Brain Single Photon Emission Research Articles

Improvement of Basal Ganglia Detectability in Brain Single Photon Emission Computerized Tomography by Wavelet Transformation in Image Processing Domain: A XCAT Phantom Study

Purpose: Noise in brain Single Photon Emission Computed Tomography (SPECT) images limits an early diagnosis of Parkinson's Disease (PD). To overcome the limitation, as an image processing approach, wavelet transformation was used to denoising the images also with a segmentation method to differentiate the basal ganglia in brain SPECT.
 Materials and Methods: The brain scans of the human 4D Extended Cardiac Torso (XCAT) phantom through the Simulating Medical Imaging Nuclear Detectors (SIMIND) simulated SPECT system were imported to the MATLAB toolkit for image processing. The reconstructed brain images by iterative reconstruction were de-noised through 9 methods of wavelet transformation at different levels, and then six segmentation methods were applied to differentiate the caudate and putamen. The Dice coefficient, Specificity, and Sensitivity evaluation criteria were calculated based on the adaptive thresholding of the selected images from segmentation. A ground truth image was manually marked by a clinical nuclear medicine specialist.
 Results: The dice coefficient was obtained in a range from 0.3979 to 0.6299, as well as the specificity criterion from 0.7682 to 0.8168 and the sensitivity from 0.9049 to 0.9871.
 The results from adaptive threshold segmentation and the evaluation criteria showed that the best levels of the nucleuses detectability were provided by level 7 of Biorthogonal, levels 4 and 7 of Coiflet, level 6 of Daubechies, level 5 of Haar, level 6 of Morlet and level 6 of Symlet methods.
 Conclusion: Parkinson’s disease may be diagnosed in the early stage by an image processing approach to improve the quality of brain SPECT images.

Dynamic multi-pinhole collimated brain SPECT of Parkinson’s disease by [123I]FP-CIT: a feasibility study of fSPECT

We investigated the feasibility of using a dopamine transporter (DaT) tracer ligand ([123I]FP-CIT) along with novel multi-pinhole brain collimators for dynamic brain single photon emission computed tomography (SPECT) in suspected Parkinson's disease patients. Thirteen patients underwent dynamic tracer acquisitions before standard imaging. Uptake values were corrected for partial volume effects. Specific binding ratio (SBRcalc) was calculated, reflecting binding potential relative to non-displaceable binding (BPND) in the cortex. Additional pharmacokinetic parameters (BPND, R1, k2) were estimated using the simplified reference tissue model, revealing differences between Kahraman low-score (LS) and high-score (HS) groups. Results showed increasing striatal tracer uptake until 100 min post-injection, with consistent values afterward. Uptake and SBRcalc ratios matched visual assessment. LS patients had lower putamen than caudate nucleus tracer uptake, decreased BPND values, while R1 and k2 values were comparable to HS patients. In conclusion, dynamic multi-pinhole SPECT using DaT tracer with the extraction of pharmacokinetic parameters is feasible and could help enable early differentiation of reduced and normal DaT values.

A Pilot Study of the Striatal Dopamine Transporter Levels in Kratom-Dependent and Normal Subjects Using 99mTc-TRODAT-1 Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT).

The study aims to elucidate the effects of kratom addiction on dopamine transporter (DAT) using[2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo[3.2.1]oct-2-yl]methyl](2-mercaptoethyl)amino]ethyl]amino]ethanethiolato(3-)-N2,N20,S2,S20]oxo-[1R-(exo-exo)]-[99mTc] technetium (99mTc-TRODAT-1) brain single photon emission computed tomography-computed tomography (SPECT-CT) in kratom-dependent and healthy subjects. We recruited 12 kratom-dependent subjects and 13 healthy men to participate in this study. Addiction, craving, depression, and cognitive scores were assessed. All subjects received a single bolus injection of 99mTc-TRODAT-1 with 914.1 MBq ± 65.5 of activity (mean ± SD). The brain SPECT-CT images were reconstructed using 3D ordered subset expectation maximization (3D-OSEM) along with attenuation correction (AC), scatter correction (SC), and resolution recovery (RR) with an iteration number of four and a subset of 10. The Cohen's Kappa interrater-reliability between two raters, the standardized uptake value of body weight (SUVBW), and the asymmetrical index percentage (AI%) were evaluated. Kappa statistics showed a fine agreement of abnormal 99mTc-TRODAT-1 uptake in the striatum region for the kratom-dependent group with the κ value of 0.69 (p = 0.0001), and the percentage of agreement for rater 1 and rater 2 was 56% and 64%, respectively. There was a reduction in average SUV in kratom-dependent subjects compared to healthy control subjects in the left caudate and left striatum (0.938 vs. 1.251, p = 0.014, and 1.055 vs. 1.29, p = 0.036, respectively). There was a significant difference in the AI% of the caudate region between the kratom-dependent group and the normal group (33% vs. 14%, p = 0.019). Our findings signify that kratom addiction, may cause a change in DAT level and the results can be confirmed using 99mTc-TRODAT-1 SPECT-CT.

Changes of regional cerebral blood flow after repeated transcranial direct current stimulation in healthy participants: a pilot study.

Transcranial direct current stimulation (tDCS) can potentially enhance brain function and cognition in healthy individuals as well as in patients with cognitive impairment. However, neural correlates of repeated tDCS remain relatively unexplored in a healthy population. To assess the effects of repeated tDCS on regional cerebral blood flow (rCBF) in healthy volunteers in a pilot investigation. Five healthy adults received bifrontal tDCS to the dorsolateral prefrontal cortex (F3-F4 montage, 1 mA intensity, 30 minutes/session, five sessions/week) over four weeks. All participants underwent brain single-photon emission computed tomography (SPECT) scans at baseline and one week after the last tDCS session. Changes in rCBF were examined using Statistical Parametric Mapping. Resting rCBF was significantly improved in the right superior frontal gyrus at the follow-up (P < 0.001). Adverse events were not reported and the stimulation was well-tolerated. Repeated tDCS may be effective for enhancing brain function in healthy participants. Larger sham-controlled studies should be performed to confirm our preliminary findings.

Experimental study of noise level optimization in brain single-photon emission computed tomography images using non-local means approach with various reconstruction methods

The noise reduction algorithm using the non-local means (NLM) approach is very efficient in nuclear medicine imaging. In this study, the applicability of the NLM noise reduction algorithm in single-photon emission computed tomography (SPECT) images with a brain phantom and the optimization of the NLM algorithm by changing the smoothing factors according to various reconstruction methods are investigated. Brain phantom images were reconstructed using filtered back projection (FBP) and ordered subset expectation maximization (OSEM). The smoothing factor of the NLM noise reduction algorithm determined the optimal coefficient of variation (COV) and contrast-to-noise ratio (CNR) results at a value of 0.020 in the FBP and OSEM reconstruction methods. We confirmed that the FBP- and OSEM-based SPECT images using the algorithm applied with the optimal smoothing factor improved the COV and CNR by 66.94% and 8.00% on average, respectively, compared to those of the original image. In conclusion, an optimized smoothing factor was derived from the NLM approach-based algorithm in brain SPECT images and may be applicable to various nuclear medicine imaging techniques in the future.

Case Report: Zen meditation-integrated CBT normalized the impaired brain function of a chronic low back pain patient—from the findings of brain blood flow SPECT imaging

Background: Mindfulness meditation for chronic pain is popular globally, but evidence of its efficacy is limited. Moreover, there are no established methods on the objective evaluation of the effectiveness of interventions for chronic pain. In this study, a chronic low back pain patient was treated with traditional Japanese Buddhism meditation-integrated cognitive behavioral therapy and the pre- and post-intervention brain single-photon emission computed tomography (SPECT) images were compared. Case: A 45-year-old man was experiencing continuous back pain after a vehicular accident and experienced insufficient improvement after drug treatment. The patient underwent a 3-month outpatient mindfulness meditation-integrated cognitive behavioral therapy program executed by a multidisciplinary team: physician visits (once a week for 30 min), multidisciplinary medical and meditation education (Zen breath counting meditation and mantra), physiotherapy interventions (twice weekly), occupational therapy interventions (twice weekly), psychiatric occupational therapy interventions (twice weekly), and nutritional interventions (twice weekly). After treatment, the patient reported a decrease in subjective pain overall, based on whether or not a pain attack occurred. Brain SPECT imaging revealed an improvement in excess blood flow from the right temporoparietal junction to the inferior parietal lobe. Conclusions: These findings indicate that Zen meditation is an effective intervention method for chronic pain and SPECT is a useful tool for measuring its effectiveness.

Posttherapy technetium-99m pentavalent dimercaptosuccinic acid brain single-photon emission computed tomography/computed tomography: diagnostic and prognostic values in patients with glioma.

To assess the value of posttherapy 99mTc-pentavalent dimercaptosuccinic acid (DMSA-V) brain SPECT/CT in patients with brain glioma. Patients with pathologically or radiologically proven glioma were prospectively enrolled in this study. 99mTc-DMSA-V brain SPECT/CT images were acquired at 120-180 min after i.v. injection of 555-740 MBq of 99mTc-DMSA-V. Three nuclear medicine physicians blindly interpreted the scans visually as positive or negative for residual/recurrent disease. Agreement between two or more readers was considered a consensus. The composite reference standard was considered based on subsequent clinical/neuroimaging follow-up or histopathology whenever available. Overall survival (OS) was calculated from the date of initial diagnosis till the death or the date of last follow-up. Thirty-four patients (18 males and 16 females; mean age 37.7 ± 16 years) were enrolled in this study. Interreader agreement between the readers ranged from 0.71 to 0.82. Based on the composite reference standard, residual/recurrent disease was confirmed in 16 patients, whereas 18 patients were negative for disease. Consensus reading of 99mTc-DMSA-V SPECT/CT accurately diagnosed 13 true positive (sensitivity 81%) and 17 true negative scans (specificity 94%). After a median follow-up of 22.9 months, 7/14 patients with positive 99mTc-DMSA-V SPECT/CT brain readings died compared to 4/20 with negative readings. The median survival was 24.1 months for the positive group and was not reached for the negative group. Posttherapy brain SPECT/CT scanning with 99mTc-DMSA-V is a noninvasive, reliable, and specific tool for evaluation of patients with brain glioma after definitive therapy. Scan positivity was associated with poor OS.

Clinical significance of asymmetric venous vasculature on minimum-intensity projection in patients with moyamoya disease.

This study analyzed the clinical significance and characteristics of asymmetric venous blood flow in patients with Moyamoya disease (MMD) using minimum intensity projection (minIP) susceptibility-weighted imaging. The minIP views of 30 patients diagnosed with MMD were retrospectively analyzed using clinical features, brain magnetic resonance angiography, electroencephalography, and brain single-photon emission computed tomography (SPECT). Simultaneously, differences between patients with acute cerebral infarction and non-MMD causes were analyzed. Twelve (40.0%) of the 30 patients had asymmetrical venous flow, which is usually seen in patients with acute cerebral infarction (P = .146). They also had significantly higher Suzuki stages than symmetric patients (P = .014), with five (41.7%) and three (25.0%) of them in stages 4 and 5, respectively. When the Suzuki stages of both hemispheres were different, more veins were found in the stenotic hemisphere (88.9%). Brain SPECT showed more severe hypoperfusion on the side with prominent vascularity in the minIP view (100.0%). Additionally, asymmetric blood flow was observed in 66.7% of the patients with cerebral infarction caused by MMD, whereas only 11.1% of the children with cerebral infarction caused by non-MMD had asymmetry (P = .005). Patients with MMD showed asymmetric hypointensity of the cortical veins with a minIP appearance. The venous structure showed greater signal loss on SWI and was more prominent in the hemisphere where stenosis was advanced or infarction occurred in other examinations. Cerebral infarction in patients with MMD tended to occur with asymmetrically prominent venous patterns with damaged areas in minIP images, which had distinct characteristics from those of patients without MMD.

Follow-Up of a Cohort of Patients with Post-Acute COVID-19 Syndrome in a Belgian Family Practice

Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don’t have immunological certainty of a COVID-19 infection. There is no known verified treatment. Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6–8 months, 15 patients were able to return to life and work after 12–18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months. The biopsychosocial consequences on patients’ lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine.

A Statistical DOI Estimation Algorithm for a SiPM-Based Clinical SPECT Insert

A prototype clinical brain single-photon emission computed tomography (SPECT) insert has been designed for use in simultaneous SPECT/MRI. The system utilizes novel slit-slat collimators which, like pinhole collimators, suffers from parallax errors due to the large incident angle of photons. A statistical algorithm has been developed to determine the depth-of-interaction (DOI) with a view to improving image performance. The importance of DOI correction was demonstrated using Monte Carlo simulation. This simulation also indicated that four DOI layers ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$3 \times 1.5\, \textrm {mm} + 3.5\, \textrm {mm}$ </tex-math></inline-formula> ) may be sufficient. The improvement in event localization was demonstrated on a single detector before implementing the algorithm on the full clinical prototype where some limitations in event localization in layers close to the readout plane were observed. Nevertheless, DOI enabled the rejection of poorly localized events with improved resolution in reconstructed line sources.

Alterations in Brain Single-Photon Emission Computed Tomography Perfusion Pattern Pre- and Post-Transcranial Magnetic Stimulation in Tinnitus Participants

Background and Aim: It have been shown that changes in organization of high stimulation related to tinnitus in special areas in brain can be eliminated using protocols based on transcranial magnetic stimulation (TMS). The current study aims to assess the pattern of brain perfusion and effects of TMS on brain activity in tinnitus participants as measured by single-photon emission computed tomography (SPECT) as well as evaluate the efficacy of TMS on severity of tinnitus. Methods: This was a cross-sectional randomized clinical trial, which was performed in 15 patients that referred to tinnitus clinic of Rasoul Akram Hospital during March 2017 to April 2018. These participant were randomly divided into two groups of active treatment with TMS and placebo. In each studied group, the variables of the brain perfusion, tinnitus handicap index (THI), pitch-matching test, loudness match of tinnitus, minimum masking level, and residual inhibition were investigated for all included tinnitus participants before and after TMS. Results: In all tinnitus participants, we had increased uptake in temporal lobes (unilateral or bilateral). In active treatment group, SPECT variables in hotspots were significantly decreased in comparison with placebo group (P &lt; 0.05). Visual analog scale of tinnitus was significantly decreased in active group rather than placebo group (P = 0.023). Conclusion: Our findings showed that tinnitus patients have abnormal brain perfusion increased uptake in temporal lobes that decreased with treatment with TMS and therefore this modality could be an appropriate therapeutic option for the improvement of tinnitus in these patients and efficacy of therapy could assessed by brain perfusion scan as well.

Optimization of block-matching and 3D filtering (BM3D) algorithm in brain SPECT imaging using fan beam collimator: Phantom study

The purpose of this study is to model and optimize the block-matching and 3D filtering (BM3D) algorithm and to evaluate its applicability in brain single-photon emission computed tomography (SPECT) images using a fan beam collimator. For quantitative evaluation of the noise level, the coefficient of variation (COV) and contrast-to-noise ratio (CNR) were used, and finally, a no-reference-based evaluation parameter was used for optimization of the BM3D algorithm in the brain SPECT images. As a result, optimized results were derived when the sigma values of the BM3D algorithm were 0.15, 0.2, and 0.25 in brain SPECT images acquired for 5, 10, and 15 s, respectively. In addition, when the sigma value of the optimized BM3D algorithm was applied, superior results were obtained compared with conventional filtering methods. In particular, we confirmed that the COV and CNR of the images obtained using the BM3D algorithm were improved by 2.40 and 2.33 times, respectively, compared with the original image. In conclusion, the usefulness of the optimized BM3D algorithm in brain SPECT images using a fan beam collimator has been proven, and based on the results, it is expected that its application in various nuclear medicine examinations will be possible.

Sequential Semiology of Seizures and Brain Perfusion Patterns in Patients with Drug-Resistant Focal Epilepsies: A Perspective from Neural Networks.

Ictal semiology and brain single-photon emission computed tomography have been performed in approaching the epileptogenic zone in drug-resistant focal epilepsies. The authors aim to describe the brain structures involved in the ictal and interictal epileptogenic network from sequential semiology and brain perfusion quantitative patterns analysis. A sequential representation of seizures was performed (n = 15). A two-level analysis (individual and global) was carried out for the analysis of brain perfusion quantification and estimating network structures from the perfusion indexes. Most of the subjects started with focal seizures without impaired consciousness, followed by staring, automatisms, language impairments and evolution to a bilateral tonic-clonic seizure (temporal lobe and posterior quadrant epilepsy). Frontal lobe epilepsy seizures continued with upper limb clonus and evolution to bilateral tonic-clonic. The perfusion index of the epileptogenic zone ranged between 0.439–1.362 (mesial and lateral structures), 0.826–1.266 in dorsolateral frontal structures and 0.678–1.507 in the occipital gyrus. The interictal epileptogenic network proposed involved the brainstem and other subcortical structures. For the ictal state, it included the rectus gyrus, putamen and cuneus. The proposed methodology provides information about the brain structures in the neural networks in patients with drug-resistant focal epilepsies.

The Role of Ictal Brain Single Photon-Emission Tomography in Refractory Epilepsy Complementary to Magnetic Resonance Imaging and Electroencephalogram – Our Experience

Background: Correct identification of the epileptogenic zone (EZ) is essential for surgical success for focal epilepsy. There are multiple modalities which are available for detecting the anatomical and the functional abnormalities. The purpose of this study was to determine the complementary role of ictal brain single photon-emission tomography (SPECT) in delineating the EZ in addition to electroencephalogram (EEG) and magnetic resonance imaging (MRI). Methodology: Clinical and diagnostic data from patients with refractory epilepsy undergoing ictal brain SPECT (IEBS), EEG, MRI between 2014 and 2019 were analyzed retrospectively. Tc99m-ethyl cysteinate dimer was administered intravenously during or within 30 s of onset of seizure activity. Results: Eighty-nine patients aged: Four months-32 years (median age: Eight years) were studied. The concordance of IEBS with MRI and EEG were studied. Among them, EEG was normal in 22 and abnormal in 67 (multifocal: 40, unifocal: 8, generalized: 19). MRI was normal in 36, abnormal in 26, nonspecific in 24 and not done in three patients. Of the 80 patients showing tracer uptake in IEBS, 14-multifocal uptake and 66-unifocal uptake (EEG and MRI were not showing any abnormality in 15 and 27 patients, respectively). Unifocal uptake in IEBS was concordant with EEG in 11 (16.67%) and MRI in 15 (27.72%). The concordance and nonconcordance of the results among the two imaging modalities or EEG assuming surgical site as the gold standard was noted. Twenty-two had undergone surgical removal of the EZ, 15 was conformable with MRI or IEBS. Conclusion: In patients with noncontributory EEG and MRI, IEBS could detect the epileptogenic focus. Therefore, depending entirely on EEG and MRI may limit its diagnosis. IEBS, MRI and EEG are complementary to each other in the detecting the epileptogenic focus.

Case of a Man with Hemichorea and Behavioral Changes: "A Red Herring".

Progressive supranuclear palsy (PSP)-pallido-nigro-luysian atrophy (PNLA) is a neuropathological entity thought to be a variant of classic PSP. Clinical features and pathologic hallmarks are the same in both conditions; however, age and order of symptom onset, disease duration and prognosis, and distribution and density of pathology differentiate the 2 entities. This study presents a PSP-PNLA case confirmed pathologically with a clinical presentation of hemichorea/ballism, spasticity, progressive hemiparesis, and a frontal behavioral syndrome with relative cognitive sparing early in the disease course. We describe the clinical progression in this unique case supplemented with video and imaging findings in the form of magnetic resonance imaging and brain single photon emission computed tomography. Final diagnosis is via pathological analysis at autopsy. We present an elderly gentleman who manifested a clinical syndrome consisting of subacute onset of chorea that at presentation was distinctly unilateral and a frontal behavioral syndrome in the setting of mild thrombocytopenia and elevated anticardiolipin antibodies. Positive antiphospholipid antibodies resulted in an initial antemortem diagnosis of primary antiphospholipid syndrome as a cause of his chorea. Longitudinal follow-up over 5 years demonstrated a progression of clinical features with hemi-motor impersistence/chorea, disinhibition and impulsivity, and eventually corticospinal distribution weakness on the initially affected side. He required nursing home care and falls necessitated wheelchair use. Postmortem neuropathological study revealed a diagnosis of frontotemporal lobar degeneration-tau, PSP-PNLA. This case broadens the phenotype of PSP-PNLA and to our knowledge is the only case presenting with unilateral chorea.

Longitudinal Single Photon Emission Computed Tomography Neuroimaging as an Indication of Improvement in Psychiatric Disorders in a Community Psychiatric Practice.

In the community, there is a need to more objectively evaluate the response of common chronic psychiatric disorders to treatment. Brain single photon emission computed tomography (SPECT) indirectly measures cerebral functional activity by uptake of a radiotracer, which follows regional cerebral blood flow. Brain 3D Thresholded SPECT scans are thresholded three dimensional images derived from brain SPECT data. A retrospective community study of longitudinal (before and after treatment) brain 3D Thresholded SPECT scans of 73 patients with all-cause psychiatric disorders (most frequent diagnostic clusters: attention-deficit hyperactivity disorder, post-mild traumatic brain injury, affective disorders, psychotic disorders, post-viral chronic syndromes), shows these baseline SPECT scans predict improvement (non-worsening to large improvement) in clinical functioning with a sensitivity of 94% (95% confidence interval 86–98%) and a specificity of 67% (95% confidence interval 21–94%). In contrast, contemporaneous analysis by the same radiologist of conventional 2D reading of the same before and after treatment brain SPECT scan data of the same 73 patients, predicted improvement (non-worsening to large improvement) in clinical functioning with a sensitivity of only 26% (95% confidence interval 17–37%) although with a specificity of 100% (95% confidence interval 44–100%). These data suggest 3D Thresholded SPECT scans can provide the clinician with a more objective measure for verifying improvement in psychiatric disorders seen in the community, consistent with prior studies of SPECT as a measure of neurobiological change. Furthermore, these data suggest 3D Thresholded SPECT scans may have clinical application in guiding treatment and potentially improving outcomes.

Frontal lobe-dominant cerebral blood flow reduction and atrophy can be progressive in Duchenne muscular dystrophy

This study aimed to clarify the characteristics and progressive changes of brain image abnormalities in Duchenne muscular dystrophy (DMD). Brain images of 39 adult patients (median age, 24 years) were retrospectively reviewed, along with intellectual and/or neurodevelopmental test results. On magnetic resonance imaging (n = 13), atrophy of the frontal lobe, pars opercularis (without other frontal atrophy), and cerebellum was observed in 6, 1, and 1 patients, respectively. On computed tomography (n = 32), atrophy of the frontal lobe, pars opercularis, temporal lobe, and occipital lobe was observed in 20, 1, 1, and 1 patients, respectively. Re-imaging of 12 patients revealed progression of cerebral atrophy in 6. All 18 patients who underwent single photon emission computed tomography had reduced total and/or focal blood flow. Reduced total cerebral blood flow was observed significantly more frequently in patients with deleterious Dp140 mutations compared to those without. Re-examination 4 years later revealed worsening of reduced blood flow in the frontotemporal lobe in 1 patient. Abnormalities were detected by at least one imaging modality in 32 of 39 patients. No significant relationship was observed between imaging abnormalities and developmental disorders or intelligence quotient. In conclusion, DMD patients frequently exhibit frontal lobe-dominant cerebral blood flow reduction and atrophy, and may be at risk of progressive cerebral atrophy and reduced cerebral blood flow. MRI, CT, and/or brain single photon emission CT are useful for detecting brain abnormalities in adult DMD patients.

Effect of Low-Dose Statins in Addition to Standard Therapy on Brain Perfusion and Neurocognitive Performance in Patients with Major Depressive Disorder

Introduction: Major depressive disorder (MDD) is a prevalent condition which has a well-known association with ischemic cardiomyopathy, probably explained by an inflammatory mediator mechanism. Statins, besides reducing cholesterol production, have pleiotropic effects including anti-inflammatory activity. The goal was to evaluate the effect of statins as an addition to standard therapy on mood status, brain perfusion, and neurocognitive performance in MDD. Methods: We studied 20 MDD patients with brain single-photon emission tomography and Cambridge Neuropsychological Test Automated Battery (CANTAB), half randomized to 10 mg of Rosuvastatin or placebo, in addition to selective serotonin reuptake inhibitors (SSRIs) therapy and being reevaluated 3 months later. The images were compared using Statistical Parametric Mapping; clinical scores (Hamilton Depression Score with 17 items and Beck’s Depression Inventory) as well as neurocognitive parameters were applied as covariances (CoV) to estimate regional cerebral blood flow (rCBF) changes with both therapies. Results: Clinical scores decreased in both groups (p = 0.0001); Beck’s presented a larger decrease with statins. We observed significantly rCBF changes expressed as significant larger clusters of voxels (p < 0.05) in the pre/subgenual anterior cingulate plus orbitofrontal cortex and a small area in the posterior cingulate gyrus in the statins group, whereas it was not observed with placebo, when using clinical scores as CoV. A similar pattern of rCBF changes was present with emotions recognition, attentional, paired associates learning, spatial planning, and working memory tasks. Conclusion: Short-term use of low-dose statins in MDD patients under SSRIs results in important rCBF changes in key mood associated areas to improvement in neurocognitive performance. These findings, even though demonstrated in a small sample, could open a new therapeutic tool in the comprehensive management of this disorder.

Low-Parameter Small Convolutional Neural Network Applied to Functional Medical Imaging of Tc-99m Trodat-1 Brain Single-Photon Emission Computed Tomography for Parkinson’s Disease

Parkinson’s disease (PD), a progressive disease that affects movement, is related to dopaminergic neuron degeneration. Tc-99m Trodat-1 brain (TRODAT) single-photon emission computed tomography (SPECT) aids the functional imaging of dopamine transporters and is used for dopaminergic neuron enumeration. Herein, we employed a convolutional neural network to facilitate PD diagnosis through TRODAT SPECT, which is simpler than models such as VGG16 and ResNet50. We retrospectively collected the data of 3188 patients (age range 20–107 years) who underwent TRODAT SPECT between June 2011 and December 2019. We developed a set of functional imaging multiclassification deep learning algorithms suitable for TRODAT SPECT on the basis of the annotations of medical experts. We then applied our self-proposed model and compared its results with those of four other models, including deep and machine learning models. TRODAT SPECT included three images collected from each patient: one presenting the maximum absorption of the metabolic function of the striatum and two adjacent images. An expert physician determined that our model’s accuracy, precision, recall, and F1-score were 0.98, 0.98, 0.98, and 0.98, respectively. Our TRODAT SPECT model provides an objective, more standardized classification correlating to the severity of PD-related diseases, thereby facilitating clinical diagnosis and preventing observer bias.

Clinical Features and Treatment Outcomes of Cerebral Arteriovenous Malformation Associated With Moyamoya Disease

Cerebral arteriovenous malformation (AVM) can rarely occur in conjunction with moyamoya disease (MMD). There is still no consensus on how to treat AVM when accompanied by MMD. In this study, we assessed the clinical features and suggested appropriate management when AVM was combined with MMD. From August 1994 to December 2020, 7 out of 4004 patients with MMD were found to have AVM. The Karnofsky Performance Scale (KPS) was used to evaluate the clinical outcomes of AVM and MMD. KPS greater than 80 was classified as a good outcome. In addition, the radiologic outcomes of the patients were evaluated. The incidence of AVM with MMD was 1.7 per 1000 persons. Five patients underwent bypass surgery for MMD, and 5 patients underwent Gamma Knife surgery (GKS) for concurrent AVM. Postoperative perfusion magnetic resonance imaging and brain single photon emission computerized tomography showed improved cerebral hemodynamics in 4 out of 7 territories. Postoperative cerebral angiography showed good revascularization in 4 out of 8 territories. After GKS, 4 patients showed complete obliteration, and 1 patient showed a significantly decreased AVM size. Six patients showed favorable clinical outcomes (KPS 80-100), and 1 patient with delayed GKS for AVM had a poor outcome (KPS 20) due to AVM rupture. In this study, AVM tended to occur where the angiographic stage of MMD was higher. When AVM is combined with MMD, MMD bypass surgery is recommended based on symptoms and cerebral perfusion status. For AVM, less invasive but effective treatments, such as GKS, should be implemented as soon as possible.