Distribution of cortical benzodiazepine receptor binding in right-handed healthy humans: a voxel-based statistical analysis of iodine 123 iomazenil SPECT with partial volume correction

The regional pattern of age-related synaptic loss in the human brain differs from gray matter volume loss: in vivo PET measurement with [11C]UCB-J

PURPOSE

Aging is a major societal concern due to age-related functional losses. Synapses are crucial components of neural circuits, and synaptic density could be a sensitive biomarker to evaluate brain function. [11C]UCB-J is a positron emission tomography (PET) ligand targeting synaptic vesicle glycoprotein 2A (SV2A), which can be used to evaluate brain synaptic density in vivo.

METHODS

We evaluated age-related changes in gray matter synaptic density, volume, and blood flow using [11C]UCB-J PET and magnetic resonance imaging (MRI) in a wide age range of 80 cognitive normal subjects (21-83 years old). Partial volume correction was applied to the PET data.

RESULTS

Significant age-related decreases were found in 13, two, and nine brain regions for volume, synaptic density, and blood flow, respectively. The prefrontal cortex showed the largest volume decline (4.9% reduction per decade: RPD), while the synaptic density loss was largest in the caudate (3.6% RPD) and medial occipital cortex (3.4% RPD). The reductions in caudate are consistent with previous SV2A PET studies and likely reflect that caudate is the site of nerve terminals for multiple major tracts that undergo substantial age-related neurodegeneration. There was a non-significant negative relationship between volume and synaptic density reductions in 16 gray matter regions.

CONCLUSION

MRI and [11]C-UCB-J PET showed age-related decreases of gray matter volume, synaptic density, and blood flow; however, the regional patterns of the reductions in volume and SV2A binding were different. Those patterns suggest that MR-based measures of GM volume may not be directly representative of synaptic density.

Impaired neuronal integrity in traumatic brain injury detected by 123I-iomazenil single photon emission computed tomography and MRI

This study was aiming at investigating the extent of neuronal damage in cases of traumatic brain injury (TBI) with diffuse axonal injury (DAI) using ¹²³I-iomazenil(IMZ) SPECT and MRI. We compared the findings in 31 patients with TBI without any major focal brain lesions and 25 age-matched normal controls. Subjects underwent ¹²³I-IMZ SPECT and MRI, and also assessment by cognitive function tests. The partial volume effect of ¹²³I-IMZ SPECT was corrected using MRI. In the patients with TBI, decreased spatial concentration of ¹²³I-IMZ binding was detected in the medial frontal/orbitofrontal cortex, posterior cingulate gyrus, cuneus, precuneus, and superior region of the cerebellum. ROC analysis of ¹²³I-IMZ SPECT for the detection of neuronal injury showed a high diagnostic ability of ¹²³I-IMZ binding density for TBI in these areas. The decreased ¹²³I-IMZ uptake density in the cuneus and precuneus was associated with cognitive decline after the injury. In the patients with TBI, brain atrophy was detected in the frontal lobe, anterior temporal and parietal cortex, corpus callosum, and posterior part of the cerebellum. Evaluation of the neuronal integrity by ¹²³I-IMZ SPECT and MRI provides important information for the diagnosis and pathological interpretation in cases of TBI with DAI.

Age-related increase in GABAA receptor distribution in the prefrontal cortex

Profound insight into age-related changes in γ-aminobutyric acid type A receptor (GABAA-R) distribution using iodine-123-iomazenil single photon emission computed tomography (IMZ-SPECT) can contribute to accurate in vivo evaluation. We evaluated the age-related changes in prefrontal cortex (PFC), which is the key region involved in various neurological and psychiatric diseases. In this study, IMZ-SPECT imaging data of 21 healthy males with an age range of 22-59 (mean, 38 ± 12) years were analyzed using three-dimensional stereotactic surface projection (3D-SSP). The Z-score images of the younger group (age < 40, n = 11) and the older group (age ≥ 40, n = 10) were compared. Subsequently, the mean RI-count ratios calculated for each Brodmann area (BA) by stereotactic extraction estimation method were compared between these groups. Thereafter, linear regression analysis between age and RI-count ratio was performed for all enrolled subjects. In the result, IMZ accumulation increased in bilateral BA10, 11, and the BA47 (left hemisphere) in the older group compared with the younger group. Furthermore, regression analysis demonstrated a significant positive correlation between age and RI-count ratio in these areas. Our findings indicate that GABAA-R distribution in the PFC relatively increases with age. Therefore, we concluded that the age-related changes should be considered to accurately evaluate pathophysiology of neurological and psychiatric diseases.

CT-Based Attenuation Correction in Brain SPECT/CT Can Improve the Lesion Detectability of Voxel-Based Statistical Analyses

Background

Integrated SPECT/CT enables non-uniform attenuation correction (AC) using built-in CT instead of the conventional uniform AC. The effect of CT-based AC on voxel-based statistical analyses of brain SPECT findings has not yet been clarified. Here, we assessed differences in the detectability of regional cerebral blood flow (CBF) reduction using SPECT voxel-based statistical analyses based on the two types of AC methods.

Subjects and Methods

N-isopropyl-p-[123I]iodoamphetamine (IMP) CBF SPECT images were acquired for all the subjects and were reconstructed using 3D-OSEM with two different AC methods: Chang’s method (Chang’s AC) and the CT-based AC method. A normal database was constructed for the analysis using SPECT findings obtained for 25 healthy normal volunteers. Voxel-based Z-statistics were also calculated for SPECT findings obtained for 15 patients with chronic cerebral infarctions and 10 normal subjects. We assumed that an analysis with a higher specificity would likely produce a lower mean absolute Z-score for normal brain tissue, and a more sensitive voxel-based statistical analysis would likely produce a higher absolute Z-score for in old infarct lesions, where the CBF was severely decreased.

Results

The inter-subject variation in the voxel values in the normal database was lower using CT-based AC, compared with Chang’s AC, for most of the brain regions. The absolute Z-score indicating a SPECT count reduction in infarct lesions was also significantly higher in the images reconstructed using CT-based AC, compared with Chang’s AC (P = 0.003). The mean absolute value of the Z-score in the 10 intact brains was significantly lower in the images reconstructed using CT-based AC than in those reconstructed using Chang’s AC (P = 0.005).

Conclusions

Non-uniform CT-based AC by integrated SPECT/CT significantly improved sensitivity and the specificity of the voxel-based statistical analyses for regional SPECT count reductions, compared with conventional uniform Chang's AC.

11C-acetate PET imaging in patients with multiple sclerosis

BACKGROUND

Activation of glial cells is a cardinal feature in multiple sclerosis (MS) pathology, and acetate has been reported to be selectively uptaken by astrocytes in the CNS. The aim of this study was to investigate the efficacy of PET with (11)C-acetate for MS diagnosis.

MATERIALS AND METHODS

Six patients with relapsing-remitting MS and 6 healthy volunteers (HV) were enrolled. The (11)C-acetate brain uptake on PET was measured in patients with MS and HV. Volume-of-interest analysis of cerebral gray and white matter based on the segmentation technique for co-registered MRI and voxel-based statistical parametric analysis were performed. Correlation between 11C-acetate uptake and the lesion number in T1- and T2- weighted MR images were also assessed.

RESULTS

The standardized uptake value (SUV) of 11C-acetate was increased in both white and gray matter in MS patients compared to HV. Voxel-based statistical analysis revealed a significantly increased SUV relative to that in the bilateral thalami (SUVt) in a broad area of white matter, particularly in the subcortical white matter of MS patients. The numbers of T2 lesions and T1 black holes were significantly correlated with SUV of (11)C-acetate in white and gray matter.

CONCLUSIONS

The 11C-acetate uptake significantly increased in MS patients and correlated to the number of MRI lesions. These preliminary data suggest that (11)C-acetate PET can be a useful clinical examination for MS patients.