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Clinical Investigations |
1 Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
2 Department of Allied Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
3 Department of Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan
4 Department of Clinical Neuroscience, Osaka University Graduate School of Medicine, Osaka, Japan
Small-vessel disease with dementia, which is the most frequent type of vascular dementia (VaD), often shows a cerebral blood flow (CBF) distribution with no obvious focal abnormalities and is therefore difficult to evaluate objectively. In this study, we combined CBF SPECT with 3-dimensional fractal analysis (3D-FA) to quantitatively assess the heterogeneity of CBF distribution and with 3-dimensional stereotactic surface projections (3D-SSP) to evaluate the distribution of CBF. We then evaluated the clinical validity of these techniques for the imaging diagnosis of VaD. Methods: The subjects consisted of 17 patients who were diagnosed as having VaD due to small-vessel disease (VaD group) on the basis of a full clinical examination, including history, neuropsychologic tests, neurologic examination, and neuroimaging methods, and 20 healthy volunteers (control group). CBF SPECT was performed with 99mTc-hexamethylpropyleneamine oxime, and the reconstructed images were subjected to image processing by 3D-FA and 3D-SSP. Based on the results, the fractal dimension (FD) was compared between the VaD and control groups, and the distribution pattern of CBF was examined in the VaD group. Results: The mean FD values in the VaD group and the control group were 1.093 ± 0.153 and 0.853 ± 0.062 (mean ± SD), respectively. The mean FD value in the VaD group was significantly higher than that in the control group (P < 0.0001). 3D-SSP analysis in the VaD group showed that there were 2 abnormal patterns: One was globally reduced blood flow in the whole cerebral cortex, and the other was a reduction mainly confined to the frontal region. Conclusion: CBF SPECT images showed higher mean FD values in the VaD group than in the control group, suggesting a difference in the heterogeneity of CBF. Image processing with 3D-SSP successfully revealed that reduced cortical blood flow could be divided into 2 patterns. Because image analysis techniques, such as 3D-FA and 3D-SSP, allowed the simple and objective evaluation of CBF in patients with VaD, these methods seem to be useful for detailed examination of the blood flow pattern detected by CBF SPECT in patients with VaD.
Key Words: vascular dementia • cerebral blood flow • fractal analysis • 3-dimensional stereotactic surface projections • SPECT
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