RACGP - Cerebral perfusion (SPECT) studies
Single Photon Emission Computed Tomography is a functional imaging technique that creates three-dimensional images of the brain on computer. This allows physicians to visualize blood flow through different areas of the brain. Por tratar-se de exame que avalia função e metabolismo cerebral, há necessidade prévia de repouso em ambiente com mínimos estímulos visuais e auditivos, além de punção prévia de acesso venoso. Após 10 a 15 minutos em repouso, será injetado o radiofármaco através do acesso venoso pré-existente. HBOT was selected for patient II on account of multiple head injuries and a developmental history of a regulatory disorder. Following 40 HBOT treatments, brain SPECT images (Figure 2 middle line) indicated increased perfusion in most areas of the cortex and in some subcortical structures. Baseline brain SPECT images for Patient II, shown in the top line of Figure 2, indicated extensive, diffuse bilateral hypoperfusion of the frontal (more accentuated on the left), temporal and orbitofrontal lobes and extended into the frontoparietal and parietal vertex areas. Additionally, there was bilateral hypoperfusion of the occipital lobes and hypoperfusion of the anterior cingulate in the dorsal aspect. The patient had robust perfusion of the thalamus and basal ganglia. There was also marked hyperperfusion in the cerebellar vermis.
In this retrospective review, six patients presented with complex neuropsychiatric conditions and comorbidities following extensive unsuccessful periods of different treatments. While experienced psychiatrists may be able to diagnose patients with neuropsychiatric conditions based on behavioral criteria, functional brain imaging tools can inform the clinician of their underlying neurobiology. Additionally, the examination of different functional areas of the brain using SPECT imaging may provide insights into the patients' status that may not identifiable during clinical assessment. Particularly, in cases of diagnostic dilemma, such as those presented herein, SPECT images were used to identify areas of hypo- and hyper-perfusion to complement the initial clinical assessment. In the cases presented herein, the improved perfusion identified in the post-treatment SPECT images, whether extensive or localized, were mirrored by particular clinical improvements. Therefore, it is fundamental for the clinician to understand how clinical improvements manifest in the patients' underlying neurobiology. This case series effectively demonstrates the importance for the clinician to combine clinical assessments evaluating presenting behaviors and symptoms, with the underlying neurobiology attainable using SPECT imaging.
In this case series, intervention with novel treatments of CTK or HBOT and PSE resulted in marked improvements in relative perfusion in previously hypoperfused areas, which correlated to the clinical improvements noted for each patient. These cases thereby provide further evidence of the clinical utility of these novel treatments for patients with complex neuropsychiatric conditions. Sim. Os riscos são mínimos e relacionados apenas a probabilidade de reação adversa a medicamentos (incluindo reação alérgica), sendo o rubor cutâneo temporário (pele avermelhada) a reação mais verificada, não se observando nenhuma reação grave que necessite de hospitalização ou que cause sequela para saúde. Diferentemente da TC e RM, que fornecem informações anatômicas das estruturas cerebrais, o SPECT cerebral vai fornecer informações funcionais (metabólicas), permitindo um diagnóstico mais acurado; pois as informações anatômicas e funcionais se complementam. 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. If you move, the pictures will be blurry and may have to be repeated. The entire test should take about one hour. You will be given a small dose of radioactive material through an intravenous (IV) line.
Exame spect cerebral - Basicamente, a cintilografia de perfusão cerebral consiste na injeção na veia de um radiofármaco lipossolúvel que apresenta a capacidade de atravessar a barreira hemato-encefálica que naturalmente protege o cérebro, e concentrarse dentro das células cerebrais (neurônios) proporcionalmente ao fluxo sanguíneo cerebral e proporcionalmente à demanda funcional, refletindo, indiretamente, o metabolismo cerebral.
Furthermore, building a database that correlates SPECT images with clinical assessments has the potential to develop more targeted treatments and to establish effective biomarkers. Baseline brain SPECT images of Patient IV, shown in the top line of Figure 5, indicated extensive bilateral hypoperfusion in the frontal lobes (most accentuated on the left side), including the dorsolateral prefrontal regions and in the parietal vertex bilaterally. Not discernible in the images provided is the hypoperfusion in both orbitofrontal areas and in the mesial aspect of the right temporal lobe. There was moderate hyperperfusion of the thalamus and marked hyperperfusion in the mid posterior, inferior aspect of the occipital lobes. Com a Cintilografia de Perfusão Cerebral é possível detectar possíveis focos de epilepsia, permitindo que o médico detecte pontos onde há baixo sinal de atividade. O exame permite a visualização de danos cerebrais decorrentes do uso de drogas, como cocaína e crack, e o diagnóstico de doenças vasculares cerebrais, bem como o Alzheimer precoce. The application of SPECT imaging as a monitoring biomarker also further contributes to the understanding and the growing literature that describes the clinical utility of these novel treatments for patients with neuropsychiatric conditions.
Para que serve o Exame Cintilografia de Perfusão Cerebral?
Basicamente, o SPECT de perfusão cerebral, consiste na injeção na
veia de radiofármacos lipossolúveis que apresentam a capacidade
de atravessar a barreira hemato-encefálica e concentrar-se dentro
das células cerebrais (neurônios) proporcionalmente ao aporte
sanguíneo e, indiretamente, proporcionalmente a demanda funcional
(metabolismo cerebral). Lembre-se: o exame é contra-indicado em
mulheres gestantes ou em amamentação. Caso esteja amamentando,
deve-se suspender a amamentação e o contato íntimo com a criança
por no mínimo 24 horas após o exame. - Não é necessário
jejum.
- Caso faça uso de medicamentos para ansiedade, depressão ou
outra indicação neurológica informe ao médico nuclear responsável
pelo exame;
- Usar roupas confortáveis, sem excessos de botões ou peças
metálicas (jóias, brincos, etc.);
- Se possuir, trazer exames recentes relacionados com o caso
(cintilografias, TC e ressonâncias) Brain SPECT images for
Patient VI. Top line relates to brain SPECT images at baseline.
Bottom line shows SPECT images 5.5 months following 24 sessions
of CTK treatment. In each row (from left to right) one temporal
slice, one sagittal slice and one axial slice and three
stereotactic surface projections of the underside, right lateral
(RLAT) and left lateral (LLAT).