Psychiatric and functional neuroimaging abnormalities in chronic hepatitis C virus patients: Is vasculitis a contributing factor?

BACKGROUND AND STUDY AIMS: Central nervous system (CNS) involvement in hepatitis C virus (HCV) infection has different facets such as anxiety, depression, cognitive impairment and vasculitis. We were interested in detecting subclinical CNS involvement in chronic HCV infected subjects with and without systemic vasculitis. PATIENTS AND METHODS: Nineteen patients (15 females and 4 males) with chronic HCV infection (mean age 46.5 ±â€¯7 and mean duration since diagnosis of HCV infection 4.7 ±â€¯4 years, including 6 (32%) Child-Pugh class A cirrhotic patients) and 30 age, sex and education matched healthy control subjects were studied. Thirteen patients had associated vasculitis. Patients and control subjects were assessed using the block design and comprehension subtests of Wechsler Bellevue Adult Intelligence Scale, Wechsler Memory scale (WMS), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Brain HMPAO Single Photon Emission Computed Tomography (SPECT) was performed for HCV patients. RESULTS: Patients with HCV had lower scores on the block design test compared to control subjects (8.37 ±â€¯1.89 versus 10.37 ±â€¯1.47, p < 0.001), lower total WMS scores (43.15 ±â€¯10.49 versus 60.27 ±â€¯8.08, p < 0.001) and higher anxiety and depression scores (16.94 ±â€¯10.46 and 37.17 ±â€¯10.38 versus 10.3 ±â€¯4.67 and 28.9 ±â€¯5.99, p = 0.004 and 0.001, respectively). Total WMS were lower in HCV patients with vasculitis compared to those without vasculitis (39.14 ±â€¯9.3 versus 51.17 ±â€¯8.3, p = 0.019) while the block design and comprehension tests, BAI and BDI were not significantly different between both groups. The block design and comprehension tests, WMS, BAI and BDI were not significantly different between cirrhotic and non-cirrhotic patients. Seven patients had different patterns of cerebral hypoperfusion on SPECT, and all of them had associated vasculitis. Abnormal SPECT was associated with lower total WMS scores (35.87 ±â€¯10.8 versus 46.79 ±â€¯8.6 in those with normal SPECT, p = 0.049). CONCLUSIONS: Vasculitis may contribute to the development of neuropsychiatric involvement in HCV patients.

Influence of early (F+0) intravenous furosemide injection on the split renal function using 99mTc-DTPA renography.

In busy nuclear medicine departments, the F+0 protocol for diuretic renography is routinely used to shorten the acquisition time. The aim of this study was to evaluate the influence of the F+0 protocol on the split renal function (SRF) during a dynamic renal scan using technetium-99m diethylene triamine pentaacetic acid (Tc-DTPA) compared with that using the standard technetium-99m dimercaptosuccinic acid (Tc-DMSA). A total of 102 patients referred for a dynamic renal scan for varied etiologies were divided into two groups: the F+0 group, comprising 53 patients who were injected with furosemide just before Tc-DTPA injection, and the F+10 group, comprising 49 patients who were injected with the diuretic at the 10th minute after radiotracer injection. All patients were also subjected to a static cortical Tc-DMSA scan with geometric quantification of SRF. A highly significant statistical difference (P<0.001) was obtained on comparing the mean value of the difference in SRF calculated using DTPA and DMSA between the F+0 and F+10 groups, being 5.0±2.6 and 1.5±0.6%, respectively. All 49 patients in the F+10 group had a difference in split function of 5% or less, whereas 17/53 patients representing 32.1% of the F+0 group had a difference in SRF of greater than 5%. Early (F+0) furosemide injection before administration of Tc-DTPA has a significant influence on the estimation of SRF of the diseased kidney (either obstructed or functionally impaired) when compared with furosemide injection after standard Tc-DMSA administration. Care should be taken during interpretation of the scan findings when accurate split function is required.