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Cerebral blood flow SPET in transient global amnesia with automated ROI analysis by 3DSRT

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Abstract

The aim of this study was to determine the areas involved in episodes of transient global amnesia (TGA) by calculation of cerebral blood flow (CBF) using 3DSRT, fully automated ROI analysis software which we recently developed. Technetium-99m l,l-ethyl cysteinate dimer single-photon emission tomography (99mTc-ECD SPET) was performed during and after TGA attacks on eight patients (four men and four women; mean study interval, 34 days). The SPET images were anatomically standardized using SPM99 followed by quantification of 318 constant ROIs, grouped into 12 segments (callosomarginal, precentral, central, parietal, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, hippocampus and cerebellum), in each hemisphere to calculate segmental CBF (sCBF) as the area-weighted mean value for each of the respective 12 segments based on the regional CBF in each ROI. Correlation of the intra- and post-episodic sCBF of each of the 12 segments of the eight patients was estimated by scatter-plot graphical analysis and Pearson’s correlation test with Fisher’s Z-transformation. For the control, 99mTc-ECD SPET was performed on eight subjects (three men and five women) and repeated within 1 month; the correlation between the first and second sCBF values of each of the 12 segments was evaluated in the same way as for patients with TGA. Excellent reproducibility between the two sCBF values was found in all 12 segments of the control subjects. However, a significant correlation between intra- and post-episodic sCBF was not shown in the thalamus or angular segments of TGA patients. The present study was preliminary, but at least suggested that thalamus and angular regions are closely involved in the symptoms of TGA.

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Fig. 1A–L
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References

  1. Hodges JR, Warlow CP. The aetiology of transient global amnesia: a case-control study of 114 cases with prospective follow up. Brain 1990; 113:639–657.

    PubMed  Google Scholar 

  2. Fredericks JAM. Transient global amnesia. Clin Neurol Neurosurg 1993; 95:265–283.

    Article  PubMed  Google Scholar 

  3. Stillhard G, Landis T, Schiess R, Regard M, Sialer G. Bitemporal hypoperfusion in transient global amnesia: 99m-Tc-HM-PAO SPECT and neuropsychological findings during and after an attack. J Neurol Neurosurg Psychiatry 1990; 53:339–342.

    CAS  PubMed  Google Scholar 

  4. Goldenberg G, Podreka I, Pfaffelmeyer N, Wassely P, Deecke L. Thalamic ischemia in transient global amnesia: a SPECT study. Neurology 1991; 41:1748–1752.

    CAS  PubMed  Google Scholar 

  5. Tanabe H, Hashikawa K, Nakagawa Y, Ikeda M, Yamamoto H, Harada K, Tsumoto T, Nishimura T, Shiraishi J, Kimura K. Memory loss due to transient hypoperfusion in the medial temporal lobes including hippocampus. Acta Neurol Scand 1991; 84:22–27.

    CAS  PubMed  Google Scholar 

  6. Lin KN, Liu RS, Yeh TP, Wang SJ, Liu HC. Posterior ischemia during an attack of transient global amnesia. Stroke 1993; 24:1093–1095.

    CAS  PubMed  Google Scholar 

  7. Takeuchi R, Yonekura Y, Matsuda H, Nishimura Y, Tanaka H, Ohta H, Sakahara H, Konishi J. Resting and acetazolamide-challenged technetium-99m-ECD SPECT in transient global amnesia. J Nucl Med 1998; 39:1360–1362.

    CAS  PubMed  Google Scholar 

  8. Talairach J, Tournoux P. Co-planar stereotaxic atlas of the human brain. Stuttgart: Thieme, 1988.

  9. Takeuchi R, Yonekura Y, Matsuda H, Konishi J. Usefulness of a three-dimensional stereotaxic ROI template on anatomically standardised99mTc-ECD SPET. Eur J Nucl Med Mol Imaging 2002; 29:331–341.

    Article  CAS  PubMed  Google Scholar 

  10. Takeuchi R, Yonekura Y, Katayama S, Takeda N, Fujita K, Konishi J. Fully automated quantification of regional cerebral blood flow with three-dimensional stereotaxic region of interest template: validation using magnetic resonance imaging -technical note-. Neurol Med Chir (Tokyo) 2003; 43:153–162.

    Google Scholar 

  11. Takeuchi R, Matsuda H, Yonekura Y, Sakahara H, Konishi J. Noninvasive quantitative measurements of regional cerebral blood flow using technetium-99m-l,l-ECD SPECT activated with acetazolamide: quantification analysis by equal-volume-split 99mTc-ECD consecutive SPECT method. J Cereb Blood Flow Metab 1997; 17:1020–1032.

    Google Scholar 

  12. Matsuda H. Tsuji S, Shuke N, Sumiya H, Tonami N, Hisada K. A quantitative approach to technetium-99m hexamethylpropylene amine oxime. Eur J Nucl Med 1992; 19:195–200.

    CAS  PubMed  Google Scholar 

  13. Matsuda H, Yagishita A, Tsuji S, Hisada K. A quantitative approach to technetium-99m ethyl cysteinate dimer: a comparison with technetium-99m hexamethylpropylene amine oxime. Eur J Nucl Med 1995; 22:633–637.

    CAS  PubMed  Google Scholar 

  14. Lassen NA, Andersen AR, Friberg L, Paulson OB. The retention of [99mTc]-d,l,-HM-PAO in the human brain after intracarotid bolus injection; a kinetic analysis. J Cereb Blood Flow Metab 1988; 8 (Suppl 1):13–22.

    Google Scholar 

  15. Friberg L, Andersen AR, Lassen NA, Holm S, Dam M. Retention of99mTc-bicisate in the human brain after intracarotid injection. J Cereb Blood Flow Metab 1994; 14 (Suppl 1):19–27.

    Google Scholar 

  16. Ohnishi T, Matsuda H, Hashimoto T, Kunihiro T, Nishikawa M, Uema T, Sasaki M. Abnormal regional cerebral blood flow in childhood autism. Brain 2000; 123:1838–1844.

    Article  PubMed  Google Scholar 

  17. Matsuda H, Higashi S, Tsuji S, Sumiya H, Miyauchi T, Hisada K, Yamashita J. High resolution Tc-99m HMPAO SPECT in a patient with transient global amnesia. Clin Nucl Med 1993; 18:46–49.

    CAS  PubMed  Google Scholar 

  18. Asada T, Matsuda H, Morooka T, Nakano S, Kimura M, Uno M. Quantitative single photon emission tomography analysis for the diagnosis of transient global amnesia: adaptation of statistical parametric mapping. Psychiatry Clin Neurosci 2000; 54:691–694.

    Article  CAS  PubMed  Google Scholar 

  19. Markowitsch HJ, Kaibe E, Kessler J, von Stockhausen HM, Ghaemi M, Heiss WD. Short-term memory deficit after focal parietal damage. J Clin Exp Neuropsychol 1999; 21:784–797.

    Article  CAS  PubMed  Google Scholar 

  20. Roland PE, Gulyas B. Visual memory, visual imagery, and visual recognition of large field patterns by the human brain: functional anatomy by positron emission tomography. Cereb Cortex 1995; 5:79–93.

    CAS  PubMed  Google Scholar 

  21. Kawashima R, Roland PE, O’Sullivan BT. Functional anatomy of reaching and visuomotor learning: a positron emission tomography study. Cereb Cortex 1995; 5:111–122.

    CAS  Google Scholar 

  22. Herath PS, Kinomura S, Roland PE. Visual recognition: evidence for two distinctive mechanisms from a PET study. Hum Brain Mapp 2001; 12:110–119.

    Article  CAS  PubMed  Google Scholar 

  23. Eustache F, Desgranges B, Petit-Taboué MC, de la Sayette V, Piot V, Sable C, Marchal G, Baron JC. Transient global amnesia: implicit/explicit memory dissociation and PET assessment of brain perfusion and oxygen metabolism in the acute stage. J Neurol Neurosurg Psychiatry 1997; 63:357–367.

    CAS  PubMed  Google Scholar 

  24. Baron JC, Petit-Taboué MC, LeDoze F, Desgranges B, Ravenel N, Marchal G. Right frontal cortex hypometabolism in transient global amnesia: a PET study. Brain 1994; 117:545–552.

    PubMed  Google Scholar 

  25. Guillery B, Desgranges B, de la Sayette V, Landeau B, Eustache F, Baron JC. Transient global amnesia: concomitant episodic memory and positron emission tomography assessment in two additional patients. Neurosci Lett 2002; 325:62–66.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Tatsuo Soma, Akihiro Takaki, Tetsuo Hosoya and Satomi Teraoka for assistance in developing 3DSRT, and Tatsuo Nomura, Takeshi Imai and Yasuhiko Arakawa for assistance in preparing this manuscript.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Nishi-Kobe Medical Center, Kohjidai 5-7-1, 651-2273, Nishi-ku, Kobe-City, Hyogo, Japan

    Ryo Takeuchi

  2. Department of Radiology, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan

    Hiroshi Matsuda

  3. Daiichi Radioisotope Laboratories, Ltd., Tokyo, Japan

    Katsunori Yoshioka

  4. Biomedical Imaging Research Center, University of Fukui, Fukui, Japan

    Yoshiharu Yonekura

Authors
  1. Ryo Takeuchi
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  2. Hiroshi Matsuda
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  3. Katsunori Yoshioka
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  4. Yoshiharu Yonekura
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Corresponding author

Correspondence to Ryo Takeuchi.

Appendix

Appendix

Revision of the fully automated ROI analysis Windows software

In the previously reported constant ROI template (three-dimensional stereotaxic ROI template; 3DSRT-t-Tal) [9], we determined ROI borders on Talairach’s co-planar stereotaxic brain atlas [8] first and then converted their co-ordinates into those on the MNI space using the conversion equations advocated by Brett et al. In short, 3DSRT-t-Tal was arranged indirectly on the MNI space. The revised constant ROI template (three-dimensional stereotactic ROI template; 3DSRT-t-MNI) was directly constructed on the anatomically standardized MR images. The complete set of ROIs of 3DSRT-t-MNI and 3DSRT-t-Tal is illustrated in Fig. 4. The red line and the black line indicate the contour of 3DSRT-t-MNI and 3DSRT-t-Tal, respectively. The ROI delineation of 3DSRT-t-MNI was substantially modified from that of 3DSRT-t-Tal to fit the fine anatomical architecture of the standardized MR images. The main points of difference are as follows: (1) the posterior border of the primary sensorimotor area around the vertex semicircularly protruded along the central sulcus; (2) ROIs around the skull base could be newly arranged, because the conversion equations advocated by Brett et al. did not indicate plausible co-ordinates in the 3DSRT-t-Tal near the skull base. Because of these corrections, 3DSRT-t-MNI agreed precisely with anatomically standardized brain images.

Fig. 4
figure 4

Diagrams showing the 636 and 536 ROIs of 3DSRT-t-MNI (red) and 3DSRT-t-Tal (black) respectively

Full size image

The previously reported 3DSRT-old could rewrite the respective header file suitable for the SPET images of major manufacturers (GE, Philips, Siemens and Toshiba). The anatomical standardization engine of SPM99 was transplanted into 3DSRT-old, but does not require the MATLAB (MathWorks Inc., Natick, MA., U.S.A.) software package, which is essential for SPM99 [10]. We revised 3DSRT-old into 3DSRT by replacing 3DSRT-t-Tal with 3DSRT-t-MNI to quantify the ROIs. Consequently, 3DSRT acts as a stand-alone application to enable fully automated objective analysis of the 636 ROIs and calculation of the area-weighted mean value for each of the 24 segments of the brain, in only a few minutes.

Validation of ROI delineation using infarcted lesions

In the previous report, we analysed the T1-weighted MR images of patients with small infarcted lesions (<10 mm in diameter) in deep grey matter to validate the delineation of 3DSRT-t-Tal, and all 20 lesions were found to be strictly concordant with the ROI delineation [10]. Strict concordance was also confirmed in 3DSRT-t-MNI, as we expected (data not shown), because the ROI arrangement of 3DSRT-t-MNI in deep grey matter is almost the same as that of 3DSRT-t-Tal. We furthermore evaluated the reliability of 3DSRT in patients with infarcted lesions in the superficial cortex. The 99mTc-ECD SPET images of 24 patients with 25 lesions (15–70 mm in diameter) processed using 3DSRT were compared with the respective MR images by three trained neuroradiologists. The size and location of the 25 lesions are summarized in Table 4. Anatomical standardization was successfully performed irrespective of the size and location of the lesions, and any problems vital to the clinical use of 3DSRT were not found. The results from patient 1 in Table 4 are illustrated in Fig. 5. MR images (Fig. 5A) showed a fresh embolism in the posterior portion of the left precentral region of the diffusion-weighted images (upper row) and the left angular old infarcted lesion in the T2-weighted images (lower row). A 99mTc-ECD SPET study was performed 30 days after the MR study. The position of the precentral (yellow arrow) and angular (white arrow) lesions showed excellent concordance with the ROI delineation of 3DSRT-t-MNI (Fig. 5B).

Table 4 Summary of patients with infarcted lesions in superficial grey matter
Full size table
Fig. 5A, B
figure 5

MR (A) and 3DSRT (B) images of patient 1 in Table 4. A Upper row, diffusion-weighted images showing a fresh embolism in the posterior portion of the left precentral region; lower row, T2-weighted images showing a left angular old infarcted lesion. B Hypoperfused areas in the left angular segment (white arrow) and the left precentral segment (yellow arrow) are shown

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Validation of ROI delineation using template images for anatomical standardization of each tracer

To validate the delineation of 3DSRT-t-MNI, we used the template images for anatomical standardization of the tracers as follows: 99mTc-ECD, 99mTc-HMPAO, 123I-IMP, 15O-H2O and 18F-FDG. All five template images were strictly concordant with the ROI delineation of 3DSRT-t-MNI. Of these images, only the 18F-FDG template is illustrated in Fig. 6.

Fig. 6
figure 6

3DSRT images with ROI delineation on the 18F-FDG template showing that the anatomical structure agrees with the ROI delineation of 3DSRT-t-MNI

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Worldwide distribution

We have started to provide 3DSRT-old under a freeware license to over 400 hospitals or institutes in Japan since April 2002. We also started to provide 3DSRT in July 2003 internationally as well as domestically. Please contact us via our e-mail address (3dsrt@drl.co.jp).

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Takeuchi, R., Matsuda, H., Yoshioka, K. et al. Cerebral blood flow SPET in transient global amnesia with automated ROI analysis by 3DSRT. Eur J Nucl Med Mol Imaging 31, 578–589 (2004). https://doi.org/10.1007/s00259-003-1406-8

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  • DOI: https://doi.org/10.1007/s00259-003-1406-8

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