Brain SPECT Imaging Research Articles

CT-guided spatial normalization of nuclear hybrid imaging adapted to enlarged ventricles: Impact on striatal uptake quantification

IntroductionSpatial normalization is a prerequisite step for the quantitative analysis of SPECT or PET brain images using volume-of-interest (VOI) template or voxel-based analysis. MRI-guided spatial normalization is the gold standard, but the wide use of PET/CT or SPECT/CT in routine clinical practice makes CT-guided spatial normalization a necessary alternative. Ventricular enlargement is observed with aging, and it hampers the spatial normalization of the lateral ventricles and striatal regions, limiting their analysis. The aim of the present study was to propose a robust spatial normalization method based on CT scans that takes into account features of the aging brain to reduce bias in the CT-guided striatal analysis of SPECT images. MethodsWe propose an enhanced CT-guided spatial normalization pipeline based on SPM12. Performance of the proposed pipeline was assessed on visually normal [123I]-FP-CIT SPECT/CT images. SPM12 default CT-guided spatial normalization was used as reference method. The metrics assessed were the overlap between the spatially normalized lateral ventricles and caudate/putamen VOIs, and the computation of caudate and putamen specific binding ratios (SBR). ResultsIn total 231 subjects (mean age ± SD = 61.9 ± 15.5 years) were included in the statistical analysis. The mean overlap between the spatially normalized lateral ventricles of subjects and the caudate VOI and the mean SBR of caudate were respectively 38.40 % (± SD = 19.48 %) of the VOI and 1.77 (± 0.79) when performing SPM12 default spatial normalization. The mean overlap decreased to 9.13 % (± SD = 1.41 %, P < 0.001) of the VOI and the SBR of caudate increased to 2.38 (± 0.51, P < 0.0001) when performing the proposed pipeline. Spatially normalized lateral ventricles did not overlap with putamen VOI using either method. The mean putamen SBR value derived from the proposed spatial normalization (2.75 ± 0.54) was not significantly different from that derived from the default SPM12 spatial normalization (2.83 ± 0.52, P > 0.05). ConclusionThe automatic CT-guided spatial normalization used herein led to a less biased spatial normalization of SPECT images, hence an improved semi-quantitative analysis. The proposed pipeline could be implemented in clinical routine to perform a more robust SBR computation using hybrid imaging.

Newly-designed adaptive non-blind deconvolution with structural similarity index in single-photon emission computed tomography

Single-photon emission computed tomography SPECT image reconstruction methods have a significant influence on image quality, with filtered back projection (FBP) and ordered subset expectation maximization (OSEM) being the most commonly used methods. In this study, we proposed newly-designed adaptive non-blind deconvolution with a structural similarity (SSIM) index that can take advantage of the FBP and OSEM image reconstruction methods. After acquiring brain SPECT images, the proposed image was obtained using an algorithm that applied the SSIM metric, defined by predicting the distribution and amount of blurring. As a result of the contrast to noise ratio (CNR) and coefficient of variation evaluation (COV), the resulting image of the proposed algorithm showed a similar trend in spatial resolution to that of FBP, while obtaining values similar to those of OSEM. In addition, we confirmed that the CNR and COV values of the proposed algorithm improved by approximately 1.69 and 1.59 times, respectively, compared with those of the algorithm involving an inappropriate deblurring process. To summarize, we proposed a new type of algorithm that combines the advantages of SPECT image reconstruction techniques and is expected to be applicable in various fields.

Brain PET and SPECT imaging and quantification: a survey of the current status in the UK.

With disease-modifying therapies in development for neurological disorders, quantitative brain imaging techniques become increasingly relevant for objective early diagnosis and assessment of response to treatment. The aim of this study was to evaluate the use of Brain SPECT and PET scans in the UK and explore drivers and barriers to using quantitative analysis through an online survey. A web-based survey with 27 questions was used to capture a snapshot of brain imaging in the UK. The survey included multiple-choice questions assessing the availability and use of quantification for DaTscan, Perfusion SPECT, FDG PET and Amyloid PET. The survey results were reviewed and interpreted by a panel of imaging experts. Forty-six unique responses were collected and analysed, with 84% of responses from brain imaging sites. Within these sites, 88% perform DaTscan, 50% Perfusion SPECT, 48% FDG PET, and 33% Amyloid PET, while a few sites use other PET tracers. Quantitative Brain analysis is used in 86% of sites performing DaTscans, 40% for Perfusion SPECT, 63% for FDG PET and 42% for Amyloid PET. Commercial tools are used more frequently than in-house software. The survey showed variations across the UK, with high availability of DaTscan imaging and quantification and lower availability of other SPECT and PET scans. The main drivers for quantification were improved reporting confidence and diagnostic accuracy, while the main barriers were a perception of a need for an appropriate database of healthy controls and a lack of training, time, and software availability.

A Headrest Made of Extruded Polystyrene Reduces the Influence of Attenuation Correction on Human Brain SPECT Images.

Previous reports suggest that a headrest made of carbon significantly influences cerebral blood flow in the anterior and posterior regions by image reconstruction and attenuation correction (AC). The present study aimed to develop a headrest that reduces the influence of the AC process on human brain SPECT. Methods: To validate the performance of a headrest made of extruded polystyrene (XPS), 10 healthy controls and 43 patients with cerebrovascular disease underwent 99mTc-ethyl cysteinate dimer SPECT using a carbon headrest and an XPS headrest. We evaluated the anterior-to-posterior and middle-to-posterior ratio of the brain regions in filtered backprojection (FBP) Chang AC, ordered-subset expectation maximization (OSEM) Chang AC, and OSEM CT-based AC. Results: The anterior-to-posterior ratio was significantly higher with the carbon headrest than with the XPS headrest in FBP Chang AC and OSEM Chang AC (P < 0.001). There was no significant difference between the materials in OSEM CT-based AC. The middle-to-posterior ratio did not differ to a statistically significant extent in any correction process. Conclusion: Acquisition of brain SPECT images with an XPS headrest and processing by the FBP or OSEM Chang AC method enables the influence of the headrest to be reduced, especially in anterior and posterior brain regions.

Scintillation event localization in hemi-ellipsoid detector for SPECT, a simulation study using Geant4 Monte-Carlo

Purpose: a high sensitivity Cardiac SPECT system using curved crystals with pinhole collimation was proposed previously (Dey, IEEE Trans. Nucl. Sci. 59 (2012) 334). Using hemi-ellipsoid CsI crystals, in simulations, the system improved sensitivity by a factor of 3 over newer generation SPECT systems (DSPECT or GE Discovery) while keeping the resolution comparable (Bhusal et al., Med. Phys. 46 (2018) 116). In this work, we hypothesize that the high curvature detector results in measurable differences in light distribution from events at different depths in the crystal. We rigorously test this by analyzing the scintillation light using Monte-Carlo (Geant4) and propose a statistical event localization method in a hemi-ellipsoid detector. We evaluate the localization error of the algorithm and the back-projected errors in object space. Methods: to develop this localization capability for the proposed design, we used Geant4 to simulate the propagation of scintillation light in a monolithic hemi-ellipsoidal CsI crystal. A look-up table (LUT) was created to map the points inside the crystal to the expected light pattern on the crystal surface using the Geant4 simulation data. Thirteen zones were considered across the crystal. In each zone, gamma-rays were simulated and the resulting photon intensity on the surface was captured, serving as our experimental interactions. An algorithm based on Poisson statistics was developed to limit the search of the experimental gamma-ray event locations into smaller regions of the LUT. The localization was fine-tuned by comparing the light distribution of the gamma interactions in selected patterns from the LUT points and then recorded. The algorithm-localized gamma-ray events were also individually back-projected to the object mid-plane, (expected mid-plane of the heart), and the error at the plane was recorded as well. Results: the light patterns of adjacent LUT points showed visually discernible differences. Excluding some outliers (up to 2%), the localized errors averaged over all the zones was 0.71 (±0.44) mm with a worse case of 1.36 (± 0.67) mm at the apex. Moreover, when back-projected to the midplane of the region of interest for Cardiac SPECT, the errors were <1 mm due to the high system magnification afforded by the apex and other zones. The average back-projection error at the mid-plane of the object was 0.4 mm±0.22 mm. Conclusion: we modeled gamma-event interactions and scintillation light spread in CsI hemi-ellipsoid detector and developed a robust statistical algorithm that localized scintillation events to within 0.71 (±0.44) mm on the average within a hemi-ellipsoid CsI detector. Moreover, due to the high system magnification afforded by the crystal, the hemi-ellipsoid unit was capable of achieving <1 mm average localization in the object space, assuming perfect pinhole collimator resolution recovery. Thus, we show that this high sensitivity system will be able to deliver images with high resolution for Cardiac SPECT. In the future, the application of this may be extended to Brain SPECT and small animal imaging.

Design Study of an Ultrahigh Resolution Brain SPECT System Using a Synthetic Compound-Eye Camera Design With Micro-Slit and Micro-Ring Apertures.

In this paper, we discuss the design study for a brain SPECT imaging system, referred to as the HelmetSPECT system, based on a spherical synthetic compound-eye (SCE) gamma camera design. The design utilizes a large number ( ~500) of semiconductor detector modules, each coupled to an aperture with a very narrow opening for high-resolution SPECT imaging applications. In this study, we demonstrate that this novel system design could provide an excellent spatial resolution, a very high sensitivity, and a rich angular sampling without scanning motion over a clinically relevant field-of-view (FOV). These properties make the proposed HelmetSPECT system attractive for dynamic imaging of epileptic patients during seizures. In ictal SPECT, there is typically no prior information on where the seizures would happen, and both the imaging resolution and quantitative accuracy of the dynamic SPECT images would provide critical information for staging the seizures outbreak and refining the plans for subsequent surgical intervention.We report the performance evaluation and comparison among similar system geometries using non-conventional apertures, such as micro-ring and micro-slit, and traditional lofthole apertures. We demonstrate that the combination of ultrahigh-resolution imaging detectors, the SCE gamma camera design, and the micro-ring and micro-slit apertures would offer an interesting approach for the future ultrahigh-resolution clinical SPECT imaging systems without sacrificing system sensitivity and FOV.

Optimization of newly developed and lead shields thicknesses for protecting taxi drivers from 99mTc injected patients

Presently, public members are exposed to sources of ionizing radiation, and health risks due to radiation exposures should be a concern. This study aims to calculate the whole-body cumulative radiation exposure of taxi drivers. Also, this study will provide the effect of using a simple lead shield and three types of glass shield AVT6, TZN-D, and SLGC-E5, by calculating the effective annual dose of the taxi drivers that work in medical centers. Two MIRD phantoms as a driver and patient, a sample body of a taxi, pure lead, and glass sheets as a shield, were simulated using the MCNP code. We assumed that the patients had undergone the brain, liver, and kidney SPECT imaging by injecting 99mTC-HMPAO, 99mTC-sulfur colloid, and 99mTC-DMSA with the activity of 740MBq, 185MBq, and 333MBq, respectively. These shields are simulated on two sides of the driver, in the back and right side. The annual effective dose was calculated for 0–3.5 g/cm2 area densities. It was observed that the 0.45, 1.09, 1.28, and 2.11 g/cm2 of Pb, TZN-D, AVT6, and SLGC-E5 respectively decrease the effective dose below the allowed limit. According to the results, using the lead shield, the effective dose was reduced by a factor up to 7.25 times. It is recommended that taxi drivers wear a 0.4 mm lead shield or its equivalent when they have Tc-99 m injected patients.

Impact of reconstruction parameters on lesion detection and localization in joint ictal/inter-ictal SPECT reconstruction.

Previously, a joint ictal/inter-ictal SPECT reconstruction was proposed to reconstruct a differential image representing the change of brain SPECT image from an inter-ictal to an ictal study. The so-called joint method yielded better performance for epileptic foci localization than the conventional subtraction method. In this study, we evaluated the performance of different reconstruction settings of the joint reconstruction of ictal/inter-ictal SPECT data, which creates a differential image showing the difference between ictal and inter-ictal images, in lesion detection and localization in epilepsy imaging. Differential images reconstructed from phantom data using the joint and the subtraction methods were compared based on lesion detection performance (channelized Hotelling observer signal-to-noise ratio (SNRCHO) averaged across four lesion-to-background contrast levels) at the optimal iteration. The joint-initial method which was the joint method that was initialized by the subtraction method at optimal iteration was also used to reconstruct differential images. These three methods with respective optimal iteration and the subtraction method with four iterations were applied to epileptic patient datasets. A human observer lesion localization study was performed based on localization receiver operating characteristic (LROC) analysis. From the phantom study, at their respective optimal iteration, the joint method yielded an improvement in lesion detection performance over the subtraction method of 26%, which increased to 145% when using the joint-initial method. From the patient study, the joint-initial method yielded the highest area under the LROC curve as compared with those of the joint and the subtraction methods with optimal iteration and with 4 iterations (0.44 vs 0.41, 0.39 and 0.36, respectively). In lesion detection and localization, the joint method at optimal iteration outperformed the subtraction method at optimal iteration and at iteration typically used in clinical practice. Furthermore, initialization by the subtraction method improved the performance of the joint method.

Rest tremor correlates with reduced contralateral striatal dopamine transporter binding in Parkinson's disease

IntroductionIn vivo dopamine transporter imaging is a useful tool for distinguishing nigrostriatal pathologies (e.g. Parkinson's disease) from other causes of tremor. However, while many of the motoric features of Parkinson's disease (e.g. bradykinesia, rigidity, hypomimia) correlate well with reduced striatal dopamine transporter binding, the same relationship has not been demonstrated for tremor. We investigated the relationship between striatal dopamine transporter binding and quantitative measures of tremor. Methods23 participants with Parkinson's disease underwent standardised clinical assessment including structured, videotaped clinical examination, tremor neurophysiology study of both upper limbs using accelerometry and surface EMG, and Technitium-99 m TRODAT-1 brain SPECT imaging. Normalised striatal uptake values were calculated. Tremor EMG and accelerometry time series were processed with Fourier transformation to identify peak tremor power within a window of 3–10Hz and to calculate the tremor stability index (TSI). ResultsSpearman correlation analyses revealed an association between tremor power and contralaterally reduced striatal uptake in a number of recording conditions. This association was strongest for rest tremor, followed by postural tremor, with the weakest association observed for kinetic tremor. Lower TSI was also associated with lower contralateral striatal uptake in a number of rest and postural conditions. ConclusionThese data suggest a relationship between Parkinsonian rest tremor and contralateral reduction in striatal dopamine binding. Use of quantitative neurophysiology techniques may allow the demonstration of clinico-pathophysiological relationships in tremor that have remained occult to previous studies.

99mTc]Tc-iPSMA SPECT brain imaging as a potential specific diagnosis of metastatic brain tumors and high-grade gliomas

BackgroundPSMA (prostate-specific membrane antigen) protein is heavily expressed in the proliferating microvasculature of high-grade gliomas (HGG) and brain metastases (BM). This research aimed to assess [99mTc]Tc-iPSMA SPECT brain imaging as a potential specific diagnosis of HGG and BM by PSMA-targeting in their proliferating vasculature. MethodsForty-one patients, with suspected brain tumors, as detected by enhanced MRI scanning, were enrolled to undergo preoperative [99mTc]Tc-iPSMA SPECT brain imaging. Semiquantitative image analyses, to evaluate the maximum target-to-background ratio (TBRmax), were performed. All diagnoses were histopathologically confirmed. PSMA expression was evaluated by immunohistochemistry (IHC) in 11 brain tumor tissues. TBRmax values were correlated with IHC results and tumor WHO grade (HGG vs LGG). Results[99mTc]Tc-iPSMA images showed increased uptake in BM, HGG, and recurrent gliomas (TBRmax of 25.1 ± 7.1, 18.5 ± 9.0, 15.0 ± 9.9, respectively), and was negative in treatment-naive patients with LGG and reactive gliosis. PSMA was highly expressed in the vascular endothelium of grade IV gliomas and BM, while its expression was extremely low in LGG and completely absent in gliosis. By using 2.8 as a threshold value for TBRmax, the specificity, sensitivity, PPV, NPV and accuracy were 100%, 94%, 100%, 77% and 95%, respectively. ConclusionsThe results of this pilot study show that [99mTc]Tc-iPSMA SPECT brain imaging is a specific and potentially useful neuroimaging tool for assessing tumoral neovasculature formation in gliomas and brain metastases.

Influence of a Headrest on Reconstruction and Attenuation Correction of Human Brain SPECT Images.

Previous reports suggest that a headrest significantly influences anterior and posterior cerebral blood flow. The present study aimed to clarify the influence of a headrest on reconstruction and attenuation correction (AC) of brain SPECT images. Methods: We evaluated the influence on cerebral blood flow in the anterior region (brain segments A + B), middle region (segments D + F), and posterior region (segment G) of the brain using filtered backprojection-AC based on the method of Chang (FBP-ChangAC), ordered-subset expectation maximization-ChangAC (OSEM-ChangAC), OSEM CT-based AC (OSEM-CTAC), and OSEM with no attenuation correction (OSEM-NoAC) with and without a headrest. The subjects were 17 healthy volunteers who underwent 99mTc-ECD SPECT. We compared the A + B/G and the D + F/G ratios of 99mTc-ECD SPECT images in each group. Results: For FBP-ChangAC, OSEM-ChangAC, and OSEM-NoAC, there were significant differences in A + B/G ratio between images obtained with a headrest and those obtained without. On the other hand, for OSEM-CTAC, there were no significant differences in A + B/G ratio regardless of whether a headrest was used. For FBP-ChangAC and OSEM-NoAC, there were significant differences in D + F/G ratio between images with a headrest and those without. For OSEM-CTAC and OSEM-ChangAC, there were no significant differences in D + F/G ratio regardless of whether a headrest was used. Conclusion: The influence of a headrest on image reconstruction and AC should be considered if FBP-ChangAC, OSEM-ChangAC, or OSEM-NoAC is used but not if OSEM-CTAC is used.

Spatial Standardization of Spect Brain Images With Perfusion Radiopharmaceuticals

Background. In the study of 3D images of the brain according to emission computed tomography (SPECT) there is a problem of their spatial orientation for the correct construction of sections and subsequent analysis of the symmetry of effective hemisphere perfusion. The brain on the original images can take virtually any orientation, resulting in asymmetry of distribution of radiopharmaceutical agents (RPA) on sections of parallel or perpendicular coordinate axes. In turn, this can lead to incorrect interpretation of clinical data. Objective. The purpose of the paper is development of a methodology and appropriate software module for the automated standardization of spatial orientation of the SPECT of the brain images, in particular, with 99mTc-hexamethylpropylene ( 99 mTc-HMPAO) perfusion RPA. Methods. 30 SPECT images of patients with different levels of brain perfusion were analyzed. Brain scintigraphic studies were performed with 99 mTc- HMPAO on a gamma camera E. Cam(Siemens) with LEHR collimator. SPECT was performed in 15–20 min after intravenous administration of RPA. The tomographic study included the collection of 128 projections for the 128×128 matrix, the RPA activity for intravenous administration was 740 MBq. The developed method of automated standardization of spatial orientation SPECT image of the brain was implemented in the software ScintyBrain in Matlab 2018. Results. The developed technique, based on finding the plane of symmetry of the hemispheres of the brain, allows determining the spatial orientation of the brain with an average error of 0.8–4°. The error in determining the angle of rotation of the sagittal sections increases with decreased perfusion of the frontal segments, and the frontal sections – depends on the presence of large-focal changes in the temporal and parietal divisions of the hemisphere. Conclusions. A method of automated spatial standardization of SPECT images of the brain was developed. The average error of the spatial angles of rotation of 3D images is in the range of 0.8–4°. The average computer analysis of the brain's spatial orientation takes up to 40 sec. The implementation of the presented method minimizes the subjective influence of specialists on the results of processing and analysis of scintigraphic images. In addition, the automated SPECT standardization procedure can significantly reduce the time of subsequent blending of SPECT brain images with other modalities.

Improvement of diagnostic accuracy of Parkinson's disease on I-123-ioflupane single photon emission computed tomography (123I FP-CIT SPECT) using new Japanese normal database.

I-123-ioflupane single photon emission computed tomography (FP-CIT-SPECT) has been used to assess dopamine transporter (DAT) loss in Parkinson's disease. The specific binding ratio (SBR), a quantitative parameter of DAT density in the striatum, may be affected by differences in age, sex, and SPECT system. The purpose of this study was to evaluate the utility of FP-CIT-SPECT using the Japanese normal database (NDB) in the diagnosis of Parkinson's disease. To standardize the quantitative outcome measures of DAT density obtained with different SPECT systems, striatal phantoms filled with striatal to background materials at ratios between 8:1 and 1:1 were measured using a gamma camera (ECAM) in our institute. Consecutive fifty patients (23 men and 27 women; age range, 40-86 years) with suspected PD undergoing FP-CIT SPECT brain imaging during the period from April to October 2016 were enrolled in this retrospective study. Their final diagnoses were PD in 28 patients and PD in 22 patients. SBRs of the patients were calculated using either new (Japanese database with different age and sex; NEWver) or old (non-Japanese database not specifying age and sex; OLDver) version software (AZE Virtual Place Hayabusa [DaTView], AZE, Ltd. Tokyo, Japan). The McNemar test was used to compare the diagnostic accuracy between old and new versions. Based on the phantom study, the calibrated SBR could be calculated by Y=1.25×Measured SBR+0.78. The sensitivities for OLDver and NEWver were 100% and 93%, respectively (p=0.5), and the specificities were 55% and 100% (p=0.002). The diagnostic accuracy of NEWver (96%) was better than that of OLDver (80%, p<0.001). FP-CIT-SPECT using the Japanese NDB improved the diagnostic accuracy of PD by improving specificity.

The Influence of Attenuation and Scatter Corrections on Quantitative Analysis of &lt;sup&gt;123&lt;/sup&gt;I-FP-CIT SPECT Brain Imaging

The Influence of Attenuation and Scatter Corrections on Quantitative Analysis of &lt;sup&gt;123&lt;/sup&gt;I-FP-CIT SPECT Brain Imaging

Changes in SPECT Brain Imaging in Pediatric Patients with Suspected Neuroborreliosis: A Series of 6 Cases

Lyme disease is a disease transmitted by ticks with a broad spectrum of comorbidity associated, from purely osteoarticular to neurological, as well as great variability comorbidity depending on the age of the individual. It currently represents an epidemic recognized by the CDC and confers a very important morbidity burden in our environment due to the frequent lack of diagnosis and early treatment. This infection has been related in the scientific literature to conditions such as fibromyalgia, autism or ADHD, among others. SPECT brain imaging is an indirect technique to measure cerebral blood flow and can be a useful tool in the diagnosis of neuroborreliosis and in the monitoring of treatment. We present a series of 6 pediatric cases with varied neuropsychiatric symptoms and suspected neuroborreliosis that showed abnormal findings in the cerebral SPECT.

SEMIQUANTITATIVE EVALUATION OF 99MTCTRODAT1 BINDING POTENTIAL BY TWO METHODS OF SPECT IMAGE RECONSTRUCTION.

TRODAT-1 is a radiopharmaceutical derived from tropane and linked to tecnecium-99m ([99mTc] TRODAT-1) has been used in studies of dopamine transporter (DAT) in central nervous system. Associated with the SPECT technique of acquisition, is able to detect changes in neurological disorders like Parkinson´s disease, evaluating the binding potential (BP) of DAT. The aim of this study was to evaluate the influence of the image reconstruction methods, Filtered Back Projection (FBP) and iterative reconstruction (OSEM), in BP values at the striatal region in 30 healthy volunteers. Images were analyzed by visual inspection and semi-quantitative analysis. Regions of interest (ROI) were made over striatal areas on both sides. Nonparametric Wilcoxon statistical analysis was performed between the BP values from the FBP and OSEM methods. Our results showed that the reconstruction methods have a statistical significant BP values difference in the total striatum (Z = -2,2787 p = 0.005), right striatum (Z = -2,602 p = 0.009) and left striatum (Z= 2,746 p = 0.006). The effect size was calculated to see if there influence in this test: the "large effect size" for all measurements was observed (total striatum r= -0.51; right striatum r= -0.48; left striatum r= -0.50). FBP is the usual method of reconstruction for brain SPECT images, and our results showed influence of the OSEM method in BP. It is concluded that the method of image reconstruction adopted should be standardized to avoid incorrect evaluations of BP values using [99mTc]TRODAT-1.

Hyperbaric Oxygen Therapy Can Induce Neuroplasticity and Significant Clinical Improvement in Patients Suffering From Fibromyalgia With a History of Childhood Sexual Abuse-Randomized Controlled Trial.

Background: Fibromyalgia syndrome (FMS), a condition considered to represent a prototype of central sensitization syndrome, can be induced by different triggers including childhood sexual abuse (CSA). Recent studies have demonstrated hyperbaric oxygen therapy (HBOT) can induce neuroplasticity and improve clinical outcome of FMS. The aim of the current study was to evaluate the effect of HBOT on patients suffering from FMS with a history of CSA.Materials and methods: A prospective randomized clinical trial conducted between July 2015 and November 2017 included women with a history of CSA who fulfilled fibromyalgia diagnosis criteria for at least 5 years prior to inclusion. Included participants (N = 30) were randomly assigned to treatment group, treated with 60 HBOT sessions and a control/crossover group received psychotherapy. After the control period, the control/crossover group was crossed to HBOT. Clinical outcomes were assessed using FMS questioners, post-traumatic stress disorder (PTSD) questioners and quality of life questioners. Objective outcome were assessed using brain function and structure imaging.Findings: Following HBOT, there was a significant improvement in all FMS questionnaires (widespread pain index, Fibromyalgia symptoms severity scale, Fibromyalgia functional impairment), most domains of quality of life, PTSD symptoms and psychological distress. The same significant improvements were demonstrated in the control following crossover to HBOT. Following HBOT, brain SPECT imaging demonstrated significant increase in brain activity in the prefrontal cortex, orbital frontal cortex, and subgenual area (p < 0.05). Brain microstructure improvement was seen by MRI-DTI in the anterior thalamic radiation (p = 0.0001), left Insula (p = 0.001), and the right Thalamus (p = 0.001).Conclusion: HBOT induced significant clinical improvement that correlates with improved brain functionality and brain microstructure in CSA related FMS patients.Trial Registration: www.Clinicaltrials.gov, identifier: NCT03376269. url: https://clinicaltrials.gov/show/NCT03376269

Dynamic image denoising for voxel-wise quantification with Statistical Parametric Mapping in molecular neuroimaging.

PurposePET and SPECT voxel kinetics are highly noised. To our knowledge, no study has determined the effect of denoising on the ability to detect differences in binding at the voxel level using Statistical Parametric Mapping (SPM).MethodsIn the present study, groups of subject-images with a 10%- and 20%- difference in binding of [123I]iomazenil (IMZ) were simulated. They were denoised with Factor Analysis (FA). Parametric images of binding potential (BPND) were produced with the simplified reference tissue model (SRTM) and the Logan non-invasive graphical analysis (LNIGA) and analyzed using SPM to detect group differences. FA was also applied to [123I]IMZ and [11C]flumazenil (FMZ) clinical images (n = 4) and the variance of BPND was evaluated.ResultsEstimations from FA-denoised simulated images provided a more favorable bias-precision profile in SRTM and LNIGA quantification. Simulated differences were detected in a higher number of voxels when denoised simulated images were used for voxel-wise estimations, compared to quantification on raw simulated images. Variability of voxel-wise binding estimations on denoised clinical SPECT and PET images was also significantly diminished.ConclusionIn conclusion, noise removal from dynamic brain SPECT and PET images may optimize voxel-wise BPND estimations and detection of biological differences using SPM.

I-123 DaTscan SPECT Brain Imaging in Parkinsonian Syndromes: Utility of the Putamen-to-Caudate Ratio.

Computer-based analysis of Dopamine transporter imaging (DaTscan) can aid in image interpretation. In this study, we examined the distribution of putamen-to-caudate ratios (PCRs) obtained by using a clinically available semiquantification method. Medical records of 32 patients (M:16) with a diagnosis of Parkinson's disease (PD) (n = 22) or Parkinson's plus syndromes (PPS) (n = 10) based on clinical follow-up, were retrospectively reviewed. Single photon emission tomography (SPECT) imaging was performed 4 hours after intravenous injection of 3-5 mCi [I-123]-ioflupane. Semiquantitative evaluation using DaTQUANT software was performed. Utility of PCR with a cutoff of .7 and .8 in the diagnosis of nigrostriatal degeneration was assessed. PD and PPS groups based on clinical assessment and caudate-to-background ratio (CBR) were assessed separately. Minimum PCR for both hemispheres was .74 ± .09 (Mean ± SD, range: .58-.89), with 65.63% patients (21/32) having PCR > .7. Mean PCR in mild nigrostriatal degeneration was .77 ± .08 (range: .62-.89) and in advanced nigrostriatal degeneration was .73 ± .09 (range: .58-.89). Mean PCR in PD group was .73 ± .09 (range: .58-.89) and in PPS group was .75 ± .10 (range: .61-.88). Although PCR can intrinsically be a useful indication of disease, this ratio obtained in our analysis by using one of the clinically available automatic semiquantitative methods has large variability and might not be a reliable numeric marker in interpretation of [I-123]ioflupane studies. This may be due to difficulty in separating caudate from putamen on SPECT images, as well as the nonuniform decreased Ioflupane uptake in both putamen and caudate.

Correlation between clinical and radiologic features of patients with Gerstmann-Sträussler-Scheinker syndrome (Pro102Leu)

Background and purposeGerstmann-Sträussler-Scheinker syndrome is a rare hereditary neurodegenerative disorder with clinical heterogeneity. This study is aim to demonstrate the clinical spectrum and radiologic characteristics of patients caused by Pro102Leu mutation in PRNP. Materials and methodsWe retrospect clinical manifestations of five patients from four Japanese families, and comprehensively analyzed their brain MRI, SPECT (N-isopropyl-p-[123I] iodoamphetamine), and PET (18F-2-fluoro-2-deoxy-d-glucose) images. ResultsAll patients developed ataxia of lower limbs and trunk, gait disturbance, dysesthesia in legs, and lower limb hyporeflexia. In the early clinical stage before dementia began, no noticeable abnormalities could be observed from brain MRI, but SPECT and PET revealed mosaic-like pattern of blood flow and glucose metabolism of the brain. Predominant abnormalities were found in the occipital and frontal lobes on SPECT and PET analysis, respectively. In SPECT analysis, blood flow of the anterior cerebellar lobes was lower than that of the posterior cerebellar lobes. ConclusionsClinical symptoms resulting from failure of dorsal horn of spinal cord and spinocerebellar tracts were observed in all cases. Radiologic findings revealed individual differences of involved region in their brain, which could produce clinical diversity. We identified a downtrend of blood flow in the anterior cerebellar lobes, a projection field of the spinocerebellar tracts, which is an important feature of Gerstmann-Sträussler-Scheinker syndrome.