F. Martín

Neuropsychological disturbances and cerebral blood flow in bipolar disorder.

OBJECTIVE To determine and correlate alterations in neuropsychological function and cerebral blood flow in bipolar patients. METHOD Assessments included the Positive and Negative Symptom Scale, Global Assessment Functioning, Wechsler Adult Intelligence Scale (WAIS), Wisconsin Card Sorting Test (WCST), Stroop test, Trail Making Test (TMT), California Verbal Learning Test (CVLT), Wechsler Memory Scale (WMS) and phonetic verbal fluency/controlled oral word association tests. Single photon emission computed tomography (SPECT) was carried out with the administration of 99mTc-HMPAO. Forty-three outpatients out of 85 fulfilling RDC diagnostic criteria for bipolar disorder and six healthy subjects were included in the study. SPECT and neuropsychological assessments were performed in 30 patients in manic (n = 7), hypomanic (n = 8), depressed (n = 12) or euthymic (n = 3) states. All assessments were carried out before starting treatment. RESULT Several corrected correlations between neuropsychological function and cerebral blood flow (CBF) were identified: executive function (WCST) and striatal, frontal, temporal, cerebellum, parietal and cingulate CBF; memory (WMS, WAIS-Digits) and striatal, frontal, temporal and parietal CBF; attentional tasks (Stroop) and striatal, temporo-medial and parietal CBF; verbal learning (CVLT) and frontal, posterior temporal, cingulate and occipital CBF; psychomotor disturbances (TMT) and anterior temporal CBF; poorer intelligence performance scores (WAIS-Vocabulary) and cerebellum and parietal CBF. CONCLUSIONS This study confirms the presence of functional disturbances in fronto-subcortical structures, the cerebellum and limbic system in bipolar patients.

The Somatics of Psyche: Structural Neuromorphometry of Bipolar Disorder

Many neuroimaging investigations report structural differences in subjects with bipolar disorder; however, conflicting results are common in the limited number of available investigations. Thus, the structural correlates of bipolar disorders remain poorly understood. The authors reviewed the early investigations using computed tomography and examined gross structural differences, such as cerebral atrophy, ventricular enlargement, or cerebellar atrophy. Many of these investigations report significant differences in these features compared with controls, whereas others found no such differences. More recent magnetic resonance imaging (MRI) investigations have employed increasingly sophisticated imaging and research methodologies, allowing for the quantitative examination of specific brain regions. Because neuropsychological and functional studies suggest abnormalities in frontal, temporal and subcortical regions, many investigators have focused their MRI neuromorphometric studies on these temporal limbic structures. However, the number of investigations examining each of these regions remains small, and conflicting results continue to be reported. It seems clear that for many brain regions, the structural changes from normal may be subtle, and that the differences in the reported studies may be due to differences in research methodologies between studies and across centers.

Limitations of Gallium-67 SPECT in histological transformation of chronic lymphocytic leukaemia: an analysis of 13 patients with clinically suspected Richter's syndrome

Summary.  Gallium‐67 single photon emission computerized tomography (Ga‐67 SPECT) was performed in 13 chronic lymphocytic leukaemia (CLL) patients suspected of evolution into diffuse large B‐cell lymphoma (DLCL) or Richters syndrome (RS). Six positive and nine negative Ga‐67 SPECTs were observed. Ten patients were biopsied (five in each group). DLCL was not detected in any Ga‐67‐positive patient, including those in whom Ga‐67‐positive areas were biopsied. The only case of DLCL was demonstrated in a Ga‐67‐negative patient. The tumoral proliferative index (Ki67 antigen expression) was moderate and similar in both groups of patients. These results illustrate the limitations of Ga‐67 SPECT in identifying RS.

Technetium 99m-labeled tetrofosmin and iodine 123-labeled metaiodobenzylguanidine scintigraphy in the assessment of transmyocardial laser revascularization

OBJECTIVE Transmyocardial laser revascularization is a new technique that improves symptoms in patients with refractory angina not amenable to conventional revascularization. The aim of this study was to assess whether transmyocardial laser revascularization produces changes in innervation, perfusion scintigraphy, or both that could explain the benefit to patients. METHODS Sixteen patients (12 men and 4 women; mean age, 60 +/- 8 years) with coronary artery disease were studied. Transmyocardial laser revascularization was performed in 39 myocardial areas supplied by a stenotic vessel. A technetium 99m-labeled tetrofosmin stress-rest tomographic scan and iodine 123-labeled metaiodobenzylguanidine planar scans were performed before and after transmyocardial laser revascularization (3 and 12 months later) to evaluate myocardial perfusion and innervation. Stress and rest perfusion images were quantified on a polar map. Ischemia uptake was also defined as the difference between rest and stress uptake for each area. Innervation planar images were visually analyzed and semiquantified. RESULTS A significant decrease in angina class from baseline was observed at 3, 6, and 12 months after transmyocardial laser revascularization (P <.005). A significant decrease in ischemia uptake was also found between the pre-transmyocardial laser revascularization and the post-transmyocardial laser revascularization studies in treated areas (P <.001). A significant improvement in stress myocardial perfusion at 3 and 12 months after transmyocardial laser revascularization was only found in treated areas that were considered ischemic in the pre-transmyocardial laser revascularization study (P <.05). At 3 months, a significant myocardial innervation worsening was observed in treated areas (P <.001), with partial recovery at 12 months (P <.05). CONCLUSION The transmyocardial laser revascularization mechanism involves both perfusion improvement and denervation, mainly at 3 months, that partially recovered at 12 months.

Tratamiento del dolor óseo metastásico con dosis repetidas de Estroncio-89 en pacientes con neoplasia de próstata

Resumen El objetivo de este estudio ha sido valorar la utilidad del tratamiento repetido con 89Sr en pacientes con neoplasia de prostata y dolor oseo metastasico. Diecisiete pacientes con respuesta parcial o completa tras una 1.a dosis de 89Sr se trataron con dos o mas dosis (total de 39 dosis). En la valoracion de los pacientes se tuvo en cuenta la capacidad funcional (Karnofsky), el dolor y el grado de analgesia. Tras la 1.a dosis, la respuesta fue buena en un 68% de los pacientes y parcial en un 32%. Tras la 2.a dosis, la respuesta fue buena en un 62%, parcial en un 15% y no hubo respuesta en un 23% de los casos. El Karnofsky pretratamiento y la duracion del efecto del 89Sr fue menor tras la 2.a dosis (p = 0,03, p = 0,02), aunque no hubo diferencias significativas en el tipo de respuesta. En conclusion, el tratamiento repetido con 89Sr puede realizarse sin mayor riesgo y con un tipo de respuesta similar a la obtenida tras la 1.a dosis.

Clinical value of 99mTc-HMPAO SPECT in depressed bipolar I patients

Regional cerebral blood flow was studied in 17 bipolar I depressed patients (DSM-IV criteria) with single photon emission computed tomography (SPECT). Visual analysis of images revealed no abnormality in eight patients and abnormal findings in nine patients. In the nine patients with abnormal findings, all showed regional decreases of the uptake of (99m)Tc-D,L-hexamethylpropylene amine oxime (HMPAO, four in the frontal region, two in the basal ganglia, and three in both the frontal region and the basal ganglia). The patients with visible SPECT abnormalities had significantly higher scores on the Hamilton Rating Scale for Depression (HDRS).

Noninvasive assessment of cardiac risk in type I diabetic patients being evaluated for combined pancreas‐kidney transplantation using dipyridamole‐MIBI perfusion

Abstract This study was performed to determine the value of dipyridamole‐99 mTc‐methoxy‐isobutyl isonitrile perfusion (99mTC‐MIBI) tomographic scintigraphy in the assessment of cardiac risk in patients being evaluated prior to combined pancreas‐kidney transplantation (PKT). We performed perfusion tomographic scintigraphy using single photon emission computed tomography (SPECT) on 77 patients. The tomographic images did not show clinically relevant findings in 65 patients. In the remaining 12 patients, coronary arteriography was performed: 2 showed normal results, 4 showed no stenosis, and 6 showed significant stenosis (≥ 70%). Seventy‐two patients underwent PKT. During the follow‐up (6–48 months), there were seven cardiac events, 4 patients with significant stenosis, and 3 with nonsignificant stenosis upon coronary arteriography, and all had pathological tomographic images. 99mTc‐MIBI tomographic scintigraphy may be useful in identifying patients at low risk of incurring cardiac events after PKT and may, in a large group of patients, obviate the need for routine coronary angiography.

Síndrome de Takotsubo. Utilidad de los estudios de Medicina Nuclear

Takotsubo syndrome can mimic an acute myocardial infarction. It is characterized by anginal chest pain with ST elevation in precordial leads, no coronary obstruction on angiography, and typical and reversible deformation of the left ventricular due to antero-apical ballooning with basal hyperkinesis. The pathophysiology of this syndrome is uncertain. It is probably multifactorial, cardiac adrenergic nervous dysfunction standing out in the acute phase. We report two cases performed within the diagnostic context of Takotsubo syndrome. Cardiac SPECT was performed using (123)I Metaiodobenzylguanidine (MIBG) and (99m)Tc-Tetrofosmin and the results of two cases were adrenergic denervation in the anterior wall without alterations in myocardial perfusion study. Identification of Takotsubo syndrome is of clinical importance because its management and prognosis differ significantly from that of acute myocardial infarction.

Takotsubo syndrome. Usefulness of nuclear medicine studies

Abstract Takotsubo syndrome can mimic an acute myocardial infarction. It is characterized by anginal chest pain with ST elevation in precordial leads, no coronary obstruction on angiography, and typical and reversible deformation of the left ventricular due to antero-apical ballooning with basal hyperkinesis. The pathophysiology of this syndrome is uncertain. It is probably multifactorial, cardiac adrenergic nervous dysfunction standing out in the acute phase. We report two cases performed within the diagnostic context of Takotsubo syndrome. Cardiac SPECT was performed using 123 I Metaiodobenzlguanidine (MIBG) and 99m Tc-Tetrofosmin and the results of two cases were adrenergic denervation in the anterior wall without alterations in myocardial perfusion study. Identification of Takotsubo syndrome is of clinical importance because its management and prognosis differ significantly from that of acute myocardial infarction.

In-111 pentetreotide uptake in a uterine myoma.

We present a case of a 43-year-old woman with a week-long epigastric pain, that did not resolve with ordinary treatment. Blood and urinary test were performed and the 5 hydroxyindoleacetic acid was elevated in the urine. There was suspicion of a carcinoid tumor. In-111 pentetreotide (Octreoscan) scan and computed tomography (CT) were performed. On the Octreoscan study we visualized hypogastric uptake that correlated with the CT image that showed a partially calcified uterine myoma. The diagnostic use of In-111 pentetreotide is for the evaluation of neuroendocrine tumors, but uptake has been demonstrated in different cell elements such as lymphocytes, fibroblasts, and endothelium.