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Morton DWA, Vennart N, Slinger H, Gannon M, Razvi S, Bartholomew P. Should we reconsider blocking the thyroid for 123 I-Ioflupane studies in elderly patients: quantifying radiation dose to the unblocked thyroid and implications for clinical practice. Nucl Med Commun 2024; 45:108-114. [PMID: 37901928 DOI: 10.1097/mnm.0000000000001785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVES To measure the absorbed dose to the thyroid in patients injected with 123 I-Ioflupane where the thyroid was not blocked with prophylaxis to investigate whether thyroid blocking should be limited to younger patients. This risk from the additional absorbed dose to the thyroid was then compared to the risk from iodine overdose through ingestion of the iodide prophylaxis, resulting in iodine-induced hyper/hypothyroidism (IIH). METHODS A cohort of patients (n = 30) who did not receive thyroid prophylaxis underwent static thyroid imaging 3 h after 123 I-Ioflupane administration. The measured thyroidal uptake of free 123 I was then extrapolated to peak uptake time (24 h post-administration). This value was used to calculate cumulated activity in the thyroid and thus thyroid-thyroid absorbed dose D(rthy←rthy ) using the relevant S-value in the MIRD method. RESULTS Mean D(rthy←rthy ) was found to be 13.6 mGy with an SD of 8.8 mGy; this would contribute an additional 0.5 mSv to the effective dose. CONCLUSION ARSAC recommends in its Notes for Guidance prophylactic thyroid blocking if the absorbed dose to the thyroid is >50 mGy; the maximum thyroid dose in this study cohort was 36.3 mGy. With risk from IIH and its associated cardiac complications increasing with age, this study suggests that iodide prophylaxis with 123 I-Ioflupane should be reconsidered for elderly patient.
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Affiliation(s)
- D William A Morton
- Department of Medical Physics, South Tyneside and Sunderland NHS Foundation Trust, Sunderland and
| | - Nicholas Vennart
- Department of Medical Physics, South Tyneside and Sunderland NHS Foundation Trust, Sunderland and
| | - Harry Slinger
- Department of Medical Physics, South Tyneside and Sunderland NHS Foundation Trust, Sunderland and
| | - Mark Gannon
- Department of Medical Physics, South Tyneside and Sunderland NHS Foundation Trust, Sunderland and
| | - Salman Razvi
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Peter Bartholomew
- Department of Medical Physics, South Tyneside and Sunderland NHS Foundation Trust, Sunderland and
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Ozolmez N, Silindir-Gunay M, Volkan-Salanci B. An overview: Radiotracers and nano-radiopharmaceuticals for diagnosis of Parkinson's disease. Appl Radiat Isot 2024; 203:111110. [PMID: 37989065 DOI: 10.1016/j.apradiso.2023.111110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
Parkinson's disease (PD) is a widespread progressive neurodegenerative disease. Clinical diagnosis approaches are insufficient to provide an early and accurate diagnosis before a substantial of loss of dopaminergic neurons. PET and SPECT can be used for accurate and early diagnosis of PD by using target-specific radiotracers. Additionally, the importance of BBB penetrating targeted nanosystems has increased in recent years. This article reviews targeted radiopharmaceuticals used in clinics and novel nanocarriers for research purposes of PD imaging.
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Affiliation(s)
- Nur Ozolmez
- Hacettepe University, Faculty of Pharmacy, Department of Radiopharmacy, Ankara, Turkey.
| | - Mine Silindir-Gunay
- Hacettepe University, Faculty of Pharmacy, Department of Radiopharmacy, Ankara, Turkey.
| | - Bilge Volkan-Salanci
- Hacettepe University, Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey.
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De Feo MS, Frantellizzi V, Locuratolo N, Di Rocco A, Farcomeni A, Pauletti C, Marongiu A, Lazri J, Nuvoli S, Fattapposta F, De Vincentis G, Spanu A. Role of Functional Neuroimaging with 123I-MIBG and 123I-FP-CIT in De Novo Parkinson's Disease: A Multicenter Study. Life (Basel) 2023; 13:1786. [PMID: 37629643 PMCID: PMC10455638 DOI: 10.3390/life13081786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/10/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Parkinson's disease is a progressive neurodegenerative disorder, with incidence and prevalence rates of 8-18 per 100,000 people per year and 0.3-1%, respectively. As parkinsonian symptoms do not appear until approximately 50-60% of the nigral DA-releasing neurons have been lost, the impact of routine structural imaging findings is minimal at early stages, making Parkinson's disease an ideal condition for the application of functional imaging techniques. The aim of this multicenter study is to assess whether 123I-FP-CIT (DAT-SPECT), 123I-MIBG (mIBG-scintigraphy) or an association of both exams presents the highest diagnostic accuracy in de novo PD patients. METHODS 288 consecutive patients with suspected diagnoses of Parkinson's disease or non- Parkinson's disease syndromes were analyzed in the present Italian multicenter retrospective study. All subjects were de novo, drug-naive patients and met the inclusion criteria of having undergone both DAT-SPECT and mIBG-scintigraphy within one month of each other. RESULTS The univariate analysis including age and both mIBG-SPECT and DAT-SPECT parameters showed that the only significant values for predicting Parkinson's disease in our population were eH/M, lH/M, ESS and LSS obtained from mIBG-scintigraphy (p < 0.001). CONCLUSIONS mIBG-scintigraphy shows higher diagnostic accuracy in de novo Parkinson's disease patients than DAT-SPECT, so given the superiority of the MIBG study, the combined use of both exams does not appear to be mandatory in the early phase of Parkinson's disease.
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Affiliation(s)
- Maria Silvia De Feo
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy (J.L.)
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy (J.L.)
| | - Nicoletta Locuratolo
- Department of Human Neurosciences, Sapienza, University of Rome, 00161 Rome, Italy
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, 00161 Rome, Italy
| | - Arianna Di Rocco
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy (J.L.)
| | - Alessio Farcomeni
- Department of Economics & Finance, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Caterina Pauletti
- Department of Human Neurosciences, Sapienza, University of Rome, 00161 Rome, Italy
| | - Andrea Marongiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Julia Lazri
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy (J.L.)
| | - Susanna Nuvoli
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | | | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy (J.L.)
| | - Angela Spanu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
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Nicastro N, Nencha U, Burkhard PR, Garibotto V. Dopaminergic imaging in degenerative parkinsonisms, an established clinical diagnostic tool. J Neurochem 2023; 164:346-363. [PMID: 34935143 DOI: 10.1111/jnc.15561] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Parkinson's disease (PD) and other neurodegenerative parkinsonisms are characterised by loss of striatal dopaminergic neurons. Dopamine functional deficits can be measured in vivo using positron emission tomography (PET) and single-photon emission computed tomography (SPECT) ligands assessing either presynaptic (e.g. dopamine synthesis and storage, transporter density) or postsynaptic terminals (i.e. D2 receptors availability). Nuclear medicine imaging thus helps the clinician to separate degenerative forms of parkinsonism with other neurological conditions, e.g. essential tremor or drug-induced parkinsonism. With the present study, we aimed at summarizing the current evidence about dopaminergic molecular imaging in the diagnostic evaluation of PD, atypical parkinsonian syndromes and dementia with Lewy bodies (DLB), as well as its potential to distinguish these conditions and to estimate disease progression. In fact, PET/SPECT methods are clinically validated and have been increasingly integrated into diagnostic guidelines (e.g. for PD and DLB). In addition, there is novel evidence on the classification properties of extrastriatal signal. Finally, dopamine imaging has an outstanding potential to detect neurodegeneration at the premotor stage, including REM-sleep behavior disorder and olfactory loss. Therefore, inclusion of subjects at an early stage for clinical trials can largely benefit from a validated in vivo biomarker such as presynaptic dopamine pathways PET/SPECT assessment.
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Affiliation(s)
- Nicolas Nicastro
- Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Umberto Nencha
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre R Burkhard
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Valentina Garibotto
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
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Oh SJ, Lee N, Nam KR, Kang KJ, Han SJ, Lee KC, Lee YJ, Choi JY. Amyloid pathology induces dysfunction of systemic neurotransmission in aged APPswe/PS2 mice. Front Neurosci 2022; 16:930613. [PMID: 35992913 PMCID: PMC9389227 DOI: 10.3389/fnins.2022.930613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/15/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to investigate how amyloid pathology affects the functional aspects of neurotransmitter systems in Alzheimer’s disease. APPswe/PS2 mice (21 months of age) and wild-type (WT) mice underwent positron emission tomography (PET) and magnetic resonance spectroscopy (MRS). First, we obtained 18F-FDG and 18F-florbetaben PET scans to evaluate neuronal integrity and amyloid pathology. Second, 18F-FPEB and 18F-FMZ PET data were acquired to assess the excitatory-inhibitory neurotransmission. Third, to monitor the dopamine system, 18F-fallypride PET was performed. Amyloid PET imaging revealed that radioactivity was higher in the AD group than that in the WT group, which was validated by immunohistochemistry. In the cortical and limbic areas, the AD group showed a 25–27% decrease and 14–35% increase in the glutamatergic and GABAergic systems, respectively. The dopaminergic system in the AD group exhibited a 29% decrease in brain uptake compared with that in the WT group. A reduction in glutamate, N-acetylaspartate, and taurine levels was observed in the AD group using MRS. Our results suggest that dysfunction of the neurotransmitter system is associated with AD pathology. Among the systems, the GABAergic system was prominent, implying that the inhibitory neurotransmission system may be the most vulnerable to AD pathology.
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Affiliation(s)
- Se Jong Oh
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Namhun Lee
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Kyung Rok Nam
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Kyung Jun Kang
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Sang Jin Han
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Kyo Chul Lee
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Yong Jin Lee
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Jae Yong Choi
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
- Radiological and Medico-Oncological Sciences, University of Science and Technology (UST), Seoul, South Korea
- *Correspondence: Jae Yong Choi,
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6
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Bauckneht M, Chiola S, Donegani MI, Raffa S, Miceli A, Ferrarazzo G, Morbelli S. Central Nervous System Imaging in Movement Disorders. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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7
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Verger A, Grimaldi S, Ribeiro MJ, Frismand S, Guedj E. Single Photon Emission Computed Tomography/Positron Emission Tomography Molecular Imaging for Parkinsonism: A Fast-Developing Field. Ann Neurol 2021; 90:711-719. [PMID: 34338333 PMCID: PMC9291534 DOI: 10.1002/ana.26187] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 11/26/2022]
Abstract
The early differential diagnosis of Parkinson disease and atypical parkinsonism is a major challenge. The use of single photon emission computed tomography (SPECT)/positron emission tomography (PET) molecular imaging to investigate parkinsonism is a fast‐developing field. Imaging biomarker research may potentially lead to more accurate disease detection, enabling earlier diagnosis and treatment. This review summarizes recent SPECT/PET advances in radiopharmaceuticals and imaging technologies/analyses that improve the diagnosis of neurodegenerative parkinsonism. We are currently witnessing a turning point in the field. Integrating molecular imaging as a diagnostic technique represents an opportunity to reassess the strategies for diagnosing neurodegenerative parkinsonism. ANN NEUROL 2021;90:711–719
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Affiliation(s)
- Antoine Verger
- Department of Nuclear Medicine & Nancyclotep Imaging Platform, Centre Hospitalier Régional Universitaire Nancy, Lorraine University, Nancy, France.,Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1254, Lorraine University, Nancy, France
| | - Stephan Grimaldi
- Department of Neurology and Movement Disorders, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France
| | - Maria-Joao Ribeiro
- Unité Mixte de Recherche 1253, iBrain, University of Tours, Institut National de la Santé et de la Recherche Médicale Centre d'Investigation Clinique 1415, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - Solène Frismand
- Department of Neurology, Centre Hospitalier Régional Universitaire Nancy, Lorraine University, Nancy, France
| | - Eric Guedj
- Aix-Marseille University, Centre National de Recherche Scientifique, Central School of Marseille, Unité Mixte de Recherche 7249, Fresnel Institute, Marseille, France.,Department of Nuclear Medicine, Public Assistance Hospitals of Marseille, Timone University Hospital, Marseille, France.,Centre Européen de Recherche en Imagerie Médicale, Aix-Marseille University, Marseille, France
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8
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Akdemir ÜÖ, Bora Tokçaer A, Atay LÖ. Dopamine transporter SPECT imaging in Parkinson’s disease and parkinsonian disorders. Turk J Med Sci 2021; 51:400-410. [PMID: 33237660 PMCID: PMC8203173 DOI: 10.3906/sag-2008-253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/24/2020] [Indexed: 12/29/2022] Open
Abstract
The dopamine transporter (DAT) imaging provides an objective tool for the assessment of dopaminergic function of presynaptic terminals which is valuable for the differential diagnosis of parkinsonian disorders related to a striatal dopaminergic deficiency from movement disorders not related a striatal dopaminergic deficiency. DAT imaging with single-photon emission computed tomography (SPECT) can be used to confirm or exclude a diagnosis of dopamine deficient parkinsonism in cases where the diagnosis is unclear. It can also detect the dopaminergic dysfunction in presymptomatic subjects at risk for Parkinson’s disease (PD) since the reduced radiotracer binding to DATs in striatum is already present in the prodromal stage of PD. This review covers the rationale of using DAT SPECT imaging in the diagnosis of PD and other parkinsonian disorders, specifically focusing on the practical aspects of imaging and routine clinical indications.
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Affiliation(s)
- Ümit Özgür Akdemir
- Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayşe Bora Tokçaer
- Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Lütfiye Özlem Atay
- Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
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9
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Extra-striatal D 2/3 receptor availability in youth at risk for addiction. Neuropsychopharmacology 2020; 45:1498-1505. [PMID: 32259831 PMCID: PMC7360619 DOI: 10.1038/s41386-020-0662-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/18/2022]
Abstract
The neurobiological traits that confer risk for addictions remain poorly understood. However, dopaminergic function throughout the prefrontal cortex, limbic system, and upper brainstem has been implicated in behavioral features that influence addiction vulnerability, including poor impulse control, and altered sensitivity to rewards and punishments (i.e., externalizing features). To test these associations in humans, we measured type-2/3 dopamine receptor (DA2/3R) availability in youth at high vs. low risk for substance use disorders (SUDs). In this study, N = 58 youth (18.5 ± 0.6 years) were recruited from cohorts that have been followed since birth. Participants with either high (high EXT; N = 27; 16 F/11 M) or low pre-existing externalizing traits (low EXT; N = 31; 20 F/11 M) underwent a 90-min positron emission tomography [18F]fallypride scan, and completed the Barratt Impulsiveness Scale (BIS-11), Substance Use Risk Profile scale (SURPS), and Sensitivity to Punishment (SP) and Sensitivity to Reward (SR) questionnaire. We found that high vs. low EXT trait participants reported elevated substance use, BIS-11, SR, and SURPS impulsivity scores, had a greater prevalence of psychiatric disorders, and exhibited higher [18F]fallypride binding potential (BPND) values in prefrontal, limbic and paralimbic regions, even when controlling for substance use. Group differences were not evident in midbrain dopamine cell body regions, but, across all participants, low midbrain BPND values were associated with low SP scores. Together, the results suggest that altered DA2/3R availability in terminal extra-striatal and dopamine cell body regions might constitute biological vulnerability traits, generating an EXT trajectory for addictions with and without co-occurring alterations in punishment sensitivity (i.e., an internalizing feature).
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Bailly M, Le Rouzic G, Metrard G, Ribeiro MJ. Faster Acquisition for Dopamine Transporter Imaging Using Swiftscan Step and Shoot Continuous SPECT Without Impairing Visual and Semiquantitative Analysis. Front Med (Lausanne) 2020; 7:235. [PMID: 32626716 PMCID: PMC7314987 DOI: 10.3389/fmed.2020.00235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/06/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: Dopamine transporter (DAT) imaging with [123I] FP-CIT (DaTSCAN) is an established diagnostic tool in parkinsonism and dementia. Using a low energy high resolution and sensitivity (LEHRS) collimator and step and shoot continuous scanning mode, Swiftscan single photon emission computed tomography (SPECT) (GE Healthcare) enhances sensitivity and enables time or dose reduction. In this phantom and clinical study, we aim to validate a 25% reduction of the acquisition time using Swiftscan and its lack of effect on visual or quantitative analysis. Methods: Anthropomorphic striatal phantom with fillable striata was used. SPECT data from 30 normals (12 men, 18 women; age range, 39–91 years; mean, 71 years ± 11) and 30 patients with Parkinson disease or other neurodegenerative disease with extra-pyramidal syndrome (16 men, 14 women; age range, 43–84 years; mean, 69 years ± 10) were also included. Both phantom and clinical data were acquired using Swiftscan and reconstructed with full-time and 25%-time reduction. Striatal binding ratios (SBRs) were calculated using DaTQUANT software. Results: Both in phantom experiments and in clinical cases, visual analysis remained stable and SBRs were not significantly different whether using Swiftscan or Swiftscan with 25%-time reduction (p < 0.001). There was an excellent inter-rater agreement and no effect of time reduction on diagnosis or on image quality. Conclusion: Using Swiftscan step and shoot continuous SPECT mode, 25%-time reduction can be applied to DaTSCAN acquisition protocols, without impairing visual or quantitative analysis.
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Affiliation(s)
| | | | - Gilles Metrard
- Nuclear Medicine Department, CHR ORLEANS, Orleans, France
| | - Maria Joao Ribeiro
- Nuclear Medicine Department, CHRU TOURS, Hôpital Bretonneau, Tours, France
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Vaz SC, Oliveira F, Herrmann K, Veit-Haibach P. Nuclear medicine and molecular imaging advances in the 21st century. Br J Radiol 2020; 93:20200095. [PMID: 32401541 PMCID: PMC10993229 DOI: 10.1259/bjr.20200095] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Currently, Nuclear Medicine has a clearly defined role in clinical practice due to its usefulness in many medical disciplines. It provides relevant diagnostic and therapeutic options leading to patients' healthcare and quality of life improvement. During the first two decades of the 21stt century, the number of Nuclear Medicine procedures increased considerably.Clinical and research advances in Nuclear Medicine and Molecular Imaging have been based on developments in radiopharmaceuticals and equipment, namely, the introduction of multimodality imaging. In addition, new therapeutic applications of radiopharmaceuticals, mainly in oncology, are underway.This review will focus on radiopharmaceuticals for positron emission tomography (PET), in particular, those labeled with Fluorine-18 and Gallium-68. Multimodality as a key player in clinical practice led to the development of new detector technology and combined efforts to improve resolution. The concept of dual probe (a single molecule labeled with a radionuclide for single photon emission computed tomography)/positron emission tomography and a light emitter for optical imaging) is gaining increasing acceptance, especially in minimally invasive radioguided surgery. The expansion of theranostics, using the same molecule for diagnosis (γ or positron emitter) and therapy (β minus or α emitter) is reshaping personalized medicine.Upcoming research and development efforts will lead to an even wider array of indications for Nuclear Medicine both in diagnosis and treatment.
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Affiliation(s)
- Sofia C. Vaz
- Nuclear Medicine - Radiopharmacology, Champalimaud Centre for
the Unknown, Champalimaud Foundation,
Lisbon, Portugal
| | - Francisco Oliveira
- Nuclear Medicine - Radiopharmacology, Champalimaud Centre for
the Unknown, Champalimaud Foundation,
Lisbon, Portugal
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen,
University of Duisburg-Essen,
Essen, Germany
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12
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EANM practice guideline/SNMMI procedure standard for dopaminergic imaging in Parkinsonian syndromes 1.0. Eur J Nucl Med Mol Imaging 2020; 47:1885-1912. [PMID: 32388612 PMCID: PMC7300075 DOI: 10.1007/s00259-020-04817-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/06/2020] [Indexed: 02/05/2023]
Abstract
Purpose This joint practice guideline or procedure standard was developed collaboratively by the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The goal of this guideline is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of dopaminergic imaging in parkinsonian syndromes. Methods Currently nuclear medicine investigations can assess both presynaptic and postsynaptic function of dopaminergic synapses. To date both EANM and SNMMI have published procedural guidelines for dopamine transporter imaging with single photon emission computed tomography (SPECT) (in 2009 and 2011, respectively). An EANM guideline for D2 SPECT imaging is also available (2009). Since the publication of these previous guidelines, new lines of evidence have been made available on semiquantification, harmonization, comparison with normal datasets, and longitudinal analyses of dopamine transporter imaging with SPECT. Similarly, details on acquisition protocols and simplified quantification methods are now available for dopamine transporter imaging with PET, including recently developed fluorinated tracers. Finally, [18F]fluorodopa PET is now used in some centers for the differential diagnosis of parkinsonism, although procedural guidelines aiming to define standard procedures for [18F]fluorodopa imaging in this setting are still lacking. Conclusion All these emerging issues are addressed in the present procedural guidelines for dopaminergic imaging in parkinsonian syndromes.
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Impact of aging on semiquantitative uptake parameters in normal rated clinical baseline [123I]Ioflupane single photon emission computed tomography/computed tomography. Nucl Med Commun 2019; 40:1001-1004. [PMID: 31343608 DOI: 10.1097/mnm.0000000000001061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Studies investigating the age-related impact on dopamine transporter binding have previously omitted the use of attenuation correction by computed tomography (CT). We aimed to explore the impact of age and gender on dopamine transporter binding on [I]Ioflupane single photon emission CT (SPECT) imaging with simultaneously acquired CT. METHODS Three hundred forty-two patients with clinically uncertain parkinsonian syndrome underwent [I]-Ioflupane SPECT/CT with CT-based attenuation correction. Two nuclear medicine physicians independently performed a visual evaluation of all scans and only visibly normal scans were included for further analysis. Moreover, the results of a fully automatic semiquantitative evaluation method were recorded. Thereafter, the obtained [I]Ioflupane binding ratio and the hemispheric asymmetry index were correlated with age and sex. RESULTS Patient age range was 41-80 years with a balanced distribution over decades. Of 342 patients, 133 (38.9%, 66 females, median age, 64 years) were considered visually normal by both observers on the SPECT/CT images. A significant inverse correlation between age and [I]Ioflupane binding ratios in the striata (R = -0.38; P < 0.001), putamina (R = -0.39; P < 0.001) and caudate nuclei (R = -0.3; P < 0.001) was demonstrated. Linear regression of all included subjects demonstrated an average decrease of 0.19 per decade in the striatal binding ratio (6.6%). No significant sex differences were found in striatal binding ratios (P = 0.86). Moreover, no significant correlation was observed between age and striatal asymmetry index (r = 0.12; P = 0.16). CONCLUSION In the present largest single-center analysis investigating [I]Ioflupane SPECT/CT in patients with clinical uncertain parkinsonian syndrome, a dopamine transporter loss of 6.6% per decade in visually normal scans was recorded.
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Peralta C, Biafore F, Depetris TS, Bastianello M. Recent Advancement and Clinical Implications of 18FDG-PET in Parkinson's Disease, Atypical Parkinsonisms, and Other Movement Disorders. Curr Neurol Neurosci Rep 2019; 19:56. [PMID: 31256288 DOI: 10.1007/s11910-019-0966-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW The molecular imaging field has been very instrumental in identifying the multiple network interactions that compose the human brain. The cerebral glucose metabolism is associated with neural function. 18F-fluoro-deoxyglucose-PET (FDG-PET) studies reflect brain metabolism in a pattern-specific manner. This article reviews FDG-PET studies in Parkinson's disease (PD), atypical parkinsonism (AP), Huntington's disease (HD), and dystonia. RECENT FINDINGS The metabolic pattern of PD, disease progression, non-motor symptoms such as fatigue, depression, apathy, impulse control disorders, and cognitive impairment, and the risk of progression to dementia have been identified with FDG-PET studies. In prodromal PD, the REM sleep behavior disorder-related covariance pattern has been described. In AP, FDG-PET studies have demonstrated to be superior to D2/D3 SPECT in differentiating PD from AP. The metabolic patterns of HD and dystonia have also been described. FDG-PET studies are an excellent tool to identify patterns of brain metabolism.
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Affiliation(s)
- Cecilia Peralta
- Department of Neurology, CEMIC University Hospital, Elias Galván 4102, C1431FWO, Buenos Aires, Argentina.
| | - Federico Biafore
- Department of Biostatistics, School of Science and Technology, National University of San Martín, Campus Miguelete, 25 de Mayo y Francia, Buenos Aires, Argentina
| | - Tamara Soto Depetris
- Department of Neurology, CEMIC University Hospital, Elias Galván 4102, C1431FWO, Buenos Aires, Argentina
| | - Maria Bastianello
- Department of Molecular and Metabolic Imaging, CEMIC University Hospital, Elias Galván, 4102, Buenos Aires, Argentina
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Abstract
PURPOSE We aimed to (a) elucidate the concordance of visual assessment of an initial I-ioflupane scan by a human interpreter with comparison to results using a fully automatic semiquantitative method and (b) to assess the accuracy compared to follow-up (f/u) diagnosis established by movement disorder specialists. METHODS An initial I-ioflupane scan was performed in 382 patients with clinically uncertain Parkinsonian syndrome. An experienced reader performed a visual evaluation of all scans independently. The findings of the visual read were compared with semiquantitative evaluation. In addition, available f/u clinical diagnosis (serving as a reference standard) was compared with results of the human read and the software. RESULTS When comparing the semiquantitative method with the visual assessment, discordance could be found in 25 (6.5%) of 382 of the cases for the experienced reader (ĸ = 0.868). The human observer indicated region of interest misalignment as the main reason for discordance. With neurology f/u serving as reference, the results of the reader revealed a slightly higher accuracy rate (87.7%, ĸ = 0.75) compared to semiquantification (86.2%, ĸ = 0.719, P < 0.001, respectively). No significant difference in the diagnostic performance of the visual read versus software-based assessment was found. CONCLUSIONS In comparison with a fully automatic semiquantitative method in I-ioflupane interpretation, human assessment obtained an almost perfect agreement rate. However, compared to clinical established diagnosis serving as a reference, visual read seemed to be slightly more accurate as a solely software-based quantitative assessment.
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Thobois S, Prange S, Scheiber C, Broussolle E. What a neurologist should know about PET and SPECT functional imaging for parkinsonism: A practical perspective. Parkinsonism Relat Disord 2018; 59:93-100. [PMID: 30181086 DOI: 10.1016/j.parkreldis.2018.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 12/16/2022]
Abstract
The diagnosis of a parkinsonian syndrome based on clinical criteria remains sometimes difficult, especially at disease onset. Brain or heart molecular imaging techniques (SPECT or PET) can provide a major help to improve and speed up diagnosis, influencing treatment strategies. Presynaptic dopaminergic imaging using either [18F]-Dopa PET or 123I -2β-Carbomethoxy-3β-(4-Iodophenyl)- N-(3-Fluoropropyl) Nortropane ([123I]-Ioflupane)SPECT demonstrates or rules out the presence of a dopaminergic degenerative process. This allows to distinguish Parkinson's disease, Parkinson "plus" syndromes and dementia with Lewy bodies (reduced radiotracers binding) from essential tremor, psychogenic, post-neuroleptic or vascular parkinsonisms, dopa-responsive dystonia and Alzheimer's disease (normal radiotracers binding). For differential diagnosis between Parkinson's disease and Parkinson "plus" syndromes, brain molecular imaging with [18F]-Fluorodeoxyglucose ([18F]-FDG) PET or 99mTc-HMPAO SPECT can provide useful information, whereas [18F]-Dopa PET or [123I]-Ioflupane does not separate these entities. Finally, sympathetic cardiac [123I]-Metaiodobenzylguanidine ([123I]-MIBG) scintigraphy or SPECT can help distinguishing Parkinson's disease and dementia with Lew bodies (decreased binding) from multiple system atrophy and progressive supranuclear palsy (normal binding). New radiotracers notably those targeting the pathological process itself such as Tau aggregates are under development and may provide interesting informations to delineate the different Parkinson "plus" syndromes.
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Affiliation(s)
- Stéphane Thobois
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, F-69675, Bron, France; Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Lyon, France; Univ Lyon, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, F-69921, Oullins, France.
| | - Stéphane Prange
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, F-69675, Bron, France; Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Lyon, France
| | - Christian Scheiber
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Médecine Nucléaire, Lyon, France
| | - Emmanuel Broussolle
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, F-69675, Bron, France; Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, Lyon, France; Univ Lyon, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, F-69921, Oullins, France
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17
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Brumberg J, Isaias IU. SPECT Molecular Imaging in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 142:37-65. [DOI: 10.1016/bs.irn.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Feltracco P, Cagnin A, Carollo C, Barbieri S, Ori C. Neurological disorders in liver transplant candidates: Pathophysiology and clinical assessment. Transplant Rev (Orlando) 2017; 31:193-206. [DOI: 10.1016/j.trre.2017.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/29/2016] [Accepted: 02/20/2017] [Indexed: 12/14/2022]
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19
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Zhu Y, Feng J, Ji J, Hou H, Chen L, Wu S, Liu Q, Yao Q, Du P, Zhang K, Chen Q, Chen Z, Zhang H, Tian M. Alteration of Monoamine Receptor Activity and Glucose Metabolism in Pediatric Patients with Anticonvulsant-Induced Cognitive Impairment. J Nucl Med 2017; 58:1490-1497. [PMID: 28302757 DOI: 10.2967/jnumed.116.189290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/27/2017] [Indexed: 01/03/2023] Open
Abstract
A landmark study from the Institute of Medicine reported that the assessment of cognitive difficulties in children with epilepsy is timely and imperative. Anticonvulsant-induced cognitive impairment could influence the quality of life more than seizure itself in patients. Although the monoaminergic system is involved in the regulation of cognitive process, its role in anticonvulsant-induced cognitive impairment remains unclear. Methods: To explore in vivo monoamine receptor binding activity in patients with anticonvulsant-induced cognitive impairment, each patient underwent PET imaging with both monoamine receptor binding agent 11C-N-methylspiperone and glucose metabolic agent 18F-FDG. Tests of intelligence quotient (IQ), including verbal IQ (VIQ), performance IQ (PIQ), and full-scale IQ (FSIQ), were performed in each patient. Results: Compared with the patients with monotherapy, patients with polytherapy had significantly lower VIQ, PIQ, and FSIQ (P < 0.01 in each comparison), as well as significantly lower monoamine receptor activities detected in the caudate nucleus, prefrontal cortex, dorsal anterior cingulate cortex, and amygdale (P < 0.05 in each comparison). However, regarding the glucose metabolism, there was no significant difference found in patients with monotherapy or polytherapy (P > 0.05). Conclusion: Monoamine receptor PET imaging could be a promising in vivo imaging biomarker for mapping anticonvulsant-induced cognitive impairment.
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Affiliation(s)
- Yuankai Zhu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianhua Feng
- Department of Paediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Jianfeng Ji
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Haifeng Hou
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Lin Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Qing Liu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Qiong Yao
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Peizhen Du
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Kai Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Qing Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Zexin Chen
- Department of Clinical Epidemiology & Biostatistics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Mei Tian
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China .,Zhejiang University Medical PET Centre, Zhejiang University, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
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Mille E, Levin J, Brendel M, Zach C, Barthel H, Sabri O, Bötzel K, Bartenstein P, Danek A, Rominger A. Cerebral Glucose Metabolism and Dopaminergic Function in Patients with Corticobasal Syndrome. J Neuroimaging 2016; 27:255-261. [PMID: 27572945 DOI: 10.1111/jon.12391] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/01/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE The corticobasal syndrome (CBS) is a clinical diagnosis that comprises a group of rare neurodegenerative diseases manifesting in movement disorder and cognitive impairment. While diagnosis is based upon clinical criteria, there have been a number of molecular imaging studies, albeit in rather small cohorts. Therefore, we investigated the pattern of cerebral glucose metabolism, as well as dopamine transporter (DAT) availability in a large and clinically well-defined cohort. METHODS Thirty-four patients fulfilling either the Armstrong or the Boeve criteria were assessed with [18 F]-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) and/or [123 I]-Ioflupane single-photon-emission-computed tomography (SPECT) for DAT availability. A small subset of patients had also undergone D2/3 receptor imaging. Imaging data were analyzed using both statistical parametric mapping and a volume-of-interest-based approach relative to data from healthy controls. RESULTS Significant reductions of the cortical glucose metabolism were observed in the central region and the adjacent frontal and parietal association areas contralateral to the side with predominant motor symptoms. Reductions were also evident in the basal ganglia, notably in the putamen contralateral to the clinically affected side, and in the bilateral thalamus. DAT availability was reduced bilaterally, most distinctly on the side contralateral to the main motor symptoms. CONCLUSIONS We replicated and refined earlier findings of impaired glucose metabolism and nigrostriatal degeneration in CBS, highlighting asymmetric cortical and subcortical hypometabolism, symmetrically reduced metabolism in the thalamus, and only a slightly asymmetric reduction in DAT, while D2/3 receptors seem to be mainly preserved. These results provide systematic evidence for the usefulness of FDG PET and dopaminergic SPECT imaging to characterize CBS.
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Affiliation(s)
- Erik Mille
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christian Zach
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
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21
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Abstract
Nuclear medicine imaging can provide important complementary information in the management of pediatric patients with neurological diseases. Pre-surgical localization of the epileptogenic focus in medically refractory epilepsy patients is the most common indication for nuclear medicine imaging in pediatric neurology. In patients with temporal lobe epilepsy, nuclear medicine imaging is particularly useful when magnetic resonance imaging findings are normal or its findings are discordant with electroencephalogram findings. In pediatric patients with brain tumors, nuclear medicine imaging can be clinically helpful in the diagnosis, directing biopsy, planning therapy, differentiating tumor recurrence from post-treatment sequelae, and assessment of response to therapy. Among other neurological diseases in which nuclear medicine has proved to be useful are patients with head trauma, inflammatory-infectious diseases and hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Ümit Özgür Akdemir
- Gazi University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey Phone: +90 312 202 61 75 E-mail:
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22
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Comparison of automatic versus manual procedures for the quantification of dopamine D2 receptor availability using I-123-IBZM-SPECT. Nucl Med Commun 2015; 36:1120-6. [DOI: 10.1097/mnm.0000000000000363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Martino G, Capasso M, Nasuti M, Bonanni L, Onofrj M, Thomas A. Dopamine transporter single-photon emission computerized tomography supports diagnosis of akinetic crisis of parkinsonism and of neuroleptic malignant syndrome. Medicine (Baltimore) 2015; 94:e649. [PMID: 25837755 PMCID: PMC4554017 DOI: 10.1097/md.0000000000000649] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Akinetic crisis (AC) is akin to neuroleptic malignant syndrome (NMS) and is the most severe and possibly lethal complication of parkinsonism. Diagnosis is today based only on clinical assessments yet is often marred by concomitant precipitating factors. Our purpose is to evidence that AC and NMS can be reliably evidenced by FP/CIT single-photon emission computerized tomography (SPECT) performed during the crisis. Prospective cohort evaluation in 6 patients. In 5 patients, affected by Parkinson disease or Lewy body dementia, the crisis was categorized as AC. One was diagnosed as having NMS because of exposure to risperidone. In all FP/CIT, SPECT was performed in the acute phase. SPECT was repeated 3 to 6 months after the acute event in 5 patients. Visual assessments and semiquantitative evaluations of binding potentials (BPs) were used. To exclude the interference of emergency treatments, FP/CIT BP was also evaluated in 4 patients currently treated with apomorphine. During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern. The follow-up re-evaluation in surviving patients showed a recovery of values to the range expected for Parkinsonisms of same disease duration. No binding effects of apomorphine were observed. By showing the outstanding binding reduction, presynaptic dopamine transporter ligand can provide instrumental evidence of AC in Parkinsonism and NMS.
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Affiliation(s)
- G Martino
- From the Department of Radiology and Radiotherapy, Nuclear Medicine University G. d'Annunzio of Chieti-Pescara (GM, MN); Neurology Clinic, State Hospital (MC, LB, MO, AT); and Department of Neuroscience and Imaging and Aging Research Center, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy (LB, MO, AT)
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Arbizu J, Luquin M, Abella J, de la Fuente-Fernández R, Fernandez-Torrón R, García-Solís D, Garrastachu P, Jiménez-Hoyuela J, Llaneza M, Lomeña F, Lorenzo-Bosquet C, Martí M, Martinez-Castrillo J, Mir P, Mitjavila M, Ruiz-Martínez J, Vela L. Functional neuroimaging in the diagnosis of patients with parkinsonism: Update and recommendations for clinical use. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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25
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Arbizu J, Luquin MR, Abella J, de la Fuente-Fernández R, Fernandez-Torrón R, García-Solís D, Garrastachu P, Jiménez-Hoyuela JM, Llaneza M, Lomeña F, Lorenzo-Bosquet C, Martí MJ, Martinez-Castrillo JC, Mir P, Mitjavila M, Ruiz-Martínez J, Vela L. [Functional neuroimaging in the diagnosis of patients with Parkinsonism: Update and recommendations for clinical use]. Rev Esp Med Nucl Imagen Mol 2014; 33:215-26. [PMID: 24731551 DOI: 10.1016/j.remn.2014.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 02/04/2014] [Accepted: 02/04/2014] [Indexed: 11/19/2022]
Abstract
Functional Neuroimaging has been traditionally used in research for patients with different Parkinsonian syndromes. However, the emergence of commercial radiotracers together with the availability of single photon emission computed tomography (SPECT) and, more recently, positron emission tomography (PET) have made them available for clinical practice. Particularly, the development of clinical evidence achieved by functional neuroimaging techniques over the past two decades have motivated a progressive inclusion of several biomarkers in the clinical diagnostic criteria for neurodegenerative diseases that occur with Parkinsonism. However, the wide range of radiotracers designed to assess the involvement of different pathways in the neurodegenerative process underlying Parkinsonian syndromes (dopaminergic nigrostriatal pathway integrity, basal ganglia and cortical neuronal activity, myocardial sympathetic innervation), and the different neuroimaging techniques currently available (scintigraphy, SPECT and PET), have generated some controversy concerning the best neuroimaging test that should be indicated for the differential diagnosis of Parkinsonism. In this article, a panel of nuclear medicine and neurology experts has evaluated the functional neuroimaging techniques emphazising practical considerations related to the diagnosis of patients with uncertain origin parkinsonism and the assessment Parkinson's disease progression.
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Affiliation(s)
- J Arbizu
- Grupo de Trabajo de Neuroimagen de la SEMNIM, Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España.
| | - M R Luquin
- Grupo de Trastornos del Movimiento de la SEN, Departamento de Neurología, Clínica Universidad de Navarra, Pamplona, España
| | - J Abella
- Servicio de Neurología, Hospital A, Marcide, Ferrol, España
| | | | - R Fernandez-Torrón
- Servicio de Neurología, Hospital Universitario Donostia, Área de Neurociencias, Instituto de Investigación Biodonostia, CIBERNED, San Sebastián, España
| | - D García-Solís
- Servicio de Medicina Nuclear, UDIM, Hospital Universitario Virgen del Rocío, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Sevilla, España
| | - P Garrastachu
- Servicio de Medicina Nuclear, Hospital San Pedro, CIBIR, Logroño, España
| | - J M Jiménez-Hoyuela
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - M Llaneza
- Servicio de Neurología, Hospital A, Marcide, Ferrol, España
| | - F Lomeña
- Servicio de Medicina Nuclear, Hospital Clinic, Barcelona, España
| | - C Lorenzo-Bosquet
- Servicio de Medicina Nuclear, Hospital Vall d́Hebron, CETIR-ERESA, Unitat Teknon, Barcelona, España
| | - M J Martí
- Unidad de Parkinson y Trastornos del Movimiento, Servicio de Neurología, ICN, CIBERNET, Hospital Clinic, Barcelona, España
| | | | - P Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Sevilla, España
| | - M Mitjavila
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Madrid, España
| | - J Ruiz-Martínez
- Unidad de Parkinson y otros Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Donostia, CIBERNED, Instituto de Salud Carlos III, San Sebastián (Guipúzcoa), España
| | - L Vela
- Servicio de Neurología, Hospital Universitario Fundación Alcorcón, Alcorcón, España
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Pandey S, Venugopal A, Kant R, Coleman R, Mukherjee J. ¹²⁴I-Epidepride: a PET radiotracer for extended imaging of dopamine D2/D3 receptors. Nucl Med Biol 2014; 41:426-31. [PMID: 24602412 DOI: 10.1016/j.nucmedbio.2014.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/15/2014] [Accepted: 01/23/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A new radiotracer, ¹²⁴I-epidepride, has been developed for the imaging of dopamine D2/3 receptors (D2/3Rs). ¹²⁴I-Epidepride (half-life of ¹²⁴I=4.2 days) allows imaging over extended periods compared to (18)F-fallypride (half-life of ¹⁸F=0.076 days) and may maximize visualization of D2/3Rs in the brain and pancreas (allowing clearance from adjacent organs). D2/3 Rs are also present in pancreatic islets where they co-localize with insulin to produce granules and may serve as a surrogate marker for imaging diabetes. METHODS ¹²⁴I-Epidepride was synthesized using N-[[(2S)-1-ethylpyrrolidin-2-yl]methyl]-5-tributyltin-2,3-dimethoxybenzamide and ¹²⁴I-iodide under no carrier added condition. Rats were used for in vitro and in vivo imaging. Brain slices were incubated with (124)I-epidepride (0.75 μCi/cc) and nonspecific binding measured with 10 μM haloperidol. Autoradiograms were analyzed by OptiQuant. ¹²⁴I-Epidepride (0.2 to 0.3 mCi, iv) was administered to rats and brain uptake at 3 hours, 24 hours, and 48 hours post injection was evaluated. RESULTS ¹²⁴I-Epidepride was obtained with 50% radiochemical yield and high radiochemical purity (>95%). (124)I-Epidepride localized in the striatum with a striatum to cerebellum ratio of 10. Binding was displaced by dopamine and haloperidol. Brain slices demonstrated localization of ¹²⁴I-epidepride up until 48 hours in the striatum. However, the extent of binding was reduced significantly. CONCLUSIONS ¹²⁴I-Epidepride is a new radiotracer suitable for extended imaging of dopamine D2/3 receptors and may have applications in imaging of receptors in the brain and monitoring pancreatic islet cell grafting.
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Affiliation(s)
- Suresh Pandey
- Preclinical Imaging, Department of Radiological Sciences, University of California - Irvine, Irvine, CA 92697, USA
| | - Archana Venugopal
- Preclinical Imaging, Department of Radiological Sciences, University of California - Irvine, Irvine, CA 92697, USA
| | - Ritu Kant
- Preclinical Imaging, Department of Radiological Sciences, University of California - Irvine, Irvine, CA 92697, USA
| | - Robert Coleman
- Preclinical Imaging, Department of Radiological Sciences, University of California - Irvine, Irvine, CA 92697, USA
| | - Jogeshwar Mukherjee
- Preclinical Imaging, Department of Radiological Sciences, University of California - Irvine, Irvine, CA 92697, USA.
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Booij J, Arbizu J, Darcourt J, Hesse S, Nobili F, Payoux P, Pappatà S, Tatsch K, Walker Z, Pagani M. Appropriate use criteria for amyloid PET imaging cannot replace guidelines: on behalf of the European Association of Nuclear Medicine. Eur J Nucl Med Mol Imaging 2014; 40:1122-5. [PMID: 23619939 DOI: 10.1007/s00259-013-2415-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wei L, Bensimon C, Lockwood J, Yan X, Fernando P, Glenn Wells R, Duan Y, Chen YX, Russell Redshaw J, Covitz PA, Ruddy TD. Synthesis and characterization of 123I-CMICE-013: A potential SPECT myocardial perfusion imaging agent. Bioorg Med Chem 2013; 21:2903-11. [DOI: 10.1016/j.bmc.2013.03.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/16/2013] [Accepted: 03/26/2013] [Indexed: 10/27/2022]
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Cirrhosis-related Parkinsonism: prevalence, mechanisms and response to treatments. J Hepatol 2013; 58:698-705. [PMID: 23220368 DOI: 10.1016/j.jhep.2012.11.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 11/22/2012] [Accepted: 11/24/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Extrapyramidal and cerebellar symptoms belong to the most prominent features of episodic hepatic encephalopathy, and usually decrease upon ammonia-lowering therapy. Rapidly progressing parkinsonian symptoms, which are unresponsive to treatment of hepatic encephalopathy, indicate cirrhosis-related Parkinsonism. This study aims at analyzing the prevalence of cirrhosis-related Parkinsonism in patients with liver cirrhosis, and to study the functional status of the striatal dopaminergic system in these patients. METHODS 214 patients with liver cirrhosis who were consecutively seen at the out-patient clinic for liver transplant candidates and/or at the transplantation wards at Hannover Medical School, between August 1, 2008 and March 31, 2011, underwent a standardized neurological examination while on the waiting list or immediately after liver transplantation. Single photon emission computer tomography (SPECT) using (123)I-beta-CIT, for the evaluation of the striatal dopamine transporter function, and (123)I-IBZM for the evaluation of the striatal dopamine D2 receptor availability, was performed in 6 patients with cirrhosis-related Parkinsonism. RESULTS Cirrhosis-related Parkinsonism was diagnosed in 9 of 214 patients (4.2%). SPECT revealed significantly decreased dopamine receptor availability in 5 of 6 patients studied, and significantly decreased dopamine transporter availability in 3. Levodopa improved motor dysfunction in two of four patients treated, although only temporarily. Incomplete recovery was observed in two patients after liver transplantation. CONCLUSIONS Cirrhosis-related Parkinsonism is more frequent than presumed. The presented data suggest pre- and postsynaptic alteration of striatal dopaminergic neurotransmission as a possible cause of cirrhosis-related Parkinsonism and reveal the limited effects of dopaminergic therapy.
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Amtage F, Spehl TS, Hellwig S, Sahm U, Hellwig B, Reuland P, Weiller C, Weber WA, Winkler C, Meyer PT. Assessment of Striatal Dopamine D2/D3 Receptor Availability with PET and 18F-Desmethoxyfallypride: Comparison of Imaging Protocols Suited for Clinical Routine. J Nucl Med 2012; 53:1558-64. [DOI: 10.2967/jnumed.112.103812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Density of striatal D2 receptors in untreated first-episode psychosis: an I123-IBZM SPECT study. Eur Neuropsychopharmacol 2011; 21:861-6. [PMID: 21470832 DOI: 10.1016/j.euroneuro.2011.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 02/22/2011] [Accepted: 03/02/2011] [Indexed: 11/24/2022]
Abstract
There is as yet no definite prognostic marker to determine whether a first-episode psychosis will become schizophrenia or not. The aim of the present study is to address whether the mechanism of sensitization of the subcortical dopaminergic pathway - yielding to an increase of the postsynaptic D2 receptors - may serve as a prognostic marker of clinical outcome in drug naïve patients with a first-episode psychosis, by means of a prospective and multicentric study with untreated first-episode psychosis patients (n=37). 123I-IBZM SPECT was performed at the time of the inclusion in the study, before antipsychotic medication was initiated. One year later, patients were assessed again so as to determine their diagnosis. There was a significant group effect at baseline in D2 Striatal/Frontal (S/F) ratios (F=10.2, p<0.001). Bonferroni posthoc comparisons attested significant differences between diagnosis (p=0.006), and between schizophrenia and control groups (p<0.001) but no differences between non-schizophrenia and control groups (p=0.9). The logistic regression model showed that D2R binding (p=0.02) and PAS (Premorbid Adjustment Scale) adulthood score (p=0.03) were predictive of the final diagnosis (schizophrenia/non-schizophrenia; Nagelkerke R(2)=0.59; X(2)=11.08, p=0.001). These findings replicate previous results on the usefulness of D2R binding as an objective prognostic parameter, together with the evaluation of premorbid adjustment, of the evolution of first-episode psychosis. In this regard, the results may provide a new view in the approach of early and personalized treatment in the debut of a psychosis.
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Safont G, Corripio I, Escartí MJ, Portella MJ, Pérez V, Ferrer M, Camacho V, Sauras RB, Alonso A, Grasa EM, Arranz B, San L, Dueñas R, Carrió I, Álvarez E. Cannabis use and striatal D2 receptor density in untreated first-episode psychosis: an in vivo SPECT study. Schizophr Res 2011; 129:169-71. [PMID: 21459559 DOI: 10.1016/j.schres.2011.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 02/24/2011] [Accepted: 03/07/2011] [Indexed: 11/17/2022]
Abstract
The biological basis of the association between cannabis-induced dopamine dysregulation and psychosis remains poorly understood. This (123)I-IBZM SPECT study assessed striatal dopamine D2 receptor (D2R) binding in 37 untreated first-episode psychosis (FEP) subjects, and 18 healthy controls. The aim was to examine if there were differences between FEP subjects with (n=14) and without (n=23) cannabis use in uptake ratios in the D2R. Striatal/Frontal cortex (S/F) uptake ratios were obtained. Healthy controls showed the lowest D2R binding ratios. No differences were found in S/F ratios between users and non-users, suggesting similar dopaminergic mechanisms underlying psychotic symptoms in both groups.
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Affiliation(s)
- Gemma Safont
- Department of Psychiatry, Hospital Universitari Mútua Terrassa, Universitat de Barcelona (UB), Plaça Dr. Robert, 5. 08221, Terrassa, Barcelona, Spain.
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Garcia A, Mirbolooki MR, Constantinescu C, Pan ML, Sevrioukov E, Milne N, Wang PH, Lakey J, Chandy KG, Mukherjee J. 18F-Fallypride PET of pancreatic islets: in vitro and in vivo rodent studies. J Nucl Med 2011; 52:1125-32. [PMID: 21680697 DOI: 10.2967/jnumed.111.088583] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Islet cell loss in the pancreas results in diabetes. A noninvasive method that measures islet cell loss and also tracks the fate of transplanted islets would facilitate the development of novel therapeutics and improve the management of diabetes. We describe a novel dopamine D(2)/D(3) receptor (D(2)/D(3)R)-based PET method to study islet cells in the rat pancreas and in islet cell transplantation. METHODS (18)F-fallypride binding to isolated rat islets and pancreas was evaluated in the absence and presence of the D(2)/D(3)R inhibitor haloperidol. After intravenous (18)F-fallypride (28-37 MBq) administration, normal rats and rats pretreated with haloperidol were imaged in a PET/CT scanner and subsequently studied ex vivo for (18)F-fallypride localization in the pancreas. A streptozotocin-treated diabetic rat model was used to study localization of (18)F-fallypride in the pancreas, in vitro and ex vivo. Rat islet cells were transplanted into the spleen and visualized using (18)F-fallypride PET. RESULTS (18)F-fallypride bound to isolated islet cells and pancreatic sections with an endocrine or exocrine selectivity of approximately 4; selectivity was reduced by haloperidol, suggesting that binding was D(2)/D(3)R-specific. Chemical destruction of islets by streptozotocin decreased (18)F-fallypride binding in pancreas by greater than 50%, paralleling the decrease in insulin immunostaining. Uptake of (18)F-fallypride in the pancreas was confirmed by radiochromatography and was 0.05% injected dose/cm(3) as measured by PET/CT. The ratio of (18)F-fallypride uptake in the pancreas to reference tissue (erector spinae muscle) was 5.5. Rat islets transplanted into the spleen were visualized in vivo by (18)F-fallypride and confirmed by immunostaining. The ratio of spleen-transplanted islets to erector spinae muscle was greater than 5, compared with a ratio of 2.8 in untransplanted rats. CONCLUSION These studies demonstrate the potential utility of (18)F-fallypride as a PET agent for islet cells.
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Affiliation(s)
- Adriana Garcia
- Preclinical Imaging Center, Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, California 92697, USA
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Calibration of gamma camera systems for a multicentre European 123I-FP-CIT SPECT normal database. Eur J Nucl Med Mol Imaging 2011; 38:1529-40. [DOI: 10.1007/s00259-011-1801-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
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SPECT imaging evaluation in movement disorders: far beyond visual assessment. Eur J Nucl Med Mol Imaging 2010; 38:764-73. [PMID: 21125269 DOI: 10.1007/s00259-010-1664-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
Abstract
Single photon emission computed tomography (SPECT) imaging with (123)I-FP-CIT is of great value in differentiating patients suffering from Parkinson's disease (PD) from those suffering from essential tremor (ET). Moreover, SPECT with (123)I-IBZM can differentiate PD from Parkinson's "plus" syndromes. Diagnosis is still mainly based on experienced observers' visual assessment of the resulting images while many quantitative methods have been developed in order to assist diagnosis since the early days of neuroimaging. The aim of this work is to attempt to categorize, briefly present and comment on a number of semi-quantification methods used in nuclear medicine neuroimaging. Various arithmetic indices have been introduced with region of interest (ROI) manual drawing methods giving their place to automated procedures, while advancing computer technology has allowed automated image registration, fusion and segmentation to bring quantification closer to the final diagnosis based on the whole of the patient's examinations results, clinical condition and response to therapy. The search for absolute quantification has passed through neuroreceptor quantification models, which are invasive methods that involve tracer kinetic modelling and arterial blood sampling, a practice that is not commonly used in a clinical environment. On the other hand, semi-quantification methods relying on computers and dedicated software try to elicit numerical information out of SPECT images. The application of semi-quantification methods aims at separating the different patient categories solving the main problem of finding the uptake in the structures of interest. The semi-quantification methods which were studied fall roughly into three categories, which are described as classic methods, advanced automated methods and pixel-based statistical analysis methods. All these methods can be further divided into various subcategories. The plethora of the existing semi-quantitative methods reinforces the feeling that visual assessment is still the base of image interpretation and that the unambiguous numerical results that will allow the absolute differentiation between the known diseases have not been standardized yet. Switching to a commonly agreed-ideally PC-based-automated software that may take raw or mildly processed data (checked for consistency and maybe corrected for attenuation and/or scatter and septal penetration) as input, work with basic operator's inference and produce validated numerical results that will support the diagnosis is in our view the aim towards which efforts should be directed. After all, semi-quantification can improve sensitivity, strengthen diagnosis, aid patient's follow-up and assess the response to therapy. Objective diagnosis, altered diagnosis in marginal cases and a common approach to multicentre trials are other benefits and future applications of semi-quantification.
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Weiller C, Meyer PT, Hennig J. [Neuroimaging in medicine]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:801-9. [PMID: 20700779 DOI: 10.1007/s00103-010-1096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neuroimaging has in recent years greatly contributed to our understanding of a wide range of aspects of central neurological diseases. These include the classification and localization of disease (e.g., in headache), the understanding of pathology (e.g., in Parkinson's disease), mechanisms of reorganization (e.g., in stroke), and the subclinical progress of disease (e.g., in degenerative diseases). Apart form presurgical mapping, clinical applications of fMRI are limited. However, functional imaging enables the formulation of neurobiological hypotheses that can be tested clinically and is suited to test classical clinical hypotheses about how the brain works. Understanding the mechanisms and the site of pathology, e.g., in cluster headaches, will lead and has led to new therapeutic strategies. New methodological developments for neuroscientific applications are aimed at the integration of functional and morphological connectivity through a combination of magnetic resonance techniques (fMRI, DTI) and electrophysiological (EEG, MEG) recordings. In addition to stimulus-dependent activations, resting state activity has found increasing interest, for example, in sleep research and various psychiatric diseases (e.g., schizophrenia, borderline).
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Affiliation(s)
- C Weiller
- Neurologische Klinik, Universität Freiburg, Deutschland.
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Martí-Climent JM, Prieto E, López Lafuente J, Arbizu J. [Neuroimaging: technical aspects and practice]. ACTA ACUST UNITED AC 2010; 29:189-210. [PMID: 20579774 DOI: 10.1016/j.remn.2010.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
Abstract
Neuroimaging using both functional and structural examinations like positron emission tomography (PET), single photon emission tomography (SPECT), computed tomography (CT) and magnetic nuclear imaging (MRI) provide supportive information of great importance for the diagnosis and treatment of patients with central nervous system disorders. Therefore, they have become commonplace in clinical practice and basic biomedical research. In recent years we have seen the development of multimodality equipment that enables PET or SPECT to be combined with a CT structural image. Moreover, experimental equipment combining PET and MRI has now been developed. Additionally, methodological features that provide a higher image quality, and analysis tools for objective quantification and interpretation have been refined. This article reviews the technical aspects of those imaging methods, highlighting the most significant and recent advances in the development of neuroimaging.
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Affiliation(s)
- J M Martí-Climent
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, España.
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Comparison of two neural network classifiers in the differential diagnosis of essential tremor and Parkinson's disease by (123)I-FP-CIT brain SPECT. Eur J Nucl Med Mol Imaging 2010; 37:2146-53. [PMID: 20567820 DOI: 10.1007/s00259-010-1481-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 04/13/2010] [Indexed: 02/08/2023]
Abstract
PURPOSE To contribute to the differentiation of Parkinson's disease (PD) and essential tremor (ET), we compared two different artificial neural network classifiers using (123)I-FP-CIT SPECT data, a probabilistic neural network (PNN) and a classification tree (ClT). METHODS (123)I-FP-CIT brain SPECT with semiquantitative analysis was performed in 216 patients: 89 with ET, 64 with PD with a Hoehn and Yahr (H&Y) score of ≤2 (early PD), and 63 with PD with a H&Y score of ≥2.5 (advanced PD). For each of the 1,000 experiments carried out, 108 patients were randomly selected as the PNN training set, while the remaining 108 validated the trained PNN, and the percentage of the validation data correctly classified in the three groups of patients was computed. The expected performance of an "average performance PNN" was evaluated. In analogy, for ClT 1,000 classification trees with similar structures were generated. RESULTS For PNN, the probability of correct classification in patients with early PD was 81.9±8.1% (mean±SD), in patients with advanced PD 78.9±8.1%, and in ET patients 96.6±2.6%. For ClT, the first decision rule gave a mean value for the putamen of 5.99, which resulted in a probability of correct classification of 93.5±3.4%. This means that patients with putamen values >5.99 were classified as having ET, while patients with putamen values <5.99 were classified as having PD. Furthermore, if the caudate nucleus value was higher than 6.97 patients were classified as having early PD (probability 69.8±5.3%), and if the value was <6.97 patients were classified as having advanced PD (probability 88.1%±8.8%). CONCLUSION These results confirm that PNN achieved valid classification results. Furthermore, ClT provided reliable cut-off values able to differentiate ET and PD of different severities.
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Van Laere K, Clerinx K, D'Hondt E, de Groot T, Vandenberghe W. Combined striatal binding and cerebral influx analysis of dynamic 11C-raclopride PET improves early differentiation between multiple-system atrophy and Parkinson disease. J Nucl Med 2010; 51:588-95. [PMID: 20237023 DOI: 10.2967/jnumed.109.070144] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Striatal dopamine D(2) receptor (D2R) PET has been proposed to differentiate between Parkinson disease (PD) and multiple-system atrophy with predominant parkinsonism (MSA-P). However, considerable overlap in striatal D(2) binding may exist between PD and MSA-P. It has been shown that imaging of neuronal activity, as determined by metabolism or perfusion, can also help distinguish PD from MSA-P. We investigated whether the differential diagnostic value of (11)C-raclopride PET could be improved by dynamic scan analysis combining D2R binding and regional tracer influx. METHODS (11)C-raclopride PET was performed in 9 MSA-P patients (mean age +/- SD, 56.2 +/- 10.2 y; disease duration, 2.9 +/- 0.8 y; median Hoehn-Yahr score, 3), 10 PD patients (mean age +/- SD, 65.7 +/- 8.1 y; disease duration, 3.3 +/- 1.5 y; median Hoehn-Yahr score, 1.5), and 10 healthy controls (mean age +/- SD, 61.6 +/- 6.5 y). Diagnosis was obtained after prolonged follow-up (MSA-P, 5.5 +/- 2.0 y; PD, 6.0 +/- 2.3 y) using validated clinical criteria. Spatially normalized parametric images of binding potential (BP) and local influx ratio (R(1) = K(1)/K'(1)) of (11)C-raclopride were obtained using a voxelwise reference tissue model with occipital cortex as reference region. Stepwise forward discriminant analysis with cross-validation, with and without the inclusion of regional R(1) values, was performed using a predefined volume-of-interest template. RESULTS Using conventional BP values, we correctly classified 65.5% (all values given with cross-validation) of 29 cases only. The combination of BP and R(1) information increased discrimination accuracy to 79.3%. When healthy controls were not included and patients only were considered, BP information alone discriminated PD and MSA-P in 84.2% of cases, but the combination with R(1) data increased accuracy to 100%. CONCLUSION Discriminant analysis using combined striatal D2R BP and cerebral influx ratio information of a single dynamic (11)C-raclopride PET scan distinguishes MSA-P and PD patients with high accuracy and is superior to conventional methods of striatal D2R binding analysis.
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Affiliation(s)
- Koen Van Laere
- Division of Nuclear Medicine, Leuven University Hospital and Katholieke Universiteit Leuven, Leuven, Belgium.
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