Abstract
1270
Objectives To evaluate whether 99mTcHM-PAO and 123I-Ioflupane brain SPECT combined use may be useful in pts with both Mv and Cg symptoms, in order to improve correct treatments.
Methods We studied 72 consecutive pts with Mv and Cg abnormalities: 18 Parkinson’s disease (PD), 8 Parkinsonism (P), 16 Alzheimer Dementia (AD), 19 Lewy Body Dementia (LBD), 6 Psychiatric Catatonia (PC) and 5 Vascular Tremor (VT). CT/MR were not specific. In all pts 99mTcHM-PAO brain perfusion and 123I-Ioflupane striatal SPECT were performed according to international guidelines. SPECT images were analized both qualitatively and quantitatively, the latter by specific software quantifying 99mTcHM-PAO brain perfusion as SD than normal data and 123I-Ioflupane striatal uptake as Bindings Potential (BP) in comparison to 20 age matched normal controls (C).
Results 99mTcHM-PAO SPECT showed bilateral temporo-parietal/fronto-temporal perfusion focal defects in all 16 AD and in 10/18 PD, bilateral temporo-occipital/parieto-occipital defects in all 19 LBD and diffuse defects in all P and in one PC intravenous drug user case; moreover, multifocal defects were present in all 5 VT, while normal perfusion in 8/18 PD and in 5/6 PC. 123I-Ioflupane SPECT was pathological in 42/72 cases (18/18 PD, 5/8 P, 18/19 LBD, 1/5 VT) and normal in the remaining 30. In 15/18 PD both putamen were involved with BP values significantly (p<0.001) lower than C. The two SPECT combined use confirmed the correct diagnosis in 87.5% of pts (all AD, P, PC and VT, 10/18 PD and 18/19 LBD), while it changed diagnosis in the remaining 12.5% (8 PD with associated dementia and 1 LBD finally diagnosed AD).
Conclusions 99mTcHM-PAO and 123I-Ioflupane SPECT combined use is useful in correctly classifying pts with both Mv and Co disorders. In particular, the two procedures permitted to identify PD cases with associated dementia and inconclusive MMSE and to diagnose AD wrongly considered as LBD thus permitting better therapeutic strategies