Clinical Usefulness of 99mTc-Hexamethyl Propylene Amine Oxime Perfusion Single Photon Emission Computed Tomography for Early Phase Multiple System Atrophy

Jong-Yoon Lee; In-Uk Song; Sung-Woo Chung; Yong-An Chung; YoungSoon Yang

doi:10.12779/dnd.2014.13.2.37

Journal List > Dement Neurocogn Disord > v.13(2) > 1120726

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Lee, Song, Chung, Chung, and Yang: Clinical Usefulness of 99mTc-Hexamethyl Propylene Amine Oxime Perfusion Single Photon Emission Computed Tomography for Early Phase Multiple System Atrophy

Original Article

Dementia and Neurocognitive Disorders 2014; 13(2): 37-41.

Published online: 30 June 2014

DOI: https://doi.org/10.12779/dnd.2014.13.2.37

Clinical Usefulness of 99mTc-Hexamethyl Propylene Amine Oxime Perfusion Single Photon Emission Computed Tomography for Early Phase Multiple System Atrophy

Jong-Yoon Lee, M.D.^*, In-Uk Song, M.D.^*, Sung-Woo Chung, M.D.^*, Yong-An Chung, M.D.^†, YoungSoon Yang, M.D.^‡

^*Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea.

^†Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

^‡Department of Neurology, Veterans Hospital, Seoul Medical Center, Seoul, Korea.

Address for correspondence: In-Uk Song, M.D. Department of Neurology, Incheon St. Mary's Hospital, The Catholic University College of Medicine, 56 Dongsu-ro, Bupyeong-gu, Incheon 403-720, Korea. Tel: +32-280-5010, siuy@cmcnu.or.kr

Received 16 May 2014 Revised 28 May 2014 Accepted 28 May 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Clinical diagnosis of multiple system atrophy (MSA) relays on signs and symptoms that are often difficult to identify particularly at early stage. Indeed neuropathological studies have demonstrated that Parkinson variant of MSA (MSA-P) is the first cause of misdiagnosis in a cohort of patients presenting with parkinsonian features. But accurate diagnosis of these disorders is important for deciding on treatment, appropriate advice and prognosis since atypical parkinsonian disorders are characterized by poor response to dopaminergic treatment and more rapid disease progression. Therefore, we conducted this study to investigate difference of perfusion Single Photon Emission Computed Tomography (SPECT) in patients with the early phase of MSA-P using SPM program.

Methods

We recruited consecutively 21 patients with MSA-P and 48 age-matched healthy controls. All subjects underwent Tc-99m HMPAO perfusion SPECT and this perfusion images were analyzed.

Results

For MSA-P, only hypoperfusion was seen in the middle frontal gyrus of left frontal lobe, superior frontal gyrus of right frontal lobe, precentral gyrus of left frontal lobe, middle frontal gyrus of right frontal lobe and precentral gyrus of right frontal lobe with respect to healthy subjects.

Conclusions

We cautiously assume that perfusion SPECT may offer significant advantages compared to other imaging techniques in the assessment of neuronal degeneration in MSA-P and may help the clinician in the diagnostic characterization of patients presenting with atypical parkinsonism.

Keywords: Multiple system atrophy, Tc-99m HMPAO perfusion SPECT, Frontal lobe

Figures and Tables

Fig. 1

Comparisons of patients with MSA-P compared with the healthy controls show cerebral regions (yellow color) with decreased regional cerebral blood flow in trans-axial MR fused images.

Table 1

Demographic and clinical characteristics of all subjects

^*All patients have taken only pramipexole.

MSA-P, Parkinson variant of multiple system atrophy; MMSE, mini-mental state examination.

Table 2

Areas with significantly decreased regional cerebral blood flow in the MSA-P patients compared with the healthy controls

Height threshold, T=6.25, corrected p=0.01; Extent threshold, k=50 voxels.

kE, Expected voxels per cluster.

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