japanese brain patient spect report

What is SPECT and how does it help TBI patients?

SPECT assists in the diagnosis, prognosis, and treatment of TBI patients. SPECT may also help uncover brain trauma in clinically confusing or complex cases because patients often fail to report or forget about significant brain injuries, perhaps due to peri-traumatic amnesia.

Is brain SPECT imaging evidence-based in complex psychiatric cases?

Brain SPECT imaging in complex psychiatric cases: an evidence-based, underutilized tool. Open Neuroimaging J. (2011) 5:40–8. 10.2174/1874440001105010040 [ PMC free article] [ PubMed] [ CrossRef] [ Google Scholar]

Is brain SPECT becoming a clinical tool?

” Nearly a decade ago, Camargo [3] wrote, “Brain SPECT … is rapidly becoming a clinical tool in many places.

Is brain SPECT imaging a potential imaging biomarker for syndrome status-related perfusion changes?

This retrospective review demonstrated that brain SPECT imaging could represent a potential imaging biomarker since syndrome status was correlated with changes in the perfusion pattern detected.

What is a SPECT scan?

A SPECT scan is a nuclear medicine exam that uses a radioactive compound to diagnose some diseases of the brain.

How long does it take to get a brain scan after a brain injection?

The imaging involves lying flat while the camera takes pictures of your brain. The technologist will help you be comfortable. The imaging will take 35 minutes. You must not move during the time the camera is taking pictures.

How long does a spectroscopic test take?

The entire test should take about one hour. Because SPECT uses radiation, you may not have a family member or friend in the room during the exam. Most of the radioactivity passes out of your body in urine or stool, while the remainder simply goes away with time.

When did PET and MRI become available?

The combination of PET and MRI data was suggested in the late 1980s, and the first technological approaches appeared in the 1990s. There were some significant challenges for incorporating both techniques into one system. For example, standard PET detectors have PMTs which are highly susceptible to magnetic fields [ 91 ]. However, the development of semiconductor technology enabled MR compatible detectors, e.g., avalanche photo diodes (APD) or silicon photomultipliers (SiPM). These detectors are able to detect gamma quanta even inside strong magnetic fields [ 92 ]. The first human imaging using simultaneous acquisitions of PET and MRI were reported in 2008 [ 93, 94 ]. Since then, PET/MRI systems for clinical purposes have become commercially available. In 2013, a joint task force of the Japanese Radiologic Society and the Japanese Society of Nuclear Medicine released Japanese FDG-PET/MRI guidelines for indications, procedures, cautions for the interpretation of images, and safety management [ 95 ]. PET/MRI enables simultaneous acquisition of PET and MRI data, which is currently available especially for neurology [ 96, 97, 98 ], cardiovascular disease [ 99, 100 ], musculoskeletal disease [ 101 ], and pediatric oncology [ 102 ].

What is nuclear medicine imaging?

Nuclear medicine imaging using single photon emission computed tomography (SPECT) and positron emission tomography (PET) has greatly contributed to both medical diagnosis of, and research in , disorders of the brain. Compared with computed tomography (CT) and magnetic resonance imaging (MRI), such images have lower spatial resolution. However, they allow for the visualization and quantification of the function and metabolism of the brain, rather than morphological information. Therefore, the selection of imaging tools should be based upon its usefulness for improving diagnostic ability or patient care on an individual basis. For brain imaging of PET and SPECT, there are a variety of radiotracers that have been developed for different purposes. Those tracers that are available or have been developed in Japan were the main focus of this review. In addition, the methods for the analysis of the data obtained by these techniques were reviewed.

What is the application of semiconductor technology to PET?

The application of semiconductor technology for PET detectors paves the way for a prosperous future not only for PET/MRI but also for PET/CT. SiPM detectors have increased sensitivity in comparison with PMT detectors, which allows for a reduced acquisition time [ 103, 104, 105 ]. Such high sensitivity also enables low-dose imaging, greatly reducing irradiation, especially for pediatric patients. Moreover, high timing resolution due to SiPM enhances time-of-flight function [ 106 ]. López-Mora et al. compared PET findings for 100 oncological patients from digital versus analog scanners and reported that digital scanner provided improved image quality and lesion detection capability compared to the analog scanner [ 107 ]. Such technological development provides more sensitive and accurate dynamic PET analysis of the brain than previous methods.

What is regional CBF?

Regional CBF is a key parameter in determining the severity of ischemic brain damage when a cerebral or carotid artery is narrowed or occluded. Quantitative assessment is also necessary, especially for patients with bilateral or severe hemodynamic compromise, because bilateral decrease (or increase) of responses may obscure abnormalities if analyzed only qualitatively. Kuhl et al. (1982) proposed the IMP-microsphere technique to quantitatively measure CBF using SPECT [ 5 ], which requires frequent or continuous arterial blood sampling for the calculation of CBF. In the 1990s, some Japanese researchers developed simpler techniques. Iida H, et al. developed the autoradiographic (ARG) method using IMP SPECT with one-point arterial blood sampling [ 3, 4 ]. Alternatively, Matsuda H, et al. developed a method using ECD SPECT without arterial blood sampling [ 6, 7 ]. The arterial input of the tracer was estimated by Patlak plot graphical analysis [ 8 ]. The trade-off in the use of the simpler technique is decreased accuracy of the quantitative values. Both of these methods have been widely used in Japan. Quantitative CBF measurements such as these are required specifically for the evaluation of cerebrovascular reserve using the acetazolamide challenge, and are essential in the evaluation of indication for and the therapeutic effects of revascularization surgery for moyamoya disease [ 9] and carotid artery stenosis [ 10 ], to name a few. Figure 1 shows a case with left middle cerebral artery (MCA) stenosis. The left MCA area displayed severely decreased vascular reserve after acetazolamide challenge. The severity of vascular reserve can be classified by CBF with and without acetazolamide challenge as in Fig. 2. The Japan EC/IC Bypass Trial (JET) study consisted of patients with Stage 2, and demonstrated that superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis improved the 2-year outcome [ 11, 12 ]. In the past, acetazolamide has been easily and widely used, however, 6 patients died following the use of acetazolamide between 1994 and 2014 in Japan. As a result, in 2015 the four related societies in Japan established comprehensive guidelines concerning the use of acetazolamide, requiring appropriate selection of patients, informed consent and appropriate monitoring of cardiac and lung function. https://www.jsts.gr.jp/img/acetazolamide.pdf (in Japanese).

What is radiolabeled tracer?

Radiolabeled tracers allow visualization of not only perfusion, but receptors, function, and metabolism as well. Although spatial resolution is lower than that of computed tomography and magnetic resonance imaging, positron emission tomography (PET) and single photon emission computed tomography ...

Do PET scanners have semiconductors?

Recently, scanners for SPECT and PET imaging have greatly benefited from the use of semiconductors. These developments contribute to obtain images with higher sensitivity and spatial resolution or, images of the same quality by shorter acquisition time than previously. The combination with CT or MRI also has great possibilities for the integration of the information obtained from different modalities.

What is SPECT brain imaging?

Mention SPECT (single photon emission computed tomography) brain imaging to a group of psychiatrists and you are likely to hear groans or angry retorts. The resistance to actually looking at brain function in psychiatric patients is startling. The well water seems to have been poisoned in psychiatry, perhaps by over-zealous marketing in the past. Early claims which were unsupported by clinical research data created a sense of distrust among psychiatrists. Oddly, nuclear medicine physicians have followed suit. Brain SPECT scanning has been underutilized and, frankly, underappreciated for decades. Nevertheless, during that same timespan, remarkable progress has been made in the hardware, software and clinical research revolving around brain SPECT scans. Herein, some of the more interesting advances will be explored and integrated into the practice of today’s busy nuclear medicine department.

What can perfusion neuroimaging teach us?

Perfusion SPECT functional neuroimaging can teach us much about a patient’s brain. The challenge that psychiatrists face is to correctly understand the strengths and weaknesses of the diagnostic constructs and how data on brain function fits together with clinical information. The false expectation of precise or pathognomonic symptoms or signs leads to unrealistic expectations from functional neuroimaging – be it SPECT, functional MRI, or FDG PET. I have offered numerous examples of situations in which the symptoms do not match the diagnosis – depressive symptoms in TBI, dementia symptoms can be either AZD or FTD, and ADHD symptoms in a variety of conditions. Information from functional neuroimaging can yield a better diagnosis and speed the diagnostic process 64. Perhaps with these thoughts both psychiatrists and nuclear medicine physicians will reconsider their biases against perfusion SPECT neuroimaging. Decades of research with functional MRI have failed to yield any useful clinical algorithms. In contrast, SPECT has demonstrated sensitivity/specificity in the 85-95% range for TBI, PTSD, AZD, FTD, MCI, and offers relevant insight into alternative neurological processes responsible for symptoms such as depressed mood, impulsivity, executive dysfunction, and others.