Dopamine transporter distribution in patients with Parkinson disease of different stages detected using single-photon emission computed tomography brain imaging

BACKGROUND： Literatures have reported that the density changes of dopamine transporter is negatively correlated with the severity degree and grading of disease condition of Parkinson disease （PD）. However, the distribution ofdopamine transporter in each nucleus of corpora striatum at each period is still unclear. OBJECTIVE： To observe the radioactive uptake distribution of dopamine transporter in bilateral corpora striata of patients with different stages of PD using single photon emission computed tomography （SPECT）, and make a comparison with healthy controls. DESIGN： Case-control analysis. SETTING： Department of Imageology, Second Hospital Affiliated to Guangzhou University of Chinese Medicine. PARTICIPANTS： Thirty patients with PD admitted to Second Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine between January and December 2005 were recruited. The involved patients, 19 male and 11 female, were aged from 36 to 80 years and with disease course of 2.5 months to 10 years. They all met the clinical diagnosis criteria of Britain Parkinson＇s disease Association Think Tank; Following Hoehn-Yahr grading： grade Ⅰ ： unilateral morbidity; grade Ⅱ： bilateral morbidity, but without balance disorder; grade Ⅲ： bilateral morbidity, accompanied with early posture balance disorder; grade Ⅳ： severe morbidity, needs more help; grade V ： without help, only in bed or wheelchair. There were 11 patients with mild PD （grade Ⅰ - Ⅱ ）, 9 patients with moderate PD （grade Ⅲ） and 10 patients with advanced PD （grade Ⅳ - Ⅴ ）. Meanwhile, 6 healthy persons were selected as normal controls. Informed consents were obtained from all the subjects. METHODS： Twenty-four hours after withdrawal of PD drugs, 30 patients with PD and 6 healthy controls took kalium perchloricum 400 mg orally. After lying down for 30 minutes, all the subjects were intravenously injected with 740 MBq 99Tc m-TRODAT-1 （Jiangsu Institute of Atomic Medicine, Batch No. 20040310） at elbow part. Following injection, image was collected using scanner for single photon emission computed tomography （ADAC Company, USA）. Matrix was 64 × 64, each detecting head revolved 180 ° , 1 frame/60 s. Sixty-four frames were collected with double detecting heads, 50 K/frame. Faultages with clearest image of corpora striatum were selected. Regions of interest （ROI） of caudate nucleus, anterior and posterior putamen and thalamic region in bilateral corpora striata were radioactively counted, and mean value of radioactive counting of ROI was used as the mean value ofpixel in each region of bilateral corpora striata. MAIN OUTCOME MEASURES： Comparison of radioactive uptake in each region of brain between healthy persons and patients with PD. RESULTS： Thirty patients with PD and six healthy persons who received body examination participated in the final result. Comparison of radioactive uptake in each region between healthy persons and patients with PD： ①In the healthy persons, high-density radioactive uptake was found in bilateral corpora striata; Structures of caudate nucleus, anterior and posterior putamen, and thalamus were clear with eudipleural radioactive distribution, and the background of peripheral brain tissue was very low. ②Radioactive intakes in opposite anterior and posterior putamen of patients with mild PD were significantly inferior to those in homolateral ones（70.45±3.35, 87.64±2.65, t =15.82, P 〈 0.05）. Structures of bilateral caudate nucleus and thalamus were clear with eudipleural radioactive distribution （P 〉 0.05）. ③Radioactive intakes in anterior and posterior putamen and thalamus of patients with moderate PD were significantly reduced as compared with healthy persons. There were significant differences in mean radioactive counting of ROI between patients with PD and healthy persons （t =5.20, P 〈 0.05： t =3.95, P 〈 0.05）; The structure of opposite caudate nucleus was not very clear, radioactive distribution of opposite caudate nucleus was significantly reduced as compared with homolateral one （81.11±4.25, 104.56±3.64, t = 14.65, P 〈 0.05）. ④As for patients with advanced PD, the structure of bilateral corpora striata was not clear, radioactive intake was significantly reduced and peripheral background was heightened, even higher than the distribution of the whole corpora striatum. CONCLUSION： SPECT DAT imaging of brain can show the distribution of radioactive uptake in each region of bilateral corpora striata of patients with different stages of PD, which is helpful to diagnose and evaluate the severity of PD.

Prediction of traumatic avascular necrosis of the femoral head by single photon emission computerized tomography and computerized tomography： an experimental study in dogs

Objective： To evaluate the femoral head perfusion and to predict the traumatic avascular necrosis （AVN） of the femoral head by single photon emission computerized tomography and computerized tomography （SPECT/CT）. Methods： Totally 18 adult beagle dogs were divided randomly into three equal-sized （n=6） groups. Subsequently different degrees of ischemia model were developed by de- stroying blood vessels of the femoral head. The left hip received sham operation as normal control and the right hip underwent blood interruption. In Group A, the ligamentum teres was cut off. In Group B, the marrow cavity of the right femoral neck was destroyed while in Group C, the soft tis- sues at the base of the femoral neck were stripped in addition to the resection of the ligamentum teres and destruction of the marrow cavity. Three hours after surgery, SPECT/ CT was performed. Laser Doppler Flowmetry （LDF） measurements were also obtained at three different time points （before operation, immediately and three hours after operation） in order to assess the change process of blood supply to the femoral head. Results： SPECT/CT showed no significant difference in the radionuclide uptake between the right and left femo- ral heads in Group A （t=-0.09,P=-0.94） and Group B （t= 0.52, P=0.62）. However, in Group C, it was 261±62 for the right femoral head, only 12% of that in the left femoral head. LDF measurements indicated that the femoral head perfusion was decreased from （45.0±3.3） PU to （39.1±3.7） PU in Group A, from （44.0±2.7） PU to （34.3±2.6） PU in Group B, and from （47.3±2.1） PU to （4.96±0.6） PU in Group C immediately after operation. However, the perfusion was restored and returned to normal values three hours after operation except in Group C. Conclusion： SPECT/CT could assess the perfusion of the femoral head semiquantitatively, which might be useful in predicting the development of traumatic AVN.

Contrast study on cognitive function with MRI and positron emission tomography imaging in transient global amnesia

OBJECTIVE: To study cognitive function and cerebral metabolic changes in patients with transient global amnesia (TGA). METHODS: Three patients with TGA were given mini-mental state examination (MMSE), revised Wechsler memory scale (WMS-R) examination and magnetic resonance imaging (MRI) scans after they had been diagnosed as TGA. Using (18)F labelled deoxyglucose as tracer, patients were given a positron emission tomography (PET) examination at different periods during recovery. RESULTS: No obvious abnormality was found in MMSE and MRI scans in the three patients. However, WMS-R examination and cerebral PET imaging displayed cognitive dysfunction of varying degrees and low metabolism in local areas related to memory in 2 of 3 patients. CONCLUSIONS: In TGA patients, cognitive function and cerebral metabolic levels are closely correlated with duration of symptoms. It is necessary to stop the TGA attack as quickly as possible early time.

Role of nuclear cardiology for guiding device therapy in patients with heart failure

Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiol-ogy and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardi-ology to guide cardiac resynchronization therapy （CRT） and to select patients for implantable cardioverter defbrillators （ICD）. Left ventricular synchrony may be assessed by radionuclide angiography or gated single-photon emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using posi-tron emission tomography and could improve conven-tional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomog-raphy/computed tomography approach for assessing myocardial viability, identifying the location of biven-tricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Fi-nally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore po-tentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better defne the role of nuclear cardiology for guiding device therapy in patients with heart failure.

Effect of L-NAME on nitric oxide and gastrointestinal motility alterations in cirrhotic rats

AIM: To investigate the effect of L-NAME on nitric oxide and gastrointestinal motility alterations in cirrhotic rats. METHODS: Rats with cirrhosis induced by carbon tetrachloride were randomly divided into two groups, one n =13 receiving 0.5mg.kg(-1) per day of N(G)-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor, for 10 days, whereas the other group (n =13) and control (n =10) rats were administrated the same volume of 9g.L(-1) saline. Half gastric emptying time and 2h residual rate were measured by SPECT, using (99m)Tc-DTPA-labeled barium sulfate as test meal. Gastrointestinal transition time was recorded simultaneously. Serum concentration of nitric oxide (NO) was determined by the kinetic cadmium reduction and colorimetric methods. Immunohistochemical SABC method was used to observe the expression and distribution of three types of nitric oxide synthase (NOS) isoforms in the rat gastrointestinal tract. Western blot was used to detect expression of gastrointestinal NOS isoforms. RESULTS: Half gastric emptying time and trans-gastrointestinal time were significantly prolonged(124.0 +/- 26.4 min; 33.7 +/- 8.9 min; 72.1 +/- 15.3 min; P【0.01), (12.4 +/- 0.5h; 9.5 +/- 0.3h; 8.2 +/- 0.8h; P【0.01), 2h residual rate was raised in cirrhotic rats than in controls and cirrhotic rats treated with L-NAME (54.9 +/- 7.6%,13.7 +/- 3.2%, 34.9 +/- 10.3%, P【0.01). Serum concentration of NO was significantly increased in cirrhotic rats than in the other groups (8.20 +/- 2.48) micromol.L(-1), (5.94 +/-1.07) micromol.L(-1) and control (5.66 +/- 1.60 micromol.L(-1), P【0.01. NOS staining intensities which were mainly located in the gastrointestinal tissues were markedly lower in cirrhotic rats than in the controls and cirrhotic rats after treated with L-NAME. CONCLUSION: Gastrointestinal motility was remarkably inhibited in cirrhotic rats, which could be alleviated by L-NAME. Nitric oxide may play an important role in the inhibition of gastrointestinal motility in cirrhotic rats.

Role of18F-FDG SPECT/CT imaging in the diagnosis and initial staging of lymphoma

Objective:To investigate the role of18F-FDG SPECT/PET in the diagnosis and initial staging of lymphoma.Methods:A retrospective analysis was carried out on 48 patients in Haikou Hospital from January 2015 to June 2018,who were eventually pathologically diagnosed with lymphoma and had undergone18F-FDG SPECT/PET before definite diagnosis.(1)Patients were divided into Hodgkin's lymphoma group,diffuse large B cell lymphoma group and other non-Hodgkin's lymphoma group according to Pathological classification;and were divided into nodal lymphoma group and extranodal lymphoma group according to the presence of invasion to the tissues beyond lymph node;and were divided into stage I+Ⅱgroup and stageⅢ+IV group according to clinical Ann Arbor staging.The diagnostic consistencies of18F-FDG SPECT/PET and conventional imaging(CI)in each group were calculated,the T/N ratios of the lymphoma lesion were analyzed as well.(2)Clinical Ann Arbor staging,SPECT/PET staging and CI staging were performed in 48 patients,respectively.Then the efficacy of SPECT/PET staging and CI staging was compared,and the consistency of SPECT/PET staging and clinical Ann Arbor staging was compared as well.Results:(1)In this study,the diagnostic consistent rates of18F-FDG SPECT/PET and CI were 45.8%(22/48)and 16.6%(8/48),respectively(χ2=9.503,P=0.002<0.01).(2)The diagnostic consistent rate of18F-FDG SPECT/PET in diffuse large B cell lymphoma group and other non-Hodgkin's lymphoma group was higher than that of CI(P<0.05).There was no statistical significance between the diagnostic consistent rates of18F-FDG SPECT/PET in the Hodgkin's lymphoma group,diffuse large B cell lymphoma group and other non-Hodgkin's lymphoma group(χ2=1.067,P=0.448>0.05).(3)The diagnostic consistent rates of18F-FDG SPECT/PET in nodal group and extranodal group were 100.0%(19/19)and 21.1%(4/19)(χ2=24.783,P=0.000<0.01),respectively.(4)The diagnostic consistent rates of18F-FDG SPECT/PET and CI were 25%(2/8)and 0(0/8)in lymphoma with early stage(stage I+Ⅱgroup)(χ2=2.268,P=0.131>0.05),and 50%(20/40)and 20%(8/40)in lymphoma with late stage(stageⅢ+IV group)(χ2=7.912,P=0.002<0.01),respectively.(5)There was no statistical significance in T/N ratios of lymphoma lesions between different pathological groups,between nodal group and extranodal group,or between the stage I+Ⅱgroup and the stageⅢ+IV group(P>0.05).(6)The total consistent rates of18F-FDG SPECT/PET and CI for initial lymphoma staging were 79.2%(38/45)and 64.4%(31/48)(χ2=18.774,P=0.000<0.01).SPECT/PET staging was well consistent with clinical Ann Arbor staging in initial lymphoma staging(Kappa=0.696,P=0.000<0.01).Conclusion:The research has showed that the consistent rates of18F-FDG SPECT/PET in the diagnosis and initial staging of lymphoma are relatively high,and18F-FDG SPECT/PET plays an important role in the diagnosis and initial staging of lymphoma.

Different imaging findings of inflammatory myofibroblastic tumor of the liver

Inflammatory myofibroblastic tumor(IMT) in the liver is an uncommon lesion of uncertain pathogenesis.In most cases,symptomatological imaging and clinical studies suggest malignancy.We report a case of liver IMT with imaging findings from positron emission tomography/computed tomography(PET/CT),contrastenhanced computed tomography(CECT) and contrastenhanced ultrasonography(CEUS).This report was the first to depict a PET/CT scan of a liver IMT that revealed an inhomogeneous,intense(fluorine 18)-fluoro-2-deoxy-D-glucose uptake.The CECT and CEUS images showed a hepatic artery supplying blood to the mass and necrosis.The characteristic histopathological features and the presence of spindle cells expressing smooth muscle actin,collagen fibers and lymphocytes allowed for the diagnosis of liver IMT.Recognizing such findings will help to achieve a correct diagnosis and may prevent inappropriate treatment.

Detection of Recurrent Cervical Cancer by Whole-body FDG PET Scans

OBJECTIVE To evaluate the role of whole-body {^18F} fluro-2- dexoxyglucose （FDG） positron emission tomography （PET） scans in the detection of recurrent cervical cancer. METHODS Between June, 2000 and January, 2006, 25 patients had undergone a PET scan at the Peking Union Medical College Hospital to evaluate possible recurrent cervical cancer. All the PET findings were reviewed and compared to available clinical data to classify each PET scan result as a true positive, true negative, false positive, or false negative. RESULTS A total of 38 PET scans were conducted on the 25 patients whose median age was 46 years. The Stage distributions were ⅠA （n = 1）, ⅠB （n = 11）, ⅡA （n =5）, ⅡB （n = 4）, ⅢB （n = 2）,ⅣB （n = 1）, and unknown Stage （n = 1）. There were 22 cases of squamous cell carcinoma and 3 cases of adenocarcinoma resulting in 9 true positive PET scans, 27 true negatives, 2 false positives and no false negatives. The sensitivity of the FDG PET scans for detecting recurrent cervical cancer was 100%, specificity 93.1%, positive predictive value 81.8%, and negative predictive value 100%. CONCLUSION The whole body FDG PET scans are a sensitive and specific imaging modality for the detection of recurrent cervical cancer. However the cost of PET scans is too high at this time. A large prospective study will determine whether this modality should be used routinely and take the place of other imaging methods in the early detection of recurrent cervical carcinoma.

A comparative study of ^(67)Ga planar and SPECT images in diagnosis of non-Hodgkin's lymphoma

To comparatively study the sensitivity and specificity of 67Ga planar and SPECT images in diagnosis of non-Hodgkin’s lymphoma. Methods Simultaneous 67Ga planar and SPECT were conducted by using Sopha DS7 SPECF for 48 intermediate lesions in 30 patients that had been pathologically confirmed, with their healthy counterparts as controls. Results Thesensitivity of planar images in head-neck, chest and abdomen was 60.0%, 72.7% and 72.7% respectively, and that of SPECTwas 93.3%, 90.9% and 81.8% respectively. The planar imaging had a general false-neck rate of 31.3%, 2.5 times higherthan SPECF imaging (12.5%) had. Both of them had the same false-positive rate (6.3%). Conclusion SPECT imaging is superior in sensitivity to planar imaging for head-neck, chest and abdomen in detection of intermediate NHL.

Efficacy and safety of therapeutic angiogenesis from direct myocardial administration of an adenoviral vector expressing vascular endothelial growth factor 165

OBJECTIVE: To investigate whether direct administration of adenoviral vectors (Ad) containing the complementary deoxyribonucleic acid (cDNA) of vascular endothelial growth factor 165 (Ad-VEGF165) induces porcine coronary collateral vessel formation, improves regional myocardial perfusion and function and is safe. METHODS: Three weeks after miniature swine underwent left thoracotomy and placement of an Ameroid constrictor on the left circumflex coronary artery (LCX), Ad-VEGF165 (n = 6) or the control, Ad expressing beta-galactosidase cDNA (Ad-Gal, n = 6), was directly administered into the ischemic myocardium in the circumflex distribution. All animals were sacrificed 4 wk after the second surgery. Myocardial perfusion and function were assessed by electrocardiogram-gated single photon emission computed tomography (GSPECT) imaging. Ex vivo coronary angiography was performed to examine collateral vessels. Toxicity was assessed by blood analyses on the day just before (day 0) and on day 1, 3, 7, 28 after vector delivery and by vascular, myocardial and liver histology after sacrifice. RESULTS: GSPECT imaging 4 wk after administration of Ad-VEGF165 demonstrated significant reduction in ischemic area (P

Involvement of midgastric transverse band in gastric empting delay of functional dyspepsia

Background Midgastric transverse band （MTB） was first observed over 100 years ago, after that many researchers worked on the subject postulated its physiologic role and the role in gastrointestinal diseases, but its function remains unclear. With progress of imaging methods, the nature of MTB is unveiling. In this study we investigated the effect of MTB on the gastric empting delay in functional dyspepsia （FD） and explored the mechanism. Methods A total of 60 patients with FD and 65 age- and sex-matched healthy people who served as controls were studied. With ^99mTc-DTPA labeled semi-solid fat-parched flour served as test meal, gastric empting was examined in all subjects by using single photon emission computed tomography. Test meal was designated as general （60 g fat-parched flour） or large （80 g fat-parched flour） meal. Stomach was divided into proximal and distal parts by MTB. Half gastric empting time, areas of different gastric parts, intragastric food distribution and MTB width were tested with in given times. Results Patients with FD showed a delayed gastric empting and increased intragastric residue. Global and regional gastric erupting velocity was decreased. The areas of distal stomach and MTB were significantly greater in the FD patients than in the controls. Throughout the whole test period a distal stomach-dominated food distribution was shown. Those who took a large meal had longer half gastric empting time and greater MTB area than those who took a general meal. Conclusions Gastric empting delay is related to enlarged MTB area. Some dyspeptic symptoms may be induced by abnormal distribution and increased retention of food in distal stomach. MTB, being like atriaventricular valve that controls blood flow in heart, regulates transport, distribution, and empting of food in the stomach.

嗅觉功能影像研究

本文就正电子发射断层照相术和功能磁共振在嗅觉功能影像的原理特点、试验设计、数据分析、刺激的产生、嗅觉功能活化区定位、影响因素、嗅觉记忆以及临床应用作一综述。

Brain glucose metabolism and neuropsychological test in patients with mild cognitive impairment

Objective To investigate the features of regional cerebral metabolic rate of glucose (rCMRglc) in patients with mild cognitive impairment(MCI) by positron emission-tomography and its relationship with neuropsychological test.Methods Positron emission tomography,mini-mental state examination and Wechsler memory scale were applied in 10 patients with MCI and 10 healthy volunteers as the control group. Results Scores of mini-mental state examination and Wechsler memory scale in MCI patients were lower than those in the control group ( P <0.01). rCMRglc of the left orbital gyrus,right middle temporal gyrus and right putamen was lower in the MCI group than in the control group ( P <0.05). Correlation analysis in the MCI group indicated that rCMRglc of many brain regions such as the orbital gyrus,putamen,left hippocampus and parahippocampal gyrus,cingulate gyrus,left amygdaloid body,precentral gyrus,postcentral gyrus,and medial occipitotemporal gyrus in MCI patients,were correlated negatively with age; while the rCMRglc of many parts of the brain such as the left putamen,temporal lobe,anterior cingulate gyrus,left insular lobe,amygdaloid body,precentral gyrus,postcentral gyrus and medial occipitotemporal gyrus were correlated positively with mini-mental state examination; and rCMRglc of the left putamen,temporal lobe,left insular lobe,precentral gyrus and postcentral gyrus were correlated positively with Wechsler memory scale. The right putamen,the right inferior temporal gyrus,precentral gyrus,and left postcentral gyrus were correlated positively with the length of education. However,only rCMRglc of the left amygdaloid body were correlated positively with gender. Conclusion The rCMRglc was lower in the orbital gyrus and putamen of MCI patients. Their rCMRglc were correlated with their cognitive impairment severity,age,length of education and sex.