Evaluation of cerebral blood flow reserve in patients with cerebrovascular disease by SPECT using technetium-99m-L, L-ethyl cysteinate dimer

A technique for measuring the resting and acetazolamide (Acz)-activated cerebral blood flow without blood sampling by consecutive single-photon emission computed tomography (SPECT) using technetium-99m-L, L-ethyl cysteinate dimer (99mTc-ECD), called the 99mTc-ECD-RVR method, was recently developed by Matsuda et al . and Takeuchi et al . We evaluated the cerebral blood flow reserve in 77 patients with cerebrovascular diseases and 24 controls using this method. Baseline mean CBF (mCBF)was calculated from the application of Patlak plot graphical analysis with radionuclide angiography, and quantitative regional CBF (rCBF) images were obtained from qualitative axial SPECT images by the mCBF and Lassen’s linearization correction. The activated SPECT images were obtained by subtraction of the first image from the second image. The mean increment ratio (IR) by calculating the mean CBF for the pre- and post-Acz in the controls was 1.26±0.12 (mean±SD). In patients with cerebrovascular disease, the reduction of the mean IR and regional IR was parallel with the degree of stenosis. This noninvasive method was also considered to be useful in evaluating the change in the hemodynamic reserve in cerebrovascular disease

Mechanism of ST segment depression during exercise tests in patients with liver cirrhosis

Purpose : To our experience, ST segment depression is sometimes detected in an exercise electrocardiogram (ECG) test in patients with liver cirrhosis who have no significant coronary stenosis. In this study, the mechanism of ST segment depression in liver cirrhosis was examined using 99mTc-methoxy-isobutyl-isonitrile (MIBI) myocardial scintigraphy. Methods : Six patients with liver cirrhosis (LC group), and 15 normal subjects (N group) were examined. To evaluate the level of myocardial blood flow, a Bull’s eye display of myocardial blood flow was performed after dividing the left ventricle into 9 segments. Exercise myocardial scintigraphy with MIBI was performed to obtain the increase in % uptake. Angiographies were performed with a CAG system by inserting a 5 French Judkins catheter via the right femoral artery. Results : No significant coronary stenosis was found in any of the LC patients. Neither a decrease in MIBI uptake nor defect was observed on Bull’s eye images from the LC group. The mean % uptake increase was 61.0 ± 5.6% in the N group. In the LC group, although neither a decrease in MIBI uptake nor a defect was visually observed on Bull’s eye images obtained during exercise, the % uptake increases (mean : 52.5 ± 5.8%) were lower than those of the N group (p<0.05). Conclusion : These findings suggest that a disorder in coronary flow reserve occurs in liver cirrhosis patients, because the decreased MIBI uptake during exercise is due to the depression of flow-mediated vasodilatation controlled by the endothelium of the coronary artery and the estrogenic digitalis action of blood flow independency

Findings of brain 99mTc-ECD SPECT in high-functioning autism : 3-dimensional stereotactic ROI template analysis of brain SPECT

The aim of this study is confirmation of an abnormal regional cerebral blood flow (rCBF) pattern in high-functioning autism (HFA). Confirmation of an abnormal rCBF pattern in HFA may be useful for elucidate of its pathophysiology and a differential diagnosis, such as with attention-deficit / hyper activity disorder (AD/HD).Brain 99mTc-ECDSPECTwas performed in 16 cases of HFA. The HFA group consisted of 16 cases of HFA. They were all male, with an IQ of 76～126. They had normal brain MRI findings, and had an age of 9～14 years. We examined abnormal rCBF in HFA by comparing the results to those in the control group. The control group consisted of 1male and 4 females cryptogenic epilepsy patients with normal intelligence. They have no problems in learning at school or mental or behavioral traits. They had normal brain MRI or SPECT findings, and had an age of 7～15 years. 3-dimensional stereotactic ROI template (3DSRT) was used to analyze SPECT data. We calculated the ‘relative rCBF (%)’ (RI count of each segment ×100 / Sum of RI count of the corresponding hemisphere), and compared the values between the two groups. We found a significantly low ‘relative rCBF (%)’ in the left temporal region in the HFA group. We also calculated the ‘L/R ratio’ (the ‘relative rCBF(%)’ of a segment on the left side / the ‘relative rCBF (%)’ of the corresponding segment on the right side), and compared the value for each segment between the two groups. There were no significant differences in any segments between the two groups. We also checked for differences in the ‘relative rCBF (%)’ between segments on the right side and corresponding segments on the left side in both the HFA and control groups. We found significant rightltleft perfusion in the angular region and significant leftltright perfusion in the pericallosal, thalamus, and hippocampus region in the HFA group. We also found significant rightltleft perfusion in the temporal region in the control group. Significant hypoperfusion in the left temporal region due to an unidentified underlying brain pathology and abnormal laterality in the angular, temporal (lack of rightltleft perfusion), pericallosal, thalamus, and hippocampus regions may influence the symptoms of autism

Atypical Familial Mediterranean Fever Complicated with Gastrointestinal Amyloidosis Diagnosed due to Paroxysmal Arthralgia and Intractable Diarrhea, Successfully Treated with Tocilizumab

A 53-year-old man with recurrent episodes of large joint pain and a low-grade fever at irregular intervals for 16 years developed right knee and ankle arthralgia, watery diarrhea, and abdominal pain. Following an ileum and colon biopsy, he was diagnosed with gastrointestinal amyloidosis. We suspected familial Mediterranean fever (FMF) based on his history and administered colchicine; his symptoms subsequently improved. Thus, he was diagnosed with atypical FMF. After tocilizumab administration, the amyloid deposits disappeared. This case suggests that physicians should consider FMF even in cases with atypical symptoms in order to prevent the progression of amyloidosis and that amyloid deposits can be eliminated by interleukin (IL)-6 inhibition