BACKGROUND: Clinical diagnosis of multiple system atrophy (MSA) relays on signs and symptoms that are often difficult to identify particularly at early stage. Indeed neuropathological studies have demonstrated that Parkinson variant of MSA (MSA-P) is the first cause of misdiagnosis in a cohort of patients presenting with parkinsonian features. But accurate diagnosis of these disorders is important for deciding on treatment, appropriate advice and prognosis since atypical parkinsonian disorders are characterized by poor response to dopaminergic treatment and more rapid disease progression. Therefore, we conducted this study to investigate difference of perfusion Single Photon Emission Computed Tomography (SPECT) in patients with the early phase of MSA-P using SPM program. METHODS: We recruited consecutively 21 patients with MSA-P and 48 age-matched healthy controls. All subjects underwent Tc-99m HMPAO perfusion SPECT and this perfusion images were analyzed. RESULTS: For MSA-P, only hypoperfusion was seen in the middle frontal gyrus of left frontal lobe, superior frontal gyrus of right frontal lobe, precentral gyrus of left frontal lobe, middle frontal gyrus of right frontal lobe and precentral gyrus of right frontal lobe with respect to healthy subjects. CONCLUSIONS: We cautiously assume that perfusion SPECT may offer significant advantages compared to other imaging techniques in the assessment of neuronal degeneration in MSA-P and may help the clinician in the diagnostic characterization of patients presenting with atypical parkinsonism.
Cohort Studies ; Diagnosis ; Diagnostic Errors ; Disease Progression ; Frontal Lobe ; Humans ; Multiple System Atrophy* ; Neurons ; Parkinsonian Disorders ; Perfusion* ; Prognosis ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVES: Autism is a well-known psychiatric disorder that is presumed to have a neural basis. To investigate the underlying neurofunctional abnormalities of autism, the authors performed single photon emission computed tomography (SPECT) on children with autism. METHODS: Fifty-five children with untreated autism (47 boys and 8 girls, mean age=50.6+/-20.28 months) were selected from among the patients visiting the child and adolescent psychiatric clinic of Seoul National University Hospital. Psychiatrists had diagnosed the participants according to the DSM-IV criteria for autistic disorder and the Childhood Autism Rating Scale (CARS) criteria for a diagnosis of autism. All participants were examined using 99mTC-HMPAO Brain SPECT. Using statistical parametric mapping (SPM) analysis, we compared the participants' SPECT images to standardized SPECT images of normal children, which had been retrospectively selected by the authors, on a voxel by voxel basis. Voxels with a p-value less than .001 were considered to be significantly different. RESULTS: The autistic group showed significant hypoperfusion in the right medial frontal gyrus, right precentral gyrus, and left precuneus gyrus. In addition, they showed no significant hyperperfusion areas when compared to the control group. CONCLUSION: The findings of hypoperfusion in the medial-frontal lobe and precuneus are accord with hemodynamic abnormalities that have been already reported. Therefore, these findings are compatible with the recently suggested "theory of mind" hypothesis and the disturbances in attention shifting that have been observed in autistic children.
Adolescent ; Autistic Disorder ; Brain ; Child ; Diagnostic and Statistical Manual of Mental Disorders ; Hemodynamics ; Humans ; Perfusion ; Psychiatry ; Retrospective Studies ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon

PURPOSE: The aim of this study is to assess the specific patterns of regional cerebral blood flow (rCBF) in patients with the early stage of subcortical vascular dementia (SVaD) and Alzheimer's disease (AD) using Tc-99m HMPAO SPECT, and to compare the differences between the two conditions. MATERIALS AND METHODS: Sixteen SVaD, 46 AD and 12 control subjects participated in this study. We included the patients with SVaD and AD according to NINCDS-ADRDA and NINDS-AIREN criteria. They were all matched for age, education and clinical dementia rating scores. Three groups were evaluated by Tc-99m HMPAO SPECT using statistical parametric mapping (SPM) for measuring rCBF. The SPECT data of patients with SVaD and AD were compared with those of normal control subjects and then compared with each other. RESULTS: SPM analysis of the SPECT image showed significant perfusion deficits on the right temporal region and thalamus, left insula and superior temporal gyrus, both cingulate gyri and frontal subgyri in patients with SVaD and on the left supramarginal gyrus, superior temporal gyrus, postcentral gyrus and inferior parietal lobule, right fugiform gyrus and both cingulate gyri in AD compared with control subjects (uncorrected p<0.01). SVaD patients revealed significant hypoperfusion in the right parahippocampal gyrus with cingulated gyrus, left insula and both frontal subgyral regions compared with AD (uncorrected p<0.01). CONCLUSION: Our study shows characteristic and different pattern of perfusion deficits in patients with SVaD and AD, and these results may be helpful to discriminate the two conditions in the early stage of illness.
Alzheimer Disease* ; Dementia ; Dementia, Vascular* ; Education ; Humans ; Parahippocampal Gyrus ; Perfusion ; Rabeprazole ; Technetium Tc 99m Exametazime* ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

A 20-year-old man underwent a Tc-99m HMPAO labeled leukocyte scan for the evaluation of an infection at the stump of an AK amputation, which was conducted due to an open communicated fracture of the left lower leg. Blood-flow and blood-pool images demonstrated a pseudoaneurysm with a focus of intense activity medial to the stump, and centered within a large photopenic defect by surrounding hematoma. Delayed image obtained at 3 hours post-injection showed persistent intense and slight increased activity. Contrast angiography confirmed the presence of a pseudoaneurysm arising from a branch of the left superficial femoral artery.
Amputation Stumps* ; Amputation* ; Aneurysm, False* ; Angiography ; Femoral Artery ; Hematoma ; Humans ; Leg ; Leukocytes* ; Radionuclide Angiography ; Technetium Tc 99m Exametazime* ; Young Adult

A 73-year-old man was admitted for intermittent episodes of fever and chills for 3 months. He had been implanted with a permanent pacemaker to control tachy-bradycardia syndrome 7 months before admission. Blood cultures were positive for Actinobacillus actinomycetemcomitans and a 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) WBC scan revealed inflammation on the pacemaker lead in extracardiac site. Oral examination revealed several dental caries. The patient was treated with intravenous ceftriaxone, followed by oral ciprofloxacin without removal of the infected pacemaker lead. He was doing well 10 months without febrile episodes after discontinuation of antibiotics. This report describes the first case of A. actinomycetemcomitans bacteremia associated with a pacemaker lead and localized by 99mTc-HMPAO WBC scan
Actinobacillus* ; Aged ; Aggregatibacter actinomycetemcomitans* ; Anti-Bacterial Agents ; Bacteremia* ; Ceftriaxone ; Chills ; Ciprofloxacin ; Dental Caries ; Diagnosis, Oral ; Fever ; Humans ; Inflammation ; Technetium Tc 99m Exametazime

A 73-year-old man was admitted for intermittent episodes of fever and chills for 3 months. He had been implanted with a permanent pacemaker to control tachy-bradycardia syndrome 7 months before admission. Blood cultures were positive for Actinobacillus actinomycetemcomitans and a 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) WBC scan revealed inflammation on the pacemaker lead in extracardiac site. Oral examination revealed several dental caries. The patient was treated with intravenous ceftriaxone, followed by oral ciprofloxacin without removal of the infected pacemaker lead. He was doing well 10 months without febrile episodes after discontinuation of antibiotics. This report describes the first case of A. actinomycetemcomitans bacteremia associated with a pacemaker lead and localized by 99mTc-HMPAO WBC scan
Actinobacillus* ; Aged ; Aggregatibacter actinomycetemcomitans* ; Anti-Bacterial Agents ; Bacteremia* ; Ceftriaxone ; Chills ; Ciprofloxacin ; Dental Caries ; Diagnosis, Oral ; Fever ; Humans ; Inflammation ; Technetium Tc 99m Exametazime

PURPOSE: The purpose of this study is to evaluate migration of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) labeled immature and mature dendritic cells (DC) in the mouse. METHODS: DC were collected from bone marrow (BM) of tibiae and femurs of mice. Immature and mature DC from BM cells were radiolabeled with 99mTc-HMPAO. To evaluate the functional and phenotypic changes of DC from radiolabeling, the allogeneic mixed lymphocyte reaction (MLR) and fluorescence-activated cell sorting (FACS) analysis were performed before and after labeling with 99mTc-HMPAO. Migration of intravenously injected DC (iv-DC) was assessed by serial gamma camera images of mice with or without subcutaneous tumor. Percent injected dose per gram (%ID/g) was calculated in lungs, liver, spleen, kidneys, and tumor through dissection of each mice after 24 hours of injection. RESULTS: Labeling efficiency of immature and mature DC were 60.4 +/- 5.4% and 61.8 +/- 6.7%, respectively. Iv-DC initially appeared in the lungs, then redistributed mainly to liver and spleen. Migration of mature DC to spleen was significantly higher than that of immature DC (38.3 +/- 4.0 % vs. 32.2 +/- 4.1 % in control group, 40.4 +/- 4.1% vs. 35.9 +/- 3.8 % in tumor group; p< 0.05). Migration to tumor was also significantly higher in mature DC than in immature DC (2.4 +/- 0.3% vs 1.7 +/- 0.2%; p=0.034). CONCLUSION: Assessment of migration pattern of DC in mice was possible using 99mTc-HMPAO labeled immature and mature DC. Migration of mature DC to spleen and tumor was higher than that of immature DC when they were i.v. injected.
Animals ; Bone Marrow ; Dendritic Cells* ; Femur ; Flow Cytometry ; Gamma Cameras ; Kidney ; Liver ; Lung ; Lymphocyte Culture Test, Mixed ; Mice* ; Radionuclide Imaging ; Spleen ; Technetium Tc 99m Exametazime ; Tibia

Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
Anti-Bacterial Agents ; Aortic Aneurysm, Abdominal ; Aortic Valve Insufficiency ; Bacteremia ; Early Diagnosis ; Endocarditis* ; Fever ; Fistula ; Groin ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mortality ; Technetium Tc 99m Exametazime ; Transplants*

Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
Anti-Bacterial Agents ; Aortic Aneurysm, Abdominal ; Aortic Valve Insufficiency ; Bacteremia ; Early Diagnosis ; Endocarditis* ; Fever ; Fistula ; Groin ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mortality ; Technetium Tc 99m Exametazime ; Transplants*

BACKGROUND: Restenosis after percutaneous coronary intervention (PCI) is a matter that still remains to be resolved. Herein, the inhibitory effect of locally delivered (99m) Tc-HMPAO (hexamethyl propylene amine oxime) on neointimal hyperplasia after coronary stenting was examined in a pocine model, and its safety and efficacy observed in patients with coronary stent restenosis. METHODS: After a stent overdilation injury, local radioisotope delivery using (99m) Tc-HMPAO was applied to one coronary artery (Group I) and control therapy to another (Group II) in each of 10 pigs. Follow-up coronary angiogram (CAG) and histopathologic assessment were performed 4 weeks after stenting. Eleven patients (10 males and one female, 62.4 +/- 5.7 years of age) underwent local administration of 30 mCi/ 2 mL (99m) Tc-HMPAO shortly after PCI, via a Dispatch CatheterTM, followed by a whole body scan to evaluate the distribution of the (99m) Tc-HMPAO, as well as a thallium-201 (Tl-201) myocardial scan to evaluate myocardial perfusion. The major adverse cardiac events (MACE) were assessed during a one-year clinical follow-up. RESULTS: On histopathological analysis, the neointimal areas were 1.2 +/- 0.6 and 2.7 +/- 0.4 mm2 (p=0.002), and the histopathological areas of stenosis were 27.16.3 and 53.4 +/- 5.2% in Groups I and II (p=0.001), respectively. In the clinical study, there was no in-hospital MACE. On a quantitative coronary angiographic analysis, the minimal luminal diameter was increased from 0.4 +/- 0.3 to 2.9 +/- 0.2 mm, and diameter stenosis decreased from 84.2 +/- 9.5 to 16.3 +/- 11.0% following PCI. Follow-up CAG was performed in 9 cases (81.8%) and restenosis occurred in 2 (22.2%). On a follow-up CAG, the minimal luminal diameter, diameter stenosis rate, lumen loss and loss index were 2.0 +/- 0.8 mm, 27.7 +/- 2.9%, 0.7 +/- 0.7 mm and 0.2 +/- 0.3, respectively. During the one-year clinical follow-up there were no cases of death or acute MI, but two cases of target vessel revascularization (18.2%). CONCLUSION: Local delivery of (99m) Tc-HMPAO, a novel radiotherapy, can be used safely and effectively for coronary stent restenosis.
Angioplasty, Transluminal, Percutaneous Coronary ; Animals ; Brachytherapy/*methods ; Coronary Angiography ; Coronary Restenosis/*radiotherapy ; Female ; Humans ; Male ; Middle Aged ; Radiopharmaceuticals/*therapeutic use ; Research Support, Non-U.S. Gov't ; *Stents ; Swine ; Technetium Tc 99m Exametazime/*therapeutic use