Allergic fungal sinusitis in the southeastern USA: involvement of a new agent Epicoccum nigrum Ehrenb. ex Schlecht. 1824

The purpose of this study is to find the correlation between middle latency auditory evoked potentials (MLAEP) and sound activated single photon emission computed tomography (SPECT) studies. This study was performed on six normal right-handed volunteers with a mean age of 35.2 +/- 7.6 years, using the split-dose technique. First, a SPECT study was performed on subjects in blinded, awake and silent states. After bilateral ears were stimulated with a click sound, MLAEP and a second SPECT study were performed. Subtraction of the first SPECT from the second SPECT revealed a statistically significant increase of cerebral blood flow (CBF) in the bilateral superior temporal region. Bilateral Na amplitudes of MLAEP had a statistically significant and good correlation with the percentages of CBF changes in the bilateral superior temporal region. The superior temporal cerebral blood flow activation can be expressed by electrophysiological activation. Moreover, correlation during the left Na components and left frontal and occipital lobe are discussed.     

Arteriovenous malformation associated with moyamoya disease

The first case of a child with an arteriovenous malformation (AVM) associated with moyamoya disease is reported. The patient presented ischemic symptoms and underwent indirect bypass surgery on both sides when she was 5 years old. Four years later she suffered from headache, and a small AVM of the left frontal lobe associated with the moyamoya vessels was detected. Single photon emission computed tomography (SPECT) was performed at age 11 and demonstrated low local cerebral blood flow (CBF) in the left frontal lobe and right temporal lobe, although the revascularization after the bypass surgery seemed to be effective, as judged on pancerebral angiography. We feel that brain ischemia due to the moyamoya disease may have played a causative role in the development of the AVM.     

Incidence of breakpoints in pericentric inversions of chromosome 4

Single-photon emission computed tomography (SPECT) and transcranial Doppler (TCD) ultrasonography were used to assess brain perfusion during cardiopulmonary bypass. Intravenous injections of technetium 99 m-hexamethylpropyleneamineoxime (99mTc-HMPAO) were administered before surgery and intraoperatively after the first 2 minutes in the first patient and at the end (42 minutes) of cardiopulmonary bypass in the second patient. The total middle cerebral artery territory counts were calculated using the region-of-interest method and compared to cerebellar regional counts. 99mTc-HMPAO uptake on SPECT scans was increased at the beginning and at the end of cardiopulmonary bypass, compared to baseline preoperative values (11-17%) in the presence of multiple microembolic signals on TCD (n1 = 35 and n2 = 42 for unilateral middle cerebral artery monitoring). These results indicate the feasibility of using HMPAO-SPECT to study brain perfusion changes during cardiac surgery. A combination of SPECT and TCD ultrasonography may be used to study the impact of microembolism during cardiac surgery with cardiopulmonary bypass.     

Single photon emission computed tomography-EEG relations in temporal lobe epilepsy

The role of single photon emission computed tomography (SPECT) as an independent confirmation test in presurgical evaluation of medically intractable temporal lobe epilepsy has not been critically investigated. Because spreading ictal discharges may cause a concomitant increase of cerebral blood flow in remote cerebral regions, a careful analysis of peri-injection EEG patterns and their relation to ictal SPECT may be important in evaluating the reliability of ictal SPECT. Both interictal and ictal EEG and SPECT were reviewed in 19 patients with temporal lobe epilepsy who achieved a successful seizure outcome after surgery. Patients were divided into unitemporal and bitemporal groups according to the lateralization of interictal epileptiform discharges (IED). Ictal EEG features were classified into lateralized and nonlateralized groups. The concordance between SPECT and EEG lateralizations was examined in each patient and correlated to the documented epileptogenic temporal lobe. Interictal SPECT correctly lateralized in eight of nine patients with unitemporal IED and in five of 10 patients with bitemporal IED. Ictal SPECT was highly concordant with the peri-injection ictal EEG but correctly lateralized the epileptogenic region in only 11 of 19 patients. When both pre- and postinjection EEG epochs lateralized ipsilaterally, all ictal SPECT images showed concordant lateralization. If pre- and postinjection EEG epochs were either different in lateralization or nonlateralization, ictal SPECT images often showed complex patterns of cerebral perfusion with a high incidence of false lateralization. Interictal SPECT was more sensitive and reliable in patients with unitemporal IED than in patients with bitemporal IEDs. Ictal SPECT was closely related with peri-injection EEG epochs but with frequent false lateralization. The role of ictal SPECT as an independent confirmation test in presurgical evaluation should be reappraised.     

Pulmonary tuberculosis revealed by lupus vulgaris in an immunocompetent patient

In patients with severe carotid stenosis or total occlusion, episodic contralateral motor dysfunction is more likely related to cerebral hypoperfusion than epileptogenic activity. A man with orthostatic-mediated right-sided limb shaking was found to have total left internal carotid artery occlusion. There was prominent reduction of cerebrovascular reserve seen on single photon emission computed tomography (SPECT) performed with and without acetazolomide. During assumption of an upright position transcranial Doppler (TCD) revealed a marked attenuation of the left middle cerebral artery flow pattern not associated with changes during electroencephalographic monitoring, even after administration of acetazolomide. In this man, limb shaking episodes were attributed to hypoperfusion of the contralateral cerebral hemisphere, and not to epileptogenic activity.     

Net efflux of cysteine, glutathione and related metabolites from rat hippocampal slices during oxygen/glucose deprivation: dependence on gamma-glutamyl transpeptidase

BACKGROUND: Effect of clot removal and surgical manipulation on cerebral blood flow (CBF) and delayed vasospasm was studied in early aneurysm surgery for subarachnoid hemorrhage (SAH). METHODS: Thirty-two patients in this study fulfilled the following criteria: ruptured anterior communicating aneurysms, computed tomography (CT) within 2 days and unilateral pterional approach within 3 days after the ictus, bilaterally symmetrical clots without intracerebral hematoma, no postoperative complication, and CBF studies with single photon emission computed tomography (SPECT) with 123I-IMP. RESULTS: Postoperative regional hypoperfusion due to brain retraction was frequently recognized on 123I-IMP-SPECT without infarction. The regional CBF (rCBF) showed a continuous fall during the first 4 weeks after the ictus, followed by improvement. The rCBF in the vicinity of the surgical route was significantly lower, especially in the acute stage (Day 3-7). A significant association between decrease of cisternal blood after surgery and the degree of local vasospasm and local CBF values during spasm stage was observed in the interhemispheric cisterns, A2 and medial frontal cortex, but not in the sylvian fissure or insular cisterns, M1 or M2, and frontal watershed and temporal cortex. CONCLUSIONS: The present study provides evidence for the effectiveness of direct clot removal by early surgery for SAH on local vasospasm and CBF reduction. However, a potential improvement in local CBF with clot removal could be masked by brain retraction, which was demonstrated to affect rCBF adversely. Therefore, it is critical to perform brain retraction as gently as possible.     

Cerebral fat embolism studied by magnetic resonance imaging, transcranial Doppler sonography, and single photon emission computed tomography: case report

Cerebral fat embolism syndrome is an uncommon complication of trauma. We present a patient who developed cerebral fat embolism syndrome secondary to long-bone fractures. Although computed tomography of the brain failed to show any intracranial lesion, magnetic resonance imaging (MRI) detected scattered, high-signal-intensity lesions on T2-weighted images. 99mTc-d, 1-hexamethyl-propylene amine oxine single photon emission computed tomography (99mTc-HMPAO SPECT) and transcranial Doppler sonography (TCD) demonstrated low cerebral blood flow in the acute stage. MRI, 99mTc-HMPAO SPECT, and TCD correlated well with the clinical course of cerebral fat embolism syndrome.     

Prefrontal dysfunction in young acute neuroleptic-naive schizophrenic patients: a resting and activation SPECT study

Regional cerebral blood flow (rCBF) was measured with single photon emission computed tomography (SPECT) in six neuroleptic-naive, young, acute schizophrenic patients and six normal control subjects. We evaluated rCBF changes in prefrontal areas at rest and during a prefrontal activation task, the Wisconsin Card Sorting Test (WCST). Schizophrenic patients had significantly higher prefrontal blood flow than did control subjects during the resting conditions. During activation, the control group showed significant increases in prefrontal blood flow, whereas the schizophrenic group did not. These results suggest that at rest there is no evidence of hypofrontality, whereas hyperfrontality seems to be the most frequent pattern in our selected sample of young acute neuroleptic-naive schizophrenic patients. Furthermore, schizophrenic patients seem to be unable to increase prefrontal blood flow under conditions that challenge the prefrontal cortex.     

Neural control of micturition in man examined with single photon emission computed tomography using 99mTc-HMPAO

THE neural mechanisms of micturition in man were studied using single photon emission computed tomography (SPECT). The areas activated during micturition, relative to the resting state, were the upper pons, the left sensorimotor cortex, the right frontal cortex and the bilateral supplementary motor areas. Some of these regions have been established by clinical and experimental studies as the neural control centre for voiding. We confirmed the neural micturition centre in healthy men using SPECT for the first time.     

Regional cerebral blood flow determination using 133Xe and a standard rotating gamma-camera

While most of the methods for quantitative regional cerebral blood flow (rCBF) determination in man requires expensive fast devices, a method is proposed using single photon emission computed tomography with a conventional rotating gamma camera and 133Xe inhalation. It is tested using a computer simulation of a cerebral exam and a simplified CBF map as a model. The results obtained show that this method is relevant and can be tested in clinical studies.     

The use of SPECT with 201Tl in the evaluation of brain tumors

There is increasing interest in the literature regarding the use of SPECT (single photon emission computed tomography) with 201Tl in the evaluation of cerebral tumours. Thallium (201Tl) is one of the isotopes most commonly used in studies of the myocardium and in the diagnosis of various tumours. Normal brain takes up very little 201Tl, but in viable tumour tissue the 201Tl becomes intracellular and is rapidly cleared from the blood stream. Such cerebral tumour uptake is related to changes in the permeability of the blood-brain barrier, regional blood flow and transport by means of the Na(+)-K+ adenosine triphosphate pump. Once the SPECT images have been obtained following administration of the radioisotope, one can calculate the indices of early and of late uptake together with the retention index. The usefulness of SPECT in the preoperative detection of malignant expansive pathology, choice of tumour region during stereotaxic biopsy, control of tumour reproduction and their differentiation from post-radiotherapy necrotic tissue, and evaluation of chemotherapy in treatment of cerebral tumours are analyzed. Finally the application of SPECT in metastatic conditions and the differential diagnosis of expansive lesions is considered.     

Production of a monoclonal antibody against the 128 kDa (CagA) protein of Helicobacter pylori

We report a case of herpes simplex encephalitis in which the patient was repeatedly examined by magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT). The patient was a 36 year-old woman who had been transferred to our institution 6 days after the onset of symptoms with mild consciousness disturbance, nuchal rigidity, and high fever. Cerebrospinal fluid examination revealed an elevated mononuclear cell count with normal sugar concentration. Intravenous aciclovir was started 7 days after the onset of symptoms. The initial plain computed tomography (CT) scans did not reveal any abnormal findings, but contrast enhanced CT the next day showed a slight enhancement effect around the affected middle cerebral artery. Serial MRI showed the initial high intensity lesion starting on the medial cortex of the temporal lobe, then spreading to throughout the entire temporal lobe. During this period SPECT showed a marked, broad hot spot in the temporal lobe. The medial temporal lobe was high density on the CT 15 days after the onset. As the encephalitic lesion spread more laterally, the hot spot on SPECT moved laterally and then decreased in activity. Eleven weeks after the onset, the MRI showed intracerebral vacuolization of the lesion and it appeared as a wide cold spot on SPECT. The cause of the hot spot seen in the acute period was thought to be vasoparalysis of the affected area rather than breakdown of the blood-brain barrier, or impaired washout of the isotope, because the SPECT images after acetazolamide administration showed the cold spot even in the subacute phase.     

Reverse redistribution during dipyridamole thallium-201 myocardial single photon emission computed tomography in coronary artery disease

Ninety-six of the consecutive 1100 patients who underwent dipyridamole thallium-201 myocardial single photon emission computed tomography (SPECT) demonstrated reverse redistribution (RR). Twenty-six of the 96 cases who had accepted coronary angiographies were included in this study. RR was present in 40 myocardial segments from the 26 patients. Seventeen segments were in the right coronary artery (RCA) distribution, 17 in the left anterior descending artery (LAD) distribution, and 6 in the left circumflex artery (LCX) distribution. Perfusion defects noted on the initial study became more severe in the delayed images in 22 segments and normal perfusion was present during the initial images in 18 segments. Seventeen segments with RR were in the distribution of coronary arteries with abnormal angiographic findings. Of the remaining 23 segments, the angiographic findings were normal. In conclusion, RR can happen in TI -201 SPECT after dipyridamole and easily appears in the territories of RCA and LAD. It does not absolutely indicate whether the arteries are significantly diseased or normal coronary arteries.     

99mTc-HMPAO labeled leukocyte SPECT in intracranial lesions

BACKGROUND: Scintigraphy with 111In (indium-111)-oxine or 99mTechnetium-hexamethylpropyleneamine oxime (99mTc-HMPAO) labeled leukocytes has been used to differentiate brain abscess from brain tumor. However, there are false positive or false negative results from planar scintigraphic images. So a more specific and sensitive scintigraphic technique needs to be developed. METHODS: Planar and single photon emission computed tomography (SPECT) images were obtained and reviewed in 14 patients with intracerebral ring-enhancing lesions on computed tomography (CT) or magnetic resonance imaging (MRI). In all patients, diagnosis was confirmed by histopathologic examination. The effect of steroids or antibiotics on scintigraphic finding was examined. RESULTS: Abscess was confirmed in six patients, tumor in six, tuberculoma and cysticercosis in one each, respectively. In all the patients with abscess, SPECT showed increased focal activity irrespective of steroid or antibiotic therapy. Increased radioactivity, which could not be detected on planar images, could be identified in two patients with abscess. In three of the six patients with tumor, radiolabeled leukocytes did not accumulate in the tumor. In the other three patients with tumor, SPECT showed focally increased activity that was less intense than the activity shown in the patients with abscess. CONCLUSIONS: 99mTc-HMPAO labeled leukocyte SPECT is useful for the differential diagnosis of intracerebral ring-enhancing lesions, and the use of steroids or antibiotics does not influence the sensitivity of SPECT. Diagnostic sensitivity of scintigraphy with labeled leukocytes could be improved by SPECT in addition to planar image.     

The role of activators in assembly of RNA polymerase II transcription complexes

Since the negative results of the international Bypass Study, extracranial-intracranial (EC-IC) bypass surgery is infrequently employed in the treatment of patients with cerebral ischemia. Newly acquired evidence concerning the pathophysiology of cerebral ischemia, however, has facilitated the identification of a small subgroup of patients with "hemodynamic" cerebral ischemia. Characteristically, these patients demonstrate severely impaired cerebrovascular reserve capacity due to occlusive disease and insufficient collateral blood supply. Over an 8-year period, 28 patients were defined by clinical and laboratory criteria as suffering from hemodynamic cerebral ischemia. All patients had recurring episodes of focal cerebral ischemia due to unilateral internal carotid artery occlusion. Computerized tomography (CT) scans either were normal or showed evidence of border zone infarction. The cerebrovascular reserve capacity was studied using 133Xe single-photon emission CT and acetazolamide challenge and was found to be significantly impaired in all patients. Based on these criteria, superficial temporal artery-middle cerebral artery anastomosis was performed to augment collateral flow to the ischemic hemispheres. Two patients died from myocardial infarction, one 4 days and the other 2 months postoperatively. One patient died from massive brain infarction and another suffered a postoperative stroke with incomplete recovery, resulting in a major morbidity and mortality rate of 14%. Minor morbidity included one patient with a subdural hematoma who subsequently recovered completely. The postoperative course was uneventful in 23 patients (82%). Over a mean follow-up period of almost 3 years, no patient had another episode of brain ischemia. Bypass patency was confirmed by postoperative angiography in 26 patients. Follow-up studies of cerebral blood flow (CBF) and cerebrovascular reserve capacity showed significant improvement of the latter while the resting CBF was essentially unchanged. In view of these findings, the authors conclude that EC-IC bypass surgery constitutes appropriate therapy for a subgroup of patients with recurrent focal cerebral ischemia, defined using the strict selection criteria employed in this study.     

Correlation of positive symptoms exclusively to hyperperfusion or hypoperfusion of cerebral cortex in never-treated schizophrenics

BACKGROUND: Studies of schizophrenia by single photon emission computed tomography (SPECT) and positron emission tomography (PET) have shown both regional cerebral hyperperfusion and hypoperfusion. The aim of this study was to examine the inter-relations between regional cerebral blood flow (rCBF), psychopathology, and effects of neuroleptic therapy. METHODS: 24 never-treated patients with acute schizophrenia were examined with hexamethylpropyleneamine-oxime brain SPECT and assessed psychopathologically according to the positive and negative syndrome scale; they were studied again after neuroleptic treatment and psychopathological remission. rCBF values that deviated from those of 20 controls by more than 2 SD were regarded as abnormal. FINDINGS: Both hyperperfused and hypoperfused patterns were found among schizophrenia patients during acute illness. The seven positive symptoms on the symptom scale showed different correlations with rCBF: formal thought disorders and grandiosity correlated positively (and strongly) with bifrontal and bitemporal rCBF; delusions, hallucinations, and distrust correlated negatively (and strongly) with cingulate, left thalamic, left frontal, and left temporal rCBF. Stereotyped ideas as a negative symptom correlated negatively (and strongly) with left frontal, cingulate, left temporal, and left parietal rCBF. After neuroleptic treatment (and reduction of positive symptoms), only negative symptoms correlated exclusively with bifrontal, bitemporal, cingulate, basal ganglia, and thalamic hypoperfusion. INTERPRETATION: Different positive symptoms are accompanied by different rCBF values--some related to hyperperfusion, others to hypoperfusion. This finding may help to explain observed inconsistencies of perfusion patterns in drug-na?ve schizophrenics.     

SPECT cerebral blood flow, MR imaging, and neuropsychological findings in traumatic head injury.

Investigated 16 patients with diffuse or contusional brain damage and 8 patients with focal lesions 5–22 mo postinjury, using single proton emission computed tomography (SPECT) cerebral blood flow (CBF) measurements and neuropsychological examination. All Ss were aged 16–64 yrs. Compared with 16 controls, the diffuse group showed significant differences on 13 of 24 measures after correction for premorbid differences, whereas the focal group was significantly impaired on only 3 tests after correction. SPECT apparently identified abnormalities not demonstrated on magnetic resonance (MR) imaging and vice versa. Abnormal regional CBF seemed to be related to neuropsychological defects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autolysis of Lactococcus lactis ssp. lactis and Lactobacillus casei ssp. casei. Cell lysis induced by a crude bacteriocin

Clinical studies indicate that patients with acute schizophrenia may benefit from benzodiazepine treatment. Therefore we investigated the benzodiazepine receptor distribution and diazepam binding in 20 patients with DSM-III schizophrenia using single photon emission computed tomography (SPECT) with iomazenil as the ligand. In each patient, two SPECT images were obtained: SPECT 1 was obtained 2 h after intravenous injection of 200 MBq I-123-iomazenil. Following SPECT 1, patients received 10 mg diazepam intravenously. Twenty min later, SPECT 2 was started. The highest iomazenil uptake was found in the occipital cortex followed by the frontal and temporal cortices. Baseline iomazenil uptake in the medial frontal cortex was significantly (P < 0.05) correlated with the BPRS total score (r = 0.46). Diazepam injection led to a significant activity decrease in iomazenil binding which was greatest in the frontal regions of interest. With respect to the medial frontal cortex, this effect was significantly (P < 0.05) more pronounced in patients with a remitting than a chronic course of the disorder. These findings suggest that changes of the benzodiazepine receptor system in the frontal cortex may be associated with severity and chronicity of schizophrenia.     

Clinical applications of fusion imaging in oncology

Recent developments in tumor imaging, made possible by advances in instrumentation and radiopharmaceuticals, has led to an increasing need for accurate anatomic correlation of single photon emission computed tomography (SPECT) and positron emission tomography (PET) images. Fusion imaging permits the functional strengths of SPECT and PET to be combined with the anatomic resolution of computed tomography (CT) and magnetic resonance imaging (MRI). Clinical applications of fusion imaging include the evaluation of brain tumors, lymphoma, hepatic lesions and monoclonal antibody studies. The continued development of these techniques will eventually allow fusion imaging to become a routine part of nuclear medicine practice.     

Chronic schizophrenia: validity of the study of regional cerebral blood flow through cerebral SPECT

OBJECTIVE: To check the validity of the diagnostic test in schizophrenia. MATERIAL AND METHODS: The cerebral blood flow (CBF) characteristics were assessed by means of single photon emission tomography (SPECT) in 24 patients with schizophrenia and 20 normal control subjects. Analysis of sensitivity, specificity and the Youden rate was made of certain RCBF patterns chosen in terms of the cerebral regions between which the greatest differences were observed according to the diagnosis, schizophrenia vs control. RESULTS: Schizophrenia vs control: sensitivity = 58.33%; specificity = 95%; positive predictive value = 93.33% and overall efficiency = 53.33%. CONCLUSIONS: Cerebral SPECT is valid in the discrimination between patients diagnosed with schizophrenia and control subjects, taking the diagnostic judgement of the psychiatrist as the gold standard, and the RCBF pattern that displays the best coefficient is hypoperfusion, in one or several of the regions: right frontal/left frontal/right parietal/thalamus: sensitivity = 58.33%; specificity = 95%; positive predictive value = 93.33% and overall efficiency = 53.33%.