The role of SPECT and PET in the management of cerebellar disorders

Learning Objectives 1. Discuss the role of imaging in the management of cerebellar disorders. 2. Describe the role of SPECT and PET in the management of cerebellar disorders.

There are a number of medical conditions associated with cerebellar damage, including strokes, TIA, hemorrhages, tumors, alcoholism, trauma, and chronic degenerative conditions such as olivopontocerebellar atrophy. Cerebellar disorder is usually suspected in patients presenting with ataxia and confirmed by specific findings on neurological examination. Final diagnosis is often made from head MRI or CT. A majority of vascular cerebellar abnormalities are better evaluated by CT or MRI imaging. Although SPECT and PET brain perfusion studies play no significant role in the stroke diagnosis, they may be used to identify high-risk patients by evaluating the adequacy of cerebrovascular reserve, and providing prognostic information to aid in decision making for further management. FDG PET after radiation therapy can be used to differentiate between brain tumor recurrence and radiation-related tumor necrosis. Additionally, there is a group of cerebellar disorders which do not display clear morphological abnormalities on the structural CT or MRI images, or on functional MRI (fMRI). In those cases, functional imaging with SPECT or PET may provide valuable information and aid in diagnosis and management of cerebellar disorders. For example, hypoglycemia induced cerebellar dysfunction does not cause any changes on MRI or CT but can be clearly visualized on FDG PET. Cases are presented that illustrate the use of SPECT and PET in the management of cerebellar disorders