Glue embolization for gastroduodenal ulcer bleeding: contribution to hemodynamics and healing process.

BACKGROUND: Although the morbidity of bowel ischemic events after glue embolization has been suggested, a causal relationship between glue and ischemia has not been clearly established. PURPOSE: To evaluate the efficiency and safety of transcatheter arterial embolization with n-butyl cyanoacrylate (NBCA-TAE) for upper gastrointestinal hemorrhage (GIH). MATERIAL AND METHODS: Between October 2006 and October 2012, 21 patients with upper GIH underwent NBCA-TAE, and endoscopic data were obtained within 30 days of follow-up. Shock index prior to and immediately after NBCA-TAE were compared to determine changes in hemodynamics. Days to Forrest type III, as assessed by follow-up endoscopy, was used as an indicator of the healing process. Other clinical outcomes included days for starting ingestion and for hospital discharge. RESULTS: Sixteen gastric and five duodenal ulcers, classified into Forrest type I, were treated. Immediate hemostasis was achieved in all the patients, and no re-bleeding occurred within the follow-up period. Shock index significantly (P < 0.001) improved from before (0.99 ± 0.076) to immediately after NBCA-TAE (0.67 ± 0.038). Sequential mucosal healing processes were observed in all the patients, and the number of days to Forrest type III was 9.6 ± 7.1. The number of days for starting ingestion and hospital discharge was 9.0 ± 4.5 and 15 ± 7.7 days, respectively. CONCLUSION: NBCA-TAE is an effective and safe method for the control of nonvariceal upper GIH, in terms of contribution to hemodynamics and healing process of the gastroduodenal mucosa.

Catheter fragmentation of acute massive pulmonary thromboembolism: distal embolisation and pulmonary arterial pressure elevation.

The aim of this study was to evaluate the relationship between pulmonary arterial pressure and distal embolisation during catheter fragmentation for the treatment of acute massive pulmonary thromboembolism with haemodynamic impairment. 25 patients with haemodynamic impairment (8 men and 17 women; aged 27-82 years) were treated by mechanical thrombus fragmentation with a modified rotating pigtail catheter. After thrombus fragmentation, all patients received local fibrinolytic therapy, followed by manual clot aspiration using a percutaneous transluminal coronary angioplasty (PTCA) guide catheter. Pulmonary arterial pressure was continuously recorded during the procedure. The Friedman test and Wilcoxon test were applied for statistical analysis. Distal embolisation was confirmed by digital subtraction angiography in 7 of the 25 patients. A significant rise in mean pulmonary arterial pressure occurred after thrombus fragmentation (before: 34.1 mmHg; after: 37.9 mmHg; p<0.05), and this group showed a significant decrease in mean pulmonary arterial pressure after thrombus aspiration (25.7 mmHg; p<0.05). No distal embolisation was seen in 18 of the 25 patients, and a significant decrease in mean pulmonary arterial pressure was confirmed after thrombus fragmentation (before: 34.2 mmHg; after: 28.1 mmHg: p<0.01), and after thrombus aspiration (23.3 mmHg; p<0.01). In conclusion, distal embolisation and a rise in pulmonary arterial pressure can occur during mechanical fragmentation using a rotating pigtail catheter for the treatment of life-threatening acute massive pulmonary thromboembolism; thrombolysis and thrombus aspiration can provide partial recanalization and haemodynamic stabilization. Continuous monitoring of pulmonary arterial pressure may contribute to the safety of these interventional procedures.

Haemodynamic changes in the liver under balloon occlusion of a portal vein branch: evaluation with single-level dynamic computed tomography during hepatic arteriography.

AIM: To assess haemodynamic changes in the liver under temporary occlusion of an intrahepatic portal vein. MATERIALS AND METHODS: Between February 2000 and October 2004, 16 patients with hepatobiliary disease underwent single-level dynamic computed tomography during hepatic arteriography (SLD-CTHA) under temporary balloon occlusion of an intrahepatic portal vein. All patients needed percutaneous transhepatic portography for therapy of their disease. SLD-CTHA was undertaken to clarify the time-attenuation curve influenced by portal vein occlusion, and it was performed continuously over a period of 30s. The difference in absolute attenuation of the liver parenchyma in segments with occluded and non-occluded portal vein branches was determined by means of the CT number, and the difference in absolute attenuation of the occluded and non-occluded portal veins themselves was also evaluated. RESULTS: SLD-CTHA demonstrated a demarcated hyperattenuation area in the corresponding distribution of the occluded portal vein branch. The attenuation of the liver parenchyma supplied by the occluded portal vein was significantly higher than that in the non-occluded area (p<0.01). The balloon-occluded portal branch enhancement in 15 of 16 cases (94%) appears due to arterio-portal communications. Failure to evaluate a remaining case for portal branch enhancement was due to absence of a visualized portal branch in the section. CONCLUSION: Under temporary occlusion of an intrahepatic portal vein, hepatic angiography produced enhancement of the occluded portal branches and their corresponding parenchymal distribution; this finding is considered consistent with the presence of arterio-portal communications.

Is technetium-99m-MIBI taken up by the normal pituitary gland? A comparison of normal pituitary glands and pituitary adenomas.

PURPOSE: The aim of this study was to compare the behavioral uptake of a normal gland and a pituitary adenoma and to assess the ability to diagnose pituitary adenoma by means of technetium-99m-hexakis-2-methoxy-isobutyl-isonitrile (MIBI) single photon emission computed tomography (SPECT). METHODS: The study included 15 patients with pituitary adenomas (mean age = 44.0 years, range 19-63) and 15 control subjects (mean age = 50.7 years, range 20-67). SPECT was performed 15 minutes after an intravenous injection of MIBI 600 MBq. The shape and location of MIBI uptake were evaluated on a magnetic resonance (MR) imaging/SPECT registration image. The shape patterns and location were classified as follows: Shape C (circular); LO (longitudinal oval); T/R (triangular or rectangular) and location P (pituitary gland or adenoma); D/C (dorsum sellae and/or clivus). RESULTS: Analysis of the uptake showed that 10 (67%) adenomas were C, and 5 (33%) were LO. Of the controls, 5 (33%) were C, and 10 (69%) were T/R. With regard to location, all patients with pituitary adenomas were classified as P, and all control subjects (93%) but one showed uptake in the dorsum sellae and clivus (D/C). CONCLUSION: MIBI was taken up in the dorsum sellae or clivus but not the normal pituitary gland and had a strong affinity for the pituitary adenoma. This result implies that MIBI SPECT may be a useful new auxiliary examination technique for the location diagnosis of pituitary adenoma.

Assessment of left ventricular diastolic function with electrocardiography-gated myocardial perfusion SPECT: comparison with multigated equilibrium radionuclide angiography.

BACKGROUND: Technetium-labeled myocardial perfusion tracers allow the simultaneous assessment of myocardial perfusion and left ventricular function by electrocardiography (ECG)-gated myocardial perfusion single photon emission computed tomography (SPECT). This study evaluates left ventricular systolic and diastolic function by ECG-gated SPECT with the use of higher framing (32 frames per cardiac cycle) data acquisition. METHODS AND RESULTS: After receiving an injection of technetium 99m tetrofosmin, 48 patients with cardiac diseases were examined by ECG-gated myocardial perfusion SPECT with a 3-headed gamma camera. During gated data collection, 32 frames per cardiac cycle were acquired over 360 degrees in 60 steps, each of which consisted of 60 beats. Immediately thereafter, the 32 frames taken at each projection angle were combined into 16-frame and 8-frame data sets. Left ventricular end-diastolic volume (LVEDV, in milliliters), left ventricular end-systolic volume (LVESV, in milliliters), and left ventricular ejection fraction (LVEF, percentage) were automatically calculated from the 32-frame, 16-frame, and 8-frame gated data sets. Left ventricular time-volume curves from the 3 data sets were generated by Fourier curve fitting analysis with the use of 3 harmonics, and then peak filling rate (PFR, per second) was measured. Twenty-nine patients also underwent multigated equilibrium radionuclide angiography (ERNA) to determine the LVEF and PFR. Combining the 32-frame data into 16-frame and 8-frame data sets from the 48 patients generated a smaller LVEDV and a larger LVESV, and LVEF was significantly lower in accordance with the decreasing number of frames. Compared with ERNA studies (n = 29), the Bland-Altman method showed underestimated LVEFs and larger 95% limits of agreement in lower framing gated SPECT. CONCLUSIONS: Left ventricular functional parameters obtained from 32-frame gated SPECT correlated closely with those determined by ERNA studies. ECG-gated SPECT with 32-frame data can provide comprehensive information with which to evaluate many types of cardiac diseases.

[Assessment of left ventricular function with the solid-state digirad 2020tc Imager].

Multigated equilibrium radionuclide ventriculography from best septal position (LAO view) was performed in 17 patients with cardiac disease with a single detector Anger-type gamma camera (GCA 602A, Toshiba), then immediately imaged with a solid-state, multi-crystal gamma camera (Digirad 2020tc Imager). Acquisition times were the same of 10 minutes. The solid-state gamma camera uses CsI(Tl) as the scintillation material and a Si photodiode. CsI(Tl) has a higher density and higher atomic number than NaI(Tl), so that its efficiency for detecting gamma rays is higher. To confirm this, total acquisition counts in 17 patients obtained from the 2020tc Imager were significantly higher than those obtained from the Anger-type camera (7847 +/- 2061 K vs. 4427 +/- 1162 K counts, p < 0.0001). In comparing left ventricular ejection fractions obtained from the Anger-type camera and the 2020tc Imager data, an excellent correlation was revealed with a correlation coefficient of 0.97 (p < 0.0001). Again, peak ejection rate and peak filling rate obtained from the 2020tc Imager data correlated well with those obtained from the Anger-type camera data (r = 0.93, p < 0.0001 and r = 0.80, p < 0.001, respectively). These data reveal that the 2020tc Imager has an excellent data collection efficiency and a high reliability in assessment of left ventricular function. Thus, the solid-state gamma camera was thought to be a useful hardware in nuclear cardiology.

[Examination concerning dissociation of left ventricular volume calculation value based on difference of analytical algorithm and perfusion tracer in gated myocardial SPECT].

According to improvement of SPECT system, ECG-gated SPECT with 201TlCl have been applied to the left ventricular volumetry. In this study 24 patients without ischemia demonstrated by stress (99mTc-TF) and rest (201TlCl) dual-isotope ECG-gated myocardial SPECT were enrolled. To evaluate left ventricular volumetry using 201Tl ECG-gated SPECT data, the left ventricular end diastolic volumes (EDV) were compared between Quantitative Gated SPECT (QGS) and Emory Cardiac Toolbox (ECT) as well as between dual-isotopes based on the same ECG-gated data. The EDV values with 99mTc data (EDVTc) using QGS were well correlated with those using ECT (r = 0.96, p < 0.0001). Both QGS and ECT demonstrated well correlation between EDVTc (r = 0.98, p < 0.0001) and the EDV value with 201Tl (EDVTl) (r = 0.93, p < 0.0001). However, QGS processing induced significantly lower EDVTl compared with EDVTc. In contrast, EDVTl were significantly higher than EDVTc in ECT performance. The QGS errors subtracting EDVTl from EDVTc were more evident according to the left ventricular volume increase. On the other hand, ECT error showed no tendency associated with the left ventricular volume. From these results, a careful strategy for selection of tracers and softwares should be necessary to assessment of quantitative values derived from ECG-gated SPECT data because of interaction with softwares, tracers, and subjects.

[Quantitative evaluation for scatter and attenuation correction in 99mTc SPECT--multicenter cooperation phantom study].

A multicenter cooperation phantom study was conducted to evaluate the accuracy of a triple energy window scatter correction technique in combination with various attenuation correction methods for 99mTc single photon emission computed tomography (SPECT) imaging. Six centers participated in this research and the data obtained with seven SPECT instruments were analyzed. The phantom used in the experiment was a 20 x 10 cm cylinder filled with homogeneous 99mTc solution, containing two kinds of cold spots (cold rod phantoms). One had a water-filled cylinder 5.5 cm in diameter positioned 2.5 cm from the center. The other contained 6 water-filled cylinders of various sizes. Contrasts of cold regions were in the range from 74% to 120% (true 100%). Another phantom had the shape of a pie-chart divided into six chambers symmetrically positioned in a cylinder 20 cm in diameter and 10 cm in height. Each chamber had volume of 480 ml and contained homogeneous 99mTc solution of different concentrations. This phantom was used to test for linearity between the radio activity concentration and reconstructed count density (linearity phantom). The intercept of the regression line obtained from the linearity phantom was 8.4 kBq ml-1 without scatter correction and -6.8 kBq ml-1 with scatter correction. Contrast was in the range from 78% to 132% (true 100%). The mean relative error for the measured activity concentration was 4.9% +/- 3.5% (mean +/- sd).

A new method of functional scintiphotosplenoportography using technetium-99m-DTPA-galactosylated human serum albumin.

BACKGROUND/AIMS: We investigated whether a new method for scintiphotosplenoportography using technetium-99m-DTPA-galactosylated human serum albumin could visualize the portal venous system and simultaneously assess hepatic function. METHODOLOGY: Thirty-two patients underwent scintiphotosplenoportography, including 4 with metastatic tumor in an otherwise normal liver, 5 with chronic hepatitis, 9 with cirrhosis, and 14 with both hepatocellular carcinoma and cirrhosis. The tracer (3 mg, 185 MBq) was injected into the spleen under ultrasonic guidance. Hepatic function was evaluated using the receptor index and the index of blood clearance, both calculated by regions of interest for liver and for heart. Spleen-to-liver times were calculated by subtracting peak activity times over the spleen from those over the portal vein. RESULTS: Correlations of blood clearance and receptor indices with plasma retention rate of indocyanine green at 15 min (respectively, r = 0.616, P < 0.0005 and r = -0.669, P < 0.0001), prothrombin time (r = -0.605, P < 0.0005 and r = 0.710, P < 0.0001), the hepaplastin test (r = -0.526, P < 0.005 and r = 0.605, P < 0.0005), serum albumin (r = -0.488, P < 0.005 and r = 0.640, P < 0.0001), and serum cholinesterase (r = -0.600, P < 0.0005 and r = 0.671, P < 0.0001) were significant. Blood clearance and receptor indices also were significantly related to clinical stage, underlying liver disease, features of radioisotopic images, and presence of esophagogastric varices (P < 0.01). Additionally spleen-to-liver time reflected progressive hepatic damage. CONCLUSIONS: Our new method of scintiphotosplenoportography using technetium-99m-DTPA-galactosylated human serum albumin can assess hepatic function and portal hemodynamics simultaneously. Results correlate with accepted, conventional diagnostic techniques. This method represents a potent new method for evaluating the hepatic system.

Comparison of Emory and Cedars-Sinai methods for assessment of left ventricular function from gated myocardial perfusion SPECT in patients with a small heart.

To evaluate the effect of left ventricular (LV) size on the calculation of LV function from gated myocardial SPECT with Emory and Cedars-Sinai programs, we performed 99mTc-tetrofosmin gated SPECT on 49 patients with ischemic heart disease. End-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) were semi-automatically calculated by each program. All patients underwent left ventriculography (LVG) within 3 months before and after the SPECT study. We grouped the patients into 22 with a calculated ESV obtained from LVG of over 50 ml (group A) and 27 with an ESV value of 50 ml or below (group B). We then compared the ESV values from gated SPECT with those from LVG in each group. In group A, the ESV from both Emory and Cedars-Sinai programs similarly correlated well with those from LVG (r = 0.92 and r = 0.93, respectively), but in group B, the ESV calculated from the Cedars-Sinai program correlated less with those from LVG (r = 0.53) than those from the Emory program did (r = 0.70). The calculated LV volumes had more errors in the Cedars-Sinai program than in the Emory program, when a patient had a small heart.

Simultaneous assessment of Tc-99m-sestamibi and I-123-BMIPP myocardial distribution in patients with myocardial infarction: evaluation of left ventricular function with ECG-gated myocardial SPECT.

123I-labeled 15-(p-iodophenyl)-3R,S-methyl pentadecanoic acid (BMIPP) is a branched-chain free fatty acid that is used to evaluate various cardiac diseases. The aim of the present study was to investigate the relationship between myocardial perfusion (99mTc-sestamibi) and BMIPP uptake, and to correlate perfusion and metabolic alterations with regional left ventricular dysfunction in patients with myocardial infarction (MI). ECG-gated dual-isotope myocardial SPECT was performed on 130 patients with MI with sestamibi (555 MBq) and BMIPP (148 MBq). The patients were classified into 3 groups according to PTCA therapy and the interval between the onset of infarction and RI injection (OR time). Group A (n = 56) included patients whose OR time was less than one month and who had undergone successful PTCA, Group B (n = 36) had OR times of less than one month and had conservative medical therapy, and Group C (n = 38) had OR times of over one month. The severity scores of the dual-isotope images were calculated from the defect scores in 9 segments. From the ECG-gated SPECT data with sestamibi, the left ventricular ejection fraction (LVEF; %) and regional wall motion were determined automatically using the QGS program LVEF obtained from gated SPECT correlated well with the severity scores for sestamibi and BMIPP (r = -0.68 and -0.76, respectively). The delta severity scores (BMIPP scores - sestamibi scores) of Group A were significantly higher than those of the other two groups (3.6 +/- 3.0 vs. 1.5 +/- 1.7 and 1.0 +/- 1.4, p < 0.001 ). The rate of dysfunctional segments with normal sestamihi distribution was significantly higher in Group A than in Group C (20.7% vs. 6.7%, p < 0.001). ECG-gated dual-isotope SPECT is useful since myocardial perfusion, fatty acid metabolism and left ventricular function can be analyzed during a single examination, so that this procedure has the potential to provide comprehensive information when evaluating patients with ischemic heart disease.

[Assessment of left ventricular contraction abnormalities with myocardial infarction using gated technetium-99m sestamibi SPECT: comparison of wall thickening and regional ejection fraction analysis for the detection of coronary artery stenosis].

ECG-gated myocardial Technetium-99m sestamibi SPECT is a useful technique to measure myocardial perfusion and function simultaneously. In this study, wall thickening (WT) and regional ejection fraction (rEF) using ECG-gated SPECT have been studied to determine which parameter would be more sensitive to detect coronary artery stenosis in patients with acute myocardial infarction (AMI). Forty-five patients (36 men, 9 women, mean age 63 +/- 9 years old) with AMI were examined. CAG was performed for all patients. ECG-gated SPECT was performed 60 min after the intravenous injection of 555 MBq 99mTc-sestamibi at rest. Commercially available software (QGS) was used to produce WT and rEF polar maps from acquired SPECT data. The WT and rEF polar maps were evaluated visually and quantitatively. WT indicated higher sensitivity (80.3% vs. 59.1%, p < 0.05) and accuracy (86.7% vs. 74.8%, p < 0.05) than rEF for detecting overall coronary artery stenosis on visual interpretation. On quantitative analysis, WT had higher specificity (91.3% vs. 75.4%, p < 0.05) and accuracy (85.9% vs. 72.6%, p < 0.05) than rEF for detecting overall coronary artery stenosis, and showed a higher specificity (93.8% vs. 59.4%, p < 0.01) and accuracy (88.9% vs. 62.2%, p < 0.01) for detecting LCX stenosis. Moreover, sensitivity of WT for detecting coronary artery stenosis without infarction was higher than that of rEF significantly in quantitative analysis (75.0% vs. 31.3%, p < 0.05). These results suggested that WT was superior to rEF for detecting the coronary artery stenosis in patients with and without myocardial infarction. We concluded that WT is more sensitive indicator to determine localization of regional left ventricular dysfunction in AMI than rEF.

Loss of interhemispheric connectivity in patients with lacunar infarction reflected by diffusion-weighted MR imaging and single-photon emission CT.

BACKGROUND AND PURPOSE: Although decreased neuronal connectivity in white matter has been reported to be a key mechanism of vascular dementia, assessment of white matter changes by diffusion-weighted MR imaging in relation to measures of associative function has not been previously addressed. We evaluated the loss of interhemispheric neuronal connectivity in vascular dementia by measuring diffusional anisotropy of the corpus callosum and determining its relationship to the regional cortical activity as reflected by cortical perfusion. METHODS: Nine patients with multiple lacunar infarction and six healthy volunteers (25-35 years old) were examined. We developed a method to determine the active cortical volume (ACV) by masking iodine-123 iodoamphetamine SPECT scans to eliminate the effect of brain atrophy. The anisotropic rate (AR) was calculated as a ratio of two perpendicular diffusion coefficients in diffusion-weighted MR imaging. RESULTS: Compared with the ACVs of the healthy volunteers, there were significant decreases in the ACVs in the frontal associative areas in the patients, and these were significantly correlated with cognitive scores. The frontal ACVs showed good correlations with the AR of the anterior corpus callosum among all participants; however, only insignificant trends toward correlation were observed between these two parameters within the patient group. CONCLUSION: A possible relationship between diffusional anisotropy of the anterior corpus callosum and frontal associative function was suggested; however, an estimation of the decrease in neuronal connectivity in patients with multiple lacunar infarction in terms of the deterioration in diffusional anisotropy requires further documentation.

Left ventricular function at rest and during bicycle exercise in normal subjects: assessment by ECG-gated myocardial perfusion SPET with 99Tcm-tetrofosmin.

99Tcm-labelled myocardial perfusion tracers allow simultaneous assessment of myocardial perfusion and left ventricular function using ECG-gated SPET. The aim of this study was to evaluate left ventricular performance during exercise by means of ECG-gated myocardial perfusion SPET. After the administration of 99Tcm-tetrofosmin (555-740 MBq), eight healthy volunteers aged 27-49 years underwent ECG-gated myocardial perfusion SPET at rest and during supine submaximal exercise (75 and 125 W), for 3 min each. Using ECG-gated SPET data, left ventricular end-diastolic volume (LVEDV) demonstrated a biphasic response during exercise (from 106.4 +/- 17.5 to 119.9 +/- 19.9 to 108.1 +/- 19.2 ml). In contrast, left ventricular end-systolic volume decreased gradually and significantly during exercise (from 47.1 +/- 11.9 to 41.5 +/- 8.9 to 36.1 +/- 10.1 ml; P < 0.05), and left ventricular ejection fraction continued to increase at higher workloads (from 56.1 +/- 6.0 to 63.0 +/- 2.7 to 67.0 +/- 4.3; P < 0.01) despite a fall in LVEDV. There was a progressive increase in cardiac output during exercise, which reached a peak of 7.2 +/- 0.9 l.min-1. We conclude that ECG-gated myocardial perfusion SPET can assess left ventricular function during exercise and may provide useful information for the evaluation of patients with ischaemic heart disease.

[Myocardial distribution of iodine-123-iodophenyl-9-methyl-pentadecanoic acid (9MPA) in patients with acute myocardial infarction: comparison with regional wall motion obtained from technetium-99m-sestamibi gated SPECT].

123I-iodophenyl-9-methyl-pentadecanoic acid (9MPA) is a modified long-chain (15 carbons) fatty acid with a methyl branch on its 9 carbon location. Myocardial SPECT images (two sets, 10 min each) were obtained starting 10 min (early phase) and 50 min (delay phase) after the injection of 160 MBq 123I-9MPA at rest in 10 patients with acute myocardial infarction. The segmental myocardial uptake (% uptake) and clearance (% washout) from early to delay image were calculated by the SPECT data. ECG-gated myocardial SPECT with 99mTc-sestamibi was also performed and segmental left ventricular (LV) wall motion was evaluated using QGS (quantitative gated SPECT) program. The % uptake of LV segments with hypokinetic or akinetic wall motion were significantly lower than those with normokinesis (p < 0.01) for both early and delay phases. The % washout of hypokinetic segments were significantly lower than those of normokinetic regions (p < 0.01), while the % washout of akinetic segments were significantly higher than those of severely hypokinetic segments (p < 0.05). Thus, 123I-9MPA myocardial distribution and clearance thought to be associated with left ventricular regional wall motion.

Crossed cerebellar diaschisis: the role of motor and premotor areas in functional connections.

The authors assessed the relationship between crossed cerebellar diaschisis (CCD) and cortico-pontine cerebellar pathway (CPCP) damage in 29 chronic supratentorial infarct patients to elucidate the role of motor and premotor areas for functional cerebro-cerebellar connections. The CCD rate was calculated from side-to-side cerebellar count differences on 123I-IMP single-photon emission computerized tomography images. Neuronal damage was estimated by the three scores of computed tomography density from equal to normal brain tissue (score 0) to equal to cerebrospinal fluid (score 2) in the 4 major regions on CPCP; frontal association, motor and premotor, sensory and parietal associations, and the posterior limb of the internal capsule. Two-factor factorial ANOVA by the score and the region revealed significant differences of the CCD rate in the score factor (score 0 or 1 vs. score 2, p = < 0.05) and the independency of these two factors. Categories determined by the scores in each region were analyzed by multiple stepwise regression analysis using the theory of quantification I, in which significant correlation only between CCD and the necrotic density (score 2) in motor and premotor areas were demonstrated (r = 0.515, p = < 0.05). The authors conclude that neuronal loss in motor and premotor areas seem to contribute significantly to functional cerebro-cerebellar disconnections.

The discrepancy between 99Tcm-ECD dynamic and static SPET images in patients with ischaemic lesions corresponds to reduced vasoreactivity to acetazolamide.

We evaluated 99Tcm-N,N'-(1,2-ethylenediyl)bis-L-cysteine diethyl ester (99Tcm-ECD) dynamic and static SPET (single photon emission tomographic) images to examine 99Tcm-ECD kinetics under ischaemic cerebrovascular conditions. In 20 patients who showed arterial occlusion on magnetic resonance angiography, dynamic (0-10 min) and static (15-35 min) SPET images were acquired after the intravenous administration of 99Tcm-ECD. Thirteen of the patients had focal perfusion deficits that were more evident on the dynamic than on the static images; the other seven showed no such discrepancy. In those patients with a mismatch between the dynamic and static images, the extent corresponded to reduced vaso-reactivity to acetazolamide. Based on quantitative analysis of the ratio of tracer uptake in affected to that in unaffected areas, the patients with discrepant findings showed significantly different ratios on the dynamic and static images, whereas those with no such mismatch did not. Our results suggest that dynamic 99Tcm-ECD images provide circulatory information and that static images reflect a filling-in phenomenon of ECD metabolites in ischaemic lesions. 99Tcm-ECD dynamic and static SPET images offer an alternative method of detecting mild perfusion deficits without the need for acetazolamide challenge.