Abstract
Application of easy Z score imaging system (eZIS) on brain perfusion SPECT images for quantitative evaluation of rCBF has attempted to explore the differential diagnosis of dementia with various degenerative diseases and to evaluate discrimination of early Alzheimer’s disease (AD) from other types of dementia. This retrospective study was done with various degenerative diseases that underwent brain perfusion SPECT using 99mTc ethyl cysteinate dimer were included. Brain perfusion SPECT was performed in 58 patients (M/F = 48/10) with mean age of 61.2±10.4 years (41-90). Decreased rCBF was observed in the area suspected early AD in 20 cases (34%) and in the frontal gyrus and insula in 10 cases (17%). And decreased rCBF was observed in occipital lobe and, precuneus, gyrus and posterior cingulate cortex in 8 cases (14%). Discrete areas of decreased rCBF were seen in 14 cases (24%) and the rest of 6 cases (11%) showed normal rCBF. Clinically suspected AD patients were divided into two groups on basis of MMSE score (group A, mild stage of AD, MMSE =20-26 and group B, moderate to severe stage of AD, MMSE=10-19). Mean MMSE and mean Z scores were 22.9±1.11 and 1.01±0.35 in group A (n = 12) while 17.56±0.96 and 2.62±0.59 in group B (n= 8). There was negative correlation between MMSE and eZIS score; r = - 0.69 in group A (p = 0.002); r = - 0.58 in group B (p = 0.019) and r = - 0.93 overall (p = 0.000). Quantification of rCBF with eZIS score was well associated with clinical MMSE scoring in this study group with clinical likelihood of having AD. In rest of the cases, SPECT findings and surface view analysis by eZIS, the affected area of decreased rCBF were consistent with clinically suspected different types of degenerative disease manifesting dementia.
Highlights
Brain single photon emission computed tomography (SPECT) is a well-established and reliable method to assess brain function through measurement of regional cerebral blood flow
We demonstrated decreased regional cerebral blood flow (rCBF) in the frontal cortex, insula, temporal cortex andorbitofrontal cortex, regions which are related to disruptivebehavioral symptoms with relative sparing of theposterior cortex in patients with frontotemporal dementia (FTD) [10]
A specific rCBF pattern was observed for each disease using easy Z score imaging system (eZIS) analysis that consistent with clinical complaint. eZIS indices, especially the rCBF pattern, may be useful in establishing the differential diagnosis between early-stage Alzheimer’s disease (AD) and FTD or VD
Summary
Brain single photon emission computed tomography (SPECT) is a well-established and reliable method to assess brain function through measurement of regional cerebral blood flow (rCBF). Applied to the brain; this technique can be used to measure regional cerebral perfusion. As such the true role of imaging is often imaging of the brain in patients with suspected neurodegenerative conditions is common and challenging, as in patients with indirect and confusing signs and symptoms, the imaging findings are subtle and equivocal. Significant progress in diagnostic accuracy has beenmade using positron emission tomography (PET) andsingle-photon emission computed tomography (SPECT) in the diagnosis of Nasreen Sultana et al.: In Differential Diagnosis of Dementia Application of Easy Z-score Imaging Systemin
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