Radiologia Brasileira - Publicação Científica Oficial do Colégio Brasileiro de Radiologia

EVALUATION OF THE BRAIN SPECT-99mTcECD AND ANALYSIS OF THE DIFFERENCE OF TYMPANIC TEMPERATURE IN 32 PATIENTS.

Danielle Cicarini de Landa; Joaquim Brasil Neto; Raphael Boechat Barros; Carlos Uribe.

Laboratório de Ciências e Compartamento da UNB; IRB – Instituto de Radioisótopos de Brasília; MediNuclear.

Objectives: To evaluate the results obtained by brain SPECT in 32 patients, and their possible relationship to inter-aural differences in tympanic temperature (TT). Methods: The results of brain SPECT with ECD in 32 patients referred to the service of Nuclear Medicine for evaluation of possible neuropsychiatric illnesses were analyzed and correlated with inter-aural differences in TT (IAD-TT). At least 04 measurements of TT were performed in each ear, in an alternated fashion. Of the 32 patients, in 22 the measurement of TT was performed before the injection of the radiotracer (group 1); in 4 the measurement was performed after the endovenous injection of the radiotracer and before the images had been taken (group 2); and in 06 patients the measurement of TT was obtained after the patient had been submitted to the brain SPECT (group 3). All patients signed an informed consent form. The analysis of IAD-TT was made using reference data from a control group of 36 normal volunteers. The nuclear physician who analyzed brain SPECTs was blind to TT values. Results: Of the total of 32 patients, 56% had abnormal brain SPECTs and 56% had abnormal IAD-TT. 61% of the patients with abnormal SPECT presented abnormal values of IAD-TT, corresponding to 59% of group 1 and 50% of the patients in the other two groups (confidence interval of 95%). Half of the patients who had normal SPECT presented abnormal IAD-TT. Conclusion: Although there are several reports correlating asymmetries in TT to asymmetrical changes in brain activity, as those that occur during a Stroop test, the possible application of this method to neurological diagnosis needs further evaluation. Brain SPECT constitutes a cost-effective, non-invasive and reproducible means of detecting asymmetries in brain function that can be correlated with IAD-TT.

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NOTICEABLE SPECT FINDINGS IN LATE STAGE OF ENCEPHALITIS – CASE REPORT.

Benedita Andrade Leal de Abreu; Anita Maria Pacheco Gonçalves; Everardo Leal Abreu; Juliana de Sousa Britto; Evandro Leal de Abreu; Nayana Alves de Brito Melo; João Batista de Abreu; Luciana dos Santos Nunes.

Centro Bionuclear de Diagnóstico; Universidade Estadual do Piauí.

Aim: Brain infections are generally well visualized by contrastenhanced computed tomography or magnetic resonance imaging (MRI). Several studies have documented the greater sensitivity of perfusion single-photon emission computed tomography (SPECT) in human virus encephalopathy. Technetium-99m ethyl cysteinate dimer (99mTc- ECD) accumulates in brain tissue in proportion to regional cerebral blood flow in healthy subjects and in patients with a variety of neurological diseases. Case report: The authors present a case of a 34 years old female patient. She has had an acute clinical picture suggestive of viral infection encephalitis without associated focal neurological symptoms, 12 years before. She presents nowadays with nominal aphasia, behavioral disturbances, lacks of awareness, and total impairment on her tasks. Neuropsychological examination showed a decline in memory and speed of cognitive processes, without circumscribed neuropsychological deficits. The patient has been treated with carbamazepin, haloperidol and clorpromazin without good clinical response. 99mTc-ECD SPECT of the brain showed larges areas of severe decreased uptake of tracer in the temporal, parietal and occipital lobes bilaterally. MRI demonstrated encephalomalacy at the parietal, occipital and temporal lobes. Comments: The authors reported a case of encephalitis in which sequential MRI and SPECT studies showed interesting findings. Both MRI and SPECT demonstrated brain lesion in its late stage. However, usefulness of SPECT is to detect alterations of blood flow and stand as a form of evaluate brain perfusion pattern and so the severity of the clinical course and prediction of the outcome. This findings suggest that SPECT may be useful as a prognostic tool in the late stages of encephalitis by evaluating the extension of lesions.

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SCINTIGRAPHIC ANALYSIS OF SIALORRHEIA IN PARKINSON’S DISEASE.

Nicareta D.H.; Rosso A.L.Z.; Maliska C.; Costa M.M.B.

Serviços de Neurologia e de Medicina Nuclear do HUCFF/UFRJ; Laboratório de Motilidade Digestiva do Departamento de Anatomia, ICB/UFRJ – Rio de Janeiro, RJ, Brasil.

Background: The sialorrhea is the increased of saliva flow that escapes from the oral cavity, beyond the margin of the lips. In spite of the association between sialorrhea and Parkinson disease, since its original description, little is known about its pathophysiology. Aims: Our aims are to contribute to the sialorrhea study in Parkinson disease by the parotid glands function analyzes. Patients and methods: We analyzed the parotid gland activity of 14 Parkinson disease patients, who presented with sialorrhea, and compared it with that of a control group of 8 healthy volunteers. The patients were selected from a group of 134 Parkinson disease patients. The study consisted in the analysis of uptake, distribution and elimination of marked saliva with sodium pertechnetate (Tc-99m). This dynamic study of the parotid glands was accomplished by a gamma camera of wide field Diacam-Siemens with matrix 128 x 128, and 40 sequential frames, with 60 seconds each. Results: Parkinson disease patients’ sialorrhea could not be related with age, time or severity of the disease. We noticed no difference between the results of the uptake of pertechnetate by the parotid gland in the two groups, but the parotid gland excretion speed in Parkinson disease patients with sialorrhea is greater than that observed in healthy individuals, with 95% of safety. Conclusions: Sialorrhea in Parkinson disease is not of the productive type. The increase of excretion speed is an influential factor in the “retention sialorrhea” and this might explain its higher prevalence in Parkinson disease.

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SPECT CEREBRAL COM ECD-99mTc EM PACIENTES HEMIPLÉGICOS SUBMETIDOS A ESTIMULAÇÃO ELÉTRICA NEUROMUSCULAR – ANÁLISE COM STATISTICAL PARAMETRIC MAPPING (SPM).

Romanato J.S.; Etchebehere E.C.S.C.; Amorim B.J.; Oberg T.; Anjos D.A.; Lima M.C.L.; Santos A.O.; Ramos C.D.; Honorato D.C.; Camargo E.E.

Serviço de Medicina Nuclear do Departamento de Radiologia e Divisão de Neurocirurgia do Departamento de Neurologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp) – Campinas, SP.

Introdução: A estimulação neuromuscular elétrica tem sido utilizada como terapia de reabilitação em pacientes com seqüelas de lesões cerebrais. Os bons resultados clínicos desta estimulação elétrica são bem conhecidos. No entanto, os efeitos desta estimulação no metabolismo e na perfusão do sistema nervoso central ainda não são bem compreendidos. Objetivo: Demonstrar as mudanças na perfusão cerebral secundárias à ativação neuronal após estímulo elétrico. Pacientes e métodos: Foram estudados catorze pacientes (2 femininos, 12 masculinos, com idades entre 13 e 60 anos – média de 37,2 anos) com hemiplegia secundária a lesões cerebrais prévias: 7 eram vítimas de traumatismo crânioencefálico e 7 eram vítimas de acidente vascular cerebral. Os pacientes realizaram SPECT de perfusão cerebral com ECD-99mTc em condições basais e após 14 semanas de estimulação elétrica (três vezes por semana, com 30 minutos cada sessão). Um grupo controle composto de 17 voluntários normais (12 femininos, 5 masculinos, idades variando de 12 a 53 anos, média de 34,8 anos) foi utilizado. O statistical parametric mapping (SPM2) foi aplicado comparando-se o estudo de cada paciente (pré e pós-estímulo) com o grupo controle. Foram avaliadas as áreas de hipoperfusão (p < 0,1%). Os resultados do estudo basal e após estimulação elétrica foram comparados. Resultados: No grupo de pacientes vítimas de traumatismo crânio-encefálico, houve redução na extensão da área de hipoperfusão em cinco pacientes (57%), ausência de alterações em dois (29%) e piora da hipoperfusão em um (14%). Nos pacientes vítimas de acidente vascular cerebral, houve aumento na extensão da hipoperfusão em seis pacientes (86%) e ausência de alterações em um (14%). Conclusão: A estimulação neuronal elétrica parece reduzir a hipoperfusão cerebral na maioria dos pacientes hemiplégicos vítimas de traumatismo crânio-encefálico, porém, parece não melhorar a hipoperfusão cerebral em pacientes com seqüelas de acidente vascular cerebral. Novos estudos com maior Tema de pacientes são necessários para confirmar esses achados.