Brain Single Photon Emission Computed Tomography With Tc-99m MIBI or Tc-99m ECD in Comparison to MRI in Multiple Sclerosis

Abstract

Purpose: To evaluate whether or not brain single photon emission computed tomography (SPECT) with Tc-99m MIBI or Tc-99m ECD (ethyl cysteinate dimer) can detect any abnormality in patients with definite multiple sclerosis (MS). We then compared these values with the results of T1, T2, and fluid-attenuated inversion recovery in magnetic resonance imaging (MRI). Materials and Methods: A total of 16 patients with proved MS were enrolled in the study, and the MRI with and without gadolinium contrast and also brain SPECT with Tc-99m MIBI (8 cases) or Tc-99m ECD (8 other cases) were performed. Results: MRI studies was performed in 16 patients (13 women and 3 men, aged 16 -38 years) and an average of 10.47, 3.7, 5.3, 1.7, and 0.9 lesions was found in respect in periventricular white matter, juxtacortical white matter, corpus callosum, cerebellar peduncles, and brainstem, whereas brain SPECT with Tc-99m MIBI or Tc-99m ECD detected no abnormality. In addition, 6 cases had some degree of contrast enhancement. Conclusions: It seems that brain SPECT with Tc-99m MIBI or Tc-99m ECD would not improve this insufficiency. The small sizes of some plaques, particularly in chronic atrophic form of lesions, and the possibility of deeper anatomic positions of plaques can explain to some extent why the MS lesions were impossible to delineate on brain scan, although additional studies are needed. 2 Gean-Marton et al have also proposed that lesions in midsagittal long repetition time (TR)/short echo time (TE) images and involvement of corpus callosum are highly specific for MS rather than other periventricular WM disorders. 3 Fast spin-echo (FSE), fluid-attenuated inversion recovery (FLAIR) FSE, and short tau inversion recovery FSE are among the other modifications to MRI, which ameliorate the sensitivity and specificity of indicated MS plaques. Key4 A combinational set of textural features application in image volumetric interpretation has also shown to be more accurate in distinguishing MS plaques from the normal appearing WM and normal WM. 5The most challenging concern regarding the MRI application for MS evaluation is the commonly poor correlation between MRI indicated levels of disease and clinical manifestations or expanded disability status scale in which the degree of lesions reported in MRI is always worse than what the extent of clinical symptoms are. 6 Although early anticipation of potential deterioration of disease is important for clinical management, 7 little prognostic capability of MRI where it cannot predict the relapse or consequent burden is another insufficiency of this procedure.8 Intracortical lesions which have been shown to be abundant in MS patients and may elicit cognitive deficit usually remains obscure on MR imaging. 9 Abnormal brain scan is reported in MS and other demyelinating disorders. Gize and Mishkin have described focal abnormalities with 203 Hg-chlormerodrin or 99mTcO4 brain scan in 36% of cases with acute MS 10 and Miller and Potsaid have also reported a case of MS with vascular infiltration in whic...

Brain perfusion imaging with voxel-based analysis in secondary progressive multiple sclerosis patients with a moderate to severe stage of disease: a boon for the workforce

“…Luke et al, who used single photon emission computed tomography (SPECT), showed hypoperfusion of cerebral blood flow (CBF) in the gray matter (GM) of the frontal lobe of patients with progressive MS compared with cerebral perfusion in control patients, although the study reported normal perfusion in patients with RR-MS [ 6 ]. Our previous study has similar results and normal brain perfusion of MS patients in the early stage and without significant disability [ 7 ]. In another study, Brooks et al showed that there was decreasing CBF and oxygen utilization in both the white matter and the cortical GM in the MS patients compared to the healthy control group [ 8 ].…”

“…Perfusion studies of MS have different results that may be due to various perfusion measurement techniques and stages of disease [ 6 , 7 ]. In our previous study, we investigated cerebral perfusion in early RR-MS patients with mild or no disability, which determined normal cerebral perfusion in all patients [ 7 ]. Other studies showed different brain perfusion in MS patients particularly in those with a progressive type of disease [ 6 ].…”

Radiolabeled annexin V imaging: A useful technique for determining apoptosis in multiple sclerosis

“…Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) that involves myelin, oligodendrocytes and axons and culminates in consecutive neuronal death and progressive neurologic disability [1,2]. Histopathological work-ups have demonstrated apoptotic neuronal cell death in demyelinated cerebral cortex lesions of MS patients [3] that cannot be identified by magnetic resonance imaging (MRI).…”

Neuropsychological functions and association with single photon emission computed tomography (SPECT) in Greek multiple sclerosis patients

“…In a recent study, Assadi et al (2010), evaluated the efficacy of SPECT imaging with Tc-99m MIBI or Tc-99m ECD to detect abnormal perfusion in MS patients and compared these values with results obtained on MRI (T1, T2, and fluid-attenuated inversion recovery) with and without the use of gadolinium contrast. The authors report that MRI was able to detect an average of 10.47, 3.7, 5.3, 1.7, and 0.9 lesions in the periventricular white matter, juxtacortical white matter, corpus callosum, cerebellar peduncles and brainstem.…”