P Bertelli

Paroxysmal arousal in epilepsy associated with cingulate hyperperfusion.

A patient with nocturnal frontal lobe epilepsy characterized by paroxysmal motor attacks during sleep had brief paroxysmal arousals (PAs), complex episodes of nocturnal paroxysmal dystonia, and epileptic nocturnal wandering since childhood. Ictal SPECT during an episode of PA demonstrated increased blood flow in the right anterior cingulate gyrus and cerebellar cortex with hypoperfusion in the right temporal and frontal associative cortices.

The ‘Fragmented’ Scintigraphic Lung Pattern in Pulmonary Lymphangitic Carcinomatosis Secondary to Breast Cancer

Pulmonary lymphangitic carcinomatosis (PLC) is an unusual presentation of diffuse infiltrative lung disease. In this report we present two cases secondary to breast cancer; the diagnosis was made by means of transbronchial lung biopsy or postmortem examination. The goal of this study was to analyze the scintigraphic pattern of pulmonary perfusion performed with technetium-99m macroaggregated albumin (99mTc-MAA) in the hope of achieving improved recognition of PLC and its subsequent diagnosis. Upon admission, both patients underwent routine clinical exams followed by chest X-rays. The second patient also underwent CT examination, and both were ultimately examined using pulmonary perfusion scintigraphy with 99mTc-MAA. In the various exams performed, the most reliable and easily identified diagnostic finding turned out to be a characteristic ‘fragmented’ lung pattern revealed with the perfusion lung scan. Unfortunately, in both cases the patients’ conditions rapidly worsened and death occurred shortly following scintigraphy. We were able to conclude that the recognition of the mentioned fragmented scintigraphic lung pattern may be useful in suspected PLC, whereas the nonspecific clinical presentation of this pathology makes diagnosis extremely difficult, with the most significant results being achieved through a comparison of scintigraphic and high resolution CT data.

Assessment of brain perfusion by ECD-Tc99m SPET in Rett Syndrome

Rett syndrome (RS) is a progressive neurological pediatric disorder which affects only girls. The aim of our study is to determinate if brain perfusion abnormalities might be able to explain the clinical manifestations and progression of the disease. Quantitative global and regional brain blood flow was evaluated in 25 RS girls and compared with a reference group of 9 children. SPET revealed a considerable global reduction in cerebral perfusion in the group of RS girls and a great statistical difference was recorded when compared with the control group. The reduction of cerebral perfusion reflects the functional disturbances in the brains of RS girls, which might be associated with precocious brain atrophy, even when morphologic imaging (MRI) appears normal.

Blood flow changes in cerebral and cerebellum cortex in obsessive-compulsive disorder patients evaluated with ECD-Tc99m SPET

A semiquantitative analysis of brain perfusion was assessed with 99mTc-ECD SPET in 30 pts affected by Obsessive-Compulsive Disorder (OCD) and in 8 normal controls. In OCD drug-free pts a significant blood flow increase in both frontal, the right temporal, the left occipital cortex, the left thalamus and in the cerebellum was observed. Moreover, cerebellum perfusion was related with several brain regions only in drug-free pts. Treated patients did not show significant blood flow abnormalities. The presence of comorbidity in OCD patients was associated with a trend of hypoperfusion. The OCD duration showed a relationship only with lenticular nuclei perfusion.

Tc99m-ECD Brain SPET in Diagnosis of Cerebral Perfusion Abnormalities in Children with Therapy-Resistant Epilepsy

We performed Tc99m-ECD interictal SPET in 26 children with severe therapy-resistant epilepsy. All children underwent detailed clinical examination, EEG investigation and brain MRI. In 21/26 children, SPET demonstrated brain blood flow abnormalities, 13 of them in the same territories with EEG alterations. MRI showed structural lesions in 6/26 children. These data confirm that brain SPET is considerably sensitive in detecting and localizing hypoperfused areas that could be associated with epileptic foci in these patients, even when the MRI pattern is normal.

Hürthle Cell Tumor and Technetium-99m-Sestamibi Scintigraphy (Single Injection Double-Phase Study)

Single injection dual-phase MIBI thyroid scintigraphy was performed on 49 pts with a cold nodule on a previous Tc99m scintigraphy. In 8 pts the nodule displayed intense and persistent MIBI uptake (8 Hurthle cell tumors). In 23 pts the nodule displayed early intense uptake with late fading activity (9 benign and 14 malignant nodules). In 18 patients the nodule showed no MIBI uptake (3 malignant and 15 benign nodules). This tecnique is able to identify Hurthle cell tumors since they retain MIBI due to the presence of an abundant granular acidophilic cytoplasm represented by crowded mitochondria.

Perfusion lung scanning with Tc-99m MAA in the assessment of Churg-Strauss syndrome.

Churg-Strauss syndrome (CSS) is a rare allergic disease characterized by eosinophilia, asthma, fever, and necrotizing vasculitis. Unlike polyarteritis nodosa, CSS presents pulmonary vasculitis with extravascular granulomatous inflammation. The lung is the organ most frequently involved. However, any organ can be affected; particularly the skin, the nervous system, the heart, or the gastrointestinal tract. The clinical picture of pulmonary allergy may precede the other components of the disease by months or years. Pulmonary perfusion scintigraphy with Tc-99m MAA is able to detect focal hypoperfusion corresponding to praecox eosinophilic infiltrations. At present, CSS usually responds to corticosteroid therapy

Detection of early systolic dysfunction in ischemia by sequential radionuclide imaging of ejection rates

The effectiveness of sequential imaging of early regional left ventricular contraction in the detection of ischémie abnormalities was assessed in 47 patients (15 with previous infarction) with angiographically proven coronary artery disease, and 11 normal volunteers, undergoing first pass radionuclide angiography with a multielement gamma camera at rest and at peak exercise. Global left ventricular hemodynamic parameters, and functional images of regional ejection fraction and ejection rate were compared to 6 pairs of sequential rate images showing the decrease and the increase of regional left ventricular volume during a time-interval of 80–280 ms (at rest) and 50–175 ms (at stress) from end-diastole. Diagnostic accuracy of sequential images (67–91%) was higher than that of ejection rate image (71–72%), and of global hemodynamic parameters (33–60%), in the detection of coronary patients. Regional sensitivity of stress sequential increase and decrease image achieved 77% and 100%, respectively. During early systole sensitivity of sequential decrease and increase images approached 100% even at rest, subsequently decreasing because of normalizing contraction. Thus, the analysis of early systolic dysfunction provided by dynamic sequential functional images of ejection rates proved to be an effective diagnostic tool in the detection of myocardial ischémie dysfunction.