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Brain perfusion single photon emission computed tomography in major psychiatric disorders: From basics to clinical practice.

Santra A, Kumar R - Indian J Nucl Med (2014)

Bottom Line: Brain single photon emission computed tomography (SPECT) is a well-established and reliable method to assess brain function through measurement of regional cerebral blood flow (rCBF).It can be used to define a patient's pathophysiological status when neurological or psychiatric symptoms cannot be explained by anatomical neuroimaging findings.It can be utilized to evaluate the involvement of brain regions in a particular patient, to individualize treatment on basis of SPECT findings, to monitor the treatment response and modify treatment, if necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Brain imaging Centre, Dakshi Diagnostics, Lucknow, Uttar Pradesh, India.

ABSTRACT
Brain single photon emission computed tomography (SPECT) is a well-established and reliable method to assess brain function through measurement of regional cerebral blood flow (rCBF). It can be used to define a patient's pathophysiological status when neurological or psychiatric symptoms cannot be explained by anatomical neuroimaging findings. Though there is ample evidence validating brain SPECT as a technique to track human behavior and correlating psychiatric disorders with dysfunction of specific brain regions, only few psychiatrists have adopted brain SPECT in routine clinical practice. It can be utilized to evaluate the involvement of brain regions in a particular patient, to individualize treatment on basis of SPECT findings, to monitor the treatment response and modify treatment, if necessary. In this article, we have reviewed the available studies in this regard from existing literature and tried to present the evidence for establishing the clinical role of brain SPECT in major psychiatric illnesses.

No MeSH data available.


Related in: MedlinePlus

Technetium-99m-hexamethylpropyleneamineoxime brain perfusion single photon emission computed tomography-computed tomography (SPECT-CT) images of a 17 year old attention deficit hyperactivity disorder patient, showing hypoperfusion in bilateral frontal cortices and bilateral medial temporal lobes. (a) Transverse view, (b) sagittal view, (c) coronal view of the SPECT-CT, (d) right lateral, (e) left lateral surface projection views of “Neurogam” processed (compared with normal population adult database) images with color scale below (d and e)
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Figure 1: Technetium-99m-hexamethylpropyleneamineoxime brain perfusion single photon emission computed tomography-computed tomography (SPECT-CT) images of a 17 year old attention deficit hyperactivity disorder patient, showing hypoperfusion in bilateral frontal cortices and bilateral medial temporal lobes. (a) Transverse view, (b) sagittal view, (c) coronal view of the SPECT-CT, (d) right lateral, (e) left lateral surface projection views of “Neurogam” processed (compared with normal population adult database) images with color scale below (d and e)

Mentions: Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in child and adolescent psychiatry. Prevalence of ADHD in the general population is approximately 5% of school-age children.[18] ADHD is characterized by a developmentally inappropriate poor attention span or age-inappropriate features of hyperactivity and impulsivity or both. To meet the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnostic criteria, the disorder should be present for at least 6 months, cause impairment in academic or social functioning, and occur before the age of 7 years. ADHD appears to be heterogeneous, with a variety of known etiologies such as head trauma, intrauterine exposure to toxins, and infections, but in the majority of cases no etiology can been determined.[19] A neurobiological basis of ADHD resulting from the involvement of the fronto-striatal system has been proposed.[20] Several studies [Table 1] analyzed the patterns of rCBF in ADHD, demonstrating decreases in brain perfusion, especially in the premotor cortex and the prefrontal cortex, and hypoperfusion of striatal and periventricular structures.[21222324] Daniel et al. found that, 65% of children and adolescents with ADHD revealed decreased perfusion in the prefrontal cortex with intellectual stress, though only 25% had decreased prefrontal lobe activity at rest.[25] There is a pattern of lateralization in prefrontal hypoperfusion from right to left with increase in age of patients as demonstrated by a study.[26] Many researcher demonstrated temporal lobe dysfunction as significant in patients with ADHD. Kaya et al. described temporal hypoperfusion being more frequent than in the frontal cortex.[27] An association of temporal lobe hypoperfusion with severity of symptoms and comorbidity have been demonstrated by some studies.[2728] Studies were also undertaken to demonstrate the response to methylphenidate treatment. Responders usually normalize the prefrontal hypoperfusion and may have increase or decrease in striatal perfusion.[2930] The nonresponders had significantly increased activity in anterior cingulated (AC) cortex at baseline.[31] We observed both prefrontal and temporal hypoperfusion in all of the seven ADHD patients scanned in our center [Figure 1] and there is evidence of prefrontal activity normalization in available post therapy scans (four out of seven in a time period of 6-9 months) after successful treatment.


Brain perfusion single photon emission computed tomography in major psychiatric disorders: From basics to clinical practice.

Santra A, Kumar R - Indian J Nucl Med (2014)

Technetium-99m-hexamethylpropyleneamineoxime brain perfusion single photon emission computed tomography-computed tomography (SPECT-CT) images of a 17 year old attention deficit hyperactivity disorder patient, showing hypoperfusion in bilateral frontal cortices and bilateral medial temporal lobes. (a) Transverse view, (b) sagittal view, (c) coronal view of the SPECT-CT, (d) right lateral, (e) left lateral surface projection views of “Neurogam” processed (compared with normal population adult database) images with color scale below (d and e)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228583&req=5

Figure 1: Technetium-99m-hexamethylpropyleneamineoxime brain perfusion single photon emission computed tomography-computed tomography (SPECT-CT) images of a 17 year old attention deficit hyperactivity disorder patient, showing hypoperfusion in bilateral frontal cortices and bilateral medial temporal lobes. (a) Transverse view, (b) sagittal view, (c) coronal view of the SPECT-CT, (d) right lateral, (e) left lateral surface projection views of “Neurogam” processed (compared with normal population adult database) images with color scale below (d and e)
Mentions: Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in child and adolescent psychiatry. Prevalence of ADHD in the general population is approximately 5% of school-age children.[18] ADHD is characterized by a developmentally inappropriate poor attention span or age-inappropriate features of hyperactivity and impulsivity or both. To meet the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnostic criteria, the disorder should be present for at least 6 months, cause impairment in academic or social functioning, and occur before the age of 7 years. ADHD appears to be heterogeneous, with a variety of known etiologies such as head trauma, intrauterine exposure to toxins, and infections, but in the majority of cases no etiology can been determined.[19] A neurobiological basis of ADHD resulting from the involvement of the fronto-striatal system has been proposed.[20] Several studies [Table 1] analyzed the patterns of rCBF in ADHD, demonstrating decreases in brain perfusion, especially in the premotor cortex and the prefrontal cortex, and hypoperfusion of striatal and periventricular structures.[21222324] Daniel et al. found that, 65% of children and adolescents with ADHD revealed decreased perfusion in the prefrontal cortex with intellectual stress, though only 25% had decreased prefrontal lobe activity at rest.[25] There is a pattern of lateralization in prefrontal hypoperfusion from right to left with increase in age of patients as demonstrated by a study.[26] Many researcher demonstrated temporal lobe dysfunction as significant in patients with ADHD. Kaya et al. described temporal hypoperfusion being more frequent than in the frontal cortex.[27] An association of temporal lobe hypoperfusion with severity of symptoms and comorbidity have been demonstrated by some studies.[2728] Studies were also undertaken to demonstrate the response to methylphenidate treatment. Responders usually normalize the prefrontal hypoperfusion and may have increase or decrease in striatal perfusion.[2930] The nonresponders had significantly increased activity in anterior cingulated (AC) cortex at baseline.[31] We observed both prefrontal and temporal hypoperfusion in all of the seven ADHD patients scanned in our center [Figure 1] and there is evidence of prefrontal activity normalization in available post therapy scans (four out of seven in a time period of 6-9 months) after successful treatment.

Bottom Line: Brain single photon emission computed tomography (SPECT) is a well-established and reliable method to assess brain function through measurement of regional cerebral blood flow (rCBF).It can be used to define a patient's pathophysiological status when neurological or psychiatric symptoms cannot be explained by anatomical neuroimaging findings.It can be utilized to evaluate the involvement of brain regions in a particular patient, to individualize treatment on basis of SPECT findings, to monitor the treatment response and modify treatment, if necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Brain imaging Centre, Dakshi Diagnostics, Lucknow, Uttar Pradesh, India.

ABSTRACT
Brain single photon emission computed tomography (SPECT) is a well-established and reliable method to assess brain function through measurement of regional cerebral blood flow (rCBF). It can be used to define a patient's pathophysiological status when neurological or psychiatric symptoms cannot be explained by anatomical neuroimaging findings. Though there is ample evidence validating brain SPECT as a technique to track human behavior and correlating psychiatric disorders with dysfunction of specific brain regions, only few psychiatrists have adopted brain SPECT in routine clinical practice. It can be utilized to evaluate the involvement of brain regions in a particular patient, to individualize treatment on basis of SPECT findings, to monitor the treatment response and modify treatment, if necessary. In this article, we have reviewed the available studies in this regard from existing literature and tried to present the evidence for establishing the clinical role of brain SPECT in major psychiatric illnesses.

No MeSH data available.


Related in: MedlinePlus