcirugía femoropoplítea. Tampoco el material utilizado parece tener influencia. Las derivaciones infrageniculares sufren más edema que las suprageniculares (AU)

Introduction: Post-surgical oedema of the femoropopliteal segment is a frequent complication, unrelated to the severity of the previous symptoms or changes in subsequent distal arterial pressure. The aim of the study is to assess whether the oedema present in femoropopliteal bypass patients is of lymphatic origin, and the possible influence of the prosthesis and the type of intervention used. Patients and methods: An analytical, observational and case-control study of 30 patients who had a femoropopliteal bypass. Isotopic lymphoscintigraphy of the superficial and deep lymphatic system was performed on both limbs in all patients selected for the study. Results: The saphenous vein was used in 19 patients and PTFE in 11. The patients were divided into controls, 15 without oedema, and cases, 15 with oedema. Surgery technique: 9 reconstructions of the popliteal portion (1st p.p.), 18 third popliteal portion (3rd p.p.), and 3 distal branches. Scintigraphy findings: Asymmetric lymphatic drainage between the 2 limbs was observed in the all 30 examinations, except 1 case (which did not have oedema). There was no lymphatic drainage in 5 cases (one developed oedema). Cases with controls and patients with an autologous or synthetic graft, as well as shunts above and below the knee, were compared. The only statistical difference obtained was that the latter developed oedema more often than those performed close to the knee. Conclusions: Therefore, the scintigraphy findings did not point to lymphatic damage as a cause of post-femoropopliteal surgery oedema. The material used did not appear to influence this. The below-knee shunts suffered more oedema than those above the knee (AU)

[Lymphoscintigraphy study of oedema after femoropopliteal segment surgery]. / Estudio mediante linfogammagrafía isotópica del edema postquirúrgico tras cirugía del sector fémoro-poplíteo.

INTRODUCTION: Post-surgical oedema of the femoropopliteal segment is a frequent complication, unrelated to the severity of the previous symptoms or changes in subsequent distal arterial pressure. The aim of the study is to assess whether the oedema present in femoropopliteal bypass patients is of lymphatic origin, and the possible influence of the prosthesis and the type of intervention used. PATIENTS AND METHODS: An analytical, observational and case-control study of 30 patients who had a femoropopliteal bypass. Isotopic lymphoscintigraphy of the superficial and deep lymphatic system was performed on both limbs in all patients selected for the study. RESULTS: The saphenous vein was used in 19 patients and PTFE in 11. The patients were divided into controls, 15 without oedema, and cases, 15 with oedema. Surgery technique: 9 reconstructions of the popliteal portion (1st p.p.), 18 third popliteal portion (3rd p.p.), and 3 distal branches. Scintigraphy findings: Asymmetric lymphatic drainage between the 2 limbs was observed in the all 30 examinations, except 1 case (which did not have oedema). There was no lymphatic drainage in 5 cases (one developed oedema). Cases with controls and patients with an autologous or synthetic graft, as well as shunts above and below the knee, were compared. The only statistical difference obtained was that the latter developed oedema more often than those performed close to the knee. CONCLUSIONS: Therefore, the scintigraphy findings did not point to lymphatic damage as a cause of post-femoropopliteal surgery oedema. The material used did not appear to influence this. The below-knee shunts suffered more oedema than those above the knee.

Colonic responses to gas loads in subgroups of patients with abdominal bloating.

OBJECTIVES: We sought to evaluate colonic gas accommodation, ileocecal competence, and colonic clearance in subgroups patients with abdominal bloating. METHODS: Thirty-six patients complaining of abdominal bloating (12 constipation-predominant irritable bowel syndrome (IBS-C), 12 diarrhea-predominant irritable bowel syndrome (IBS-D), and 12 functional bloating) and 18 healthy controls were studied. Abdominal perception and girth were measured during: (i) 1 h continuous infusion of gas at 24 ml/min into the rectum (accommodation period) and (ii) 30 min free rectal gas evacuation (clearance period). In eight patients and eight healthy subjects, the gas infused was labeled with radioactive xenon (74 MBq (133)Xe), and gas distribution was determined by scintigraphy. RESULTS: Colonic gas accommodation produced significantly more abdominal symptoms and distension in patients than in healthy subjects (3.8+/-0.2 vs. 2.4+/-0.3 perception score; P<0.001; 10.9+/-0.6 vs. 8.3+/-0.5 mm girth increment; P=0.009). Scintigraphy showed no differences in colonic gas distribution and no ileal gas reflux, but patients exhibited impaired gas clearance from the proximal colon (63%+/-10% clearance in 30 min vs. 80%+/-2% in health; P=0.042), resulting in more residual gas (506+/-46 vs. 174+/-47 ml; P<0.001), perception (1.9+/-0.2 vs. 1.0+/-0.2 score; P=0.015), and girth increment (4.2+/-0.7 vs. 2.2+/-0.5 mm; P=0.024); IBS-C patients exhibited increased sensation and objective distension, as opposed to sensation only in IBS-D and distension only in functional bloating. CONCLUSIONS: Patients with abdominal bloating have normal colonic accommodation and ileocecal competence but impaired gas clearance from the proximal colon after retrograde infusion, and the consequences of this dysfunction are related to bowel habit.

Reserva contráctil negativa con bajas dosis de dobutamina en los pacientes con miocardiopatía isquémica estudiados mediante gated-SPECT de perfusión miocárdica / Negative contractile reserve with low-dose dobutamine in patients with ischemic cardiomyopathy investigated by gated myocardial perfusion SPECT

Introducción y objetivos. Analizar la respuesta contráctil negativa (RCN) del ventrículo izquierdo (VI) en la gated-SPECT con bajas dosis de dobutamina (BDD) en pacientes con miocardiopatía isquémica (MI). Métodos. Se estudió prospectivamente a 68 pacientes (media de edad, 60 ± 11 años; 7 mujeres) con MI mediante gated-SPECT en reposo y durante la infusión de BDD. Se relacionó la RCN (aumento de la puntuación del engrosamiento ≥ 1 unidad) con los criterios gammagráficos de viabilidad y los resultados de la coronariografía. Resultados. El 42,6% (29/68) de los pacientes presentó uno o más segmentos con RCN. En el 14,7% (n = 10) de los pacientes se observó una disminución de la fracción de eyección ≥ 4% con las BDD. Estos pacientes se caracterizaron por tener un mayor número de segmentos con RCN (2,8 ± 2,5 frente a 0,87 ± 0,4; p = 0,042), con un valor de corte en el análisis de curva ROC ≥ 2 segmentos con RCN (sensibilidad, 70%; especificidad, 74%; +LR, 2,71; -LR, 0,40). El 94% (74/79) de los segmentos con RCN correspondía a miocardio vivo (normal o viable gammagráficamente). De los 17 segmentos con acinesia o hipocinesia severa y RCN, 12 (71%) tenían criterios gammagráficos de viabilidad y en su mayoría (10/12) correspondían a territorios con arteria coronaria abierta. Conclusiones. La RCN no es un fenómeno infrecuente en los pacientes con MI y se relaciona con una disminución de la función sistólica general del VI. Mayoritariamente se observa en segmentos con criterios gammagráficos de viabilidad y dependientes de una arteria coronaria abierta (AU)

Introduction and objectives. To investigate negative contractile responses in the left ventricle during low-dose dobutamine (LDD) gated single-photon emission computed tomography (SPECT) in patients with ischemic cardiomyopathy. Methods. Sixty-eight consecutive patients (mean age, 60±11 years; 7 male) with ischemic cardiomyopathy (i.e., left ventricular ejection fraction [LVEF] ≤40%) were evaluated using gated-SPECT at rest and during LDD infusion. Associations between a negative contractile reserve (i.e., a ≥1-grade improvement in wall thickening score with LDD infusion) and scintigraphic viability criteria and coronary angiography findings were analyzed. Results. Some 42.6% (29/68) of patients had a negative contractile reserve in one or more segments. In 14.7% (n=10), the LVEF decreased by ≥4% with LDD. These patients had more segments with a negative contractile reserve (2.8±2.5 vs. 0.87±0.40; P=.042), and the cut-off value on receiver operating characteristic curve analysis was ≥2 segments with a negative contractile reserve (sensitivity 70%, specificity 74%, positive likelihood ratio 2.71, negative likelihood ratio 0.40). Some 94% (74/79) of segments with a negative contractile reserve were in viable myocardium (i.e. normal or viable on scintigraphy). Twelve of 17 segments with akinesia or severe hypokinesia and a negative contractile reserve satisfied scintigraphic viability criteria, with the majority (10/12) lying in territories supplied by a patent coronary artery. Conclusions. A negative contractile reserve was not uncommon in patients with ischemic cardiomyopathy and was associated with a general decrease in left ventricular systolic function. It was observed mainly in myocardial segments that appeared viable on scintigraphy and were supplied by a patent coronary artery (AU)

Negative contractile reserve with low-dose dobutamine in patients with ischemic cardiomyopathy investigated by gated myocardial perfusion SPECT.

INTRODUCTION AND OBJECTIVES: To investigate negative contractile responses in the left ventricle during low-dose dobutamine (LDD) gated single-photon emission computed tomography (SPECT) in patients with ischemic cardiomyopathy. METHODS: Sixty-eight consecutive patients (mean age, 60 + or - 11 years; 7 male) with ischemic cardiomyopathy (i.e., left ventricular ejection fraction [LVEF] < or = 40%) were evaluated using gated-SPECT at rest and during LDD infusion. Associations between a negative contractile reserve (i.e., a > or = 1-grade improvement in wall thickening score with LDD infusion) and scintigraphic viability criteria and coronary angiography findings were analyzed. RESULTS: Some 42.6% (29/68) of patients had a negative contractile reserve in one or more segments. In 14.7% (n=10), the LVEF decreased by > or = 4% with LDD. These patients had more segments with a negative contractile reserve (2.8 + or - 2.5 vs. 0.87 + or - 0.40; P=.042), and the cut-off value on receiver operating characteristic curve analysis was > or =2 segments with a negative contractile reserve (sensitivity 70%, specificity 74%, positive likelihood ratio 2.71, negative likelihood ratio 0.40). Some 94% (74/79) of segments with a negative contractile reserve were in viable myocardium (i.e. normal or viable on scintigraphy). Twelve of 17 segments with akinesia or severe hypokinesia and a negative contractile reserve satisfied scintigraphic viability criteria, with the majority (10/12) lying in territories supplied by a patent coronary artery. CONCLUSIONS: A negative contractile reserve was not uncommon in patients with ischemic cardiomyopathy and was associated with a general decrease in left ventricular systolic function. It was observed mainly in myocardial segments that appeared viable on scintigraphy and were supplied by a patent coronary artery.

Análisis del engrosamiento segmentario ventricular izquierdo con bajas dosis de dobutamina mediante gated-SPECT en la miocardiopatía isquémica / Low-dose dobutamine gated-SPECT analysis of feft ventricular segmental wall thickening in ischemic cardiomyopathy

Introducción y objetivos. El propósito de este estudio es analizar mediante gated-SPECT con bajas dosis de dobutamina (BDD) el engrosamiento segmentario del ventrículo izquierdo (VI) y su relación con los cambios de la fracción de eyección (FE) y los volúmenes ventriculares en los pacientes con miocardiopatía isquémica. Métodos. Estudio prospectivo y multicéntrico de 89 pacientes con miocardiopatía isquémica (FE £ 40%) estudiados mediante gated-SPECT reposo-BDD. El VI se dividió en 17 segmentos y se analizó el engrosamiento sistólico de los 1.513 segmentos durante la infusión de BDD. Resultados. La FE mejoró significativamente en el estudio con BDD (el 30,8 frente al 33,2%; p < 0,001) a expensas de una reducción del volumen telesistólico (136,4 frente a 130,5 ml; p = 0,005). En el 33,7% de los pacientes el aumento de la FE fue 3 5% y en el 5,6% de los pacientes disminuyó al menos el 5%. Con BDD, una mejoría en al menos tres segmentos con engrosamiento basal muy disminuido (odds ratio [OR] = 18,3; intervalo de confianza [IC] del 95%, 5,3-63) y una mejoría en más de 10 segmentos con alteraciones leves-moderadas del engrosamiento basal (OR = 4,53; IC del 95%, 1,26-16,16) se relacionaron con un incremento de la FE 3 5%. Conclusiones. Cuando se analiza la reserva contráctil total del VI con BDD en la gated-SPECT, debe tenerse en cuenta no sólo el comportamiento de los segmentos con engrosamiento basal muy deprimido, que es donde se plantea la viabilidad, sino también el de los segmentos con alteraciones ligeras-moderadas y el de aquellos en que el engrosamiento empeora (AU)

Introduction and objectives. The objective of this study was to use low-dose dobutamine (LDD) gated single-photon emission computed tomography (SPECT) to evaluate segmental thickening of the left ventricle (LV) and its relationship with changes in ejection fraction (EF) and ventricular volumes in patients with ischemic cardiomyopathy. Methods. This prospective multicenter study involved 89 patients with ischemic cardiomyopathy (ie, EF £40%) who underwent LDD gated-SPECT at rest. The LV was divided into 17 segments and systolic thickening was assessed in a total of 1513 segments during LDD infusion. Results. A significant increase in LVEF (33.2% vs 30.8%; P<.001) was observed during LDD infusion and occurred at the expense of a reduction in end-systolic volume (130.5 mL vs 136.4 mL; P=.005). The increase in EF was ≥5% in 33.7% of patients, while the EF decreased by ≥5% in 5.6% of patients. With LDD infusion, both an improvement in ≥3 segments with severely decreased baseline thickening (odds ratio [OR] = 18.3; 95% confidence interval [CI], 5.3-63) and an improvement in ≥10 segments with mild-to-moderate alterations in baseline thickening (OR=4.53; 95% CI, 1.26-16.16) were associated with a ≥5% increase in LVEF. Conclusions. During the assessment of global left ventricular contractile reserve by LDD gated-SPECT, attention should be paid not only to the behavior of segments with severely decreased baseline thickening, which are generally regarded as indicating viability, but also to segments with mild-to-moderate alterations and to those in which thickening decreases (AU)

Low-dose dobutamine gated-SPECT analysis of left ventricular segmental wall thickening in ischemic cardiomyopathy.

INTRODUCTION AND OBJECTIVES: The objective of this study was to use low-dose dobutamine (LDD) gated single-photon emission computed tomography (SPECT) to evaluate segmental thickening of the left ventricle (LV) and its relationship with changes in ejection fraction (EF) and ventricular volumes in patients with ischemic cardiomyopathy. METHODS: This prospective multicenter study involved 89 patients with ischemic cardiomyopathy (i.e., EF < or =40%) who underwent LDD gated-SPECT at rest. The LV was divided into 17 segments and systolic thickening was assessed in a total of 1513 segments during LDD infusion. RESULTS; A significant increase in LVEF (33.2% vs. 30.8%; P< .001) was observed during LDD infusion and occurred at the expense of a reduction in end-systolic volume (130.5 mL vs. 136.4 mL; P=.005). The increase in EF was > or =5% in 33.7% of patients, while the EF decreased by > or =5% in 5.6% of patients. With LDD infusion, both an improvement in > or =3 segments with severely decreased baseline thickening (odds ratio [OR] = 18.3; 95% confidence interval [CI], 5.3-63) and an improvement in > or =10 segments with mild-to-moderate alterations in baseline thickening (OR = 4.53; 95% CI, 1.26-16.16) were associated with a > or =5% increase in LVEF. CONCLUSIONS: During the assessment of global left ventricular contractile reserve by LDD gated-SPECT, attention should be paid not only to the behavior of segments with severely decreased baseline thickening, which are generally regarded as indicating viability, but also to segments with mild-to-moderate alterations and to those in which thickening decreases.

[Differential diagnosis of parkinsonism using dopamine transporters brain SPECT]. / Contribución de la SPECT cerebral de transportadores de dopamina en el diagnóstico diferencial de los parkinsonismos.

BACKGROUND AND OBJECTIVE: Parkinsonism is a group of neurological disorders characterized by extrapiramidal signs. Often, the differential diagnosis between parkinsonism, essential tremor and drug-induced parkinsonism is difficult. The aim of the study was to evaluate the utility of (123I)-FP-CIT SPECT in patients with movement disorders. PATIENTS AND METHOD: 52 patients were referred from the neurology department to characterize those with parkinsonism. Patients were clinically evaluated and those with Parkinson's disease were assessed using the rating scale Hoehn & Yahr and the UPDRS motor score. Subsequently, a (123I)-FP-CIT SPECT was performed with a qualitative analysis. RESULTS: All patients with essential tremor and drug-induced parkinsonism had a normal SPECT. All patients with parkinsonism displayed SPECT defects, except for four who had a normal SPECT result. Two of them were categorized as vascular parkinsonisms, one patient had a Shy-Drager's syndrome and the another one had probably a Parkinson's disease. The sensitivity and specificity were 90.47% (38/42; CI95%, 81.59%-99.35%) and 100% (10/10; CI95%, 69.15%-100%), respectively. CONCLUSIONS: (123I)-FP-CIT SPECT is an effective tool to study the integrity of the dopaminergic nigrostriatal system. Moreover, it permits to characterize the different types of parkinsonism.