Brain SPECT in dementia a clinical-scintigraphic correlation

Buchpiguel, Carlos A.; Mathias, Sandra C.; Itaya, Liliam Y.; Barros, Nélio G.; Portela, Luis A.P.; Freitas, Jose M. M.; Caramelli, Paulo; Carrilho, Paulo E.; Bacheschi, Luiz A.; Hironaka, Fausto H; Nitrini, Ricardo

doi:10.1590/S0004-282X1996000300003

Abstracts

The aim of this study was to compare the accuracy of computed tomography (CT) and single photon emission computerized tomography (SPECT) in the diagnosis of dementia. Fifty-two patients with clinical diagnosis of dementia and 11 controls were studied. The scans were interpreted by one experienced neuroradiologist and one nuclear radiologist, both blinded to the clinical data. In the diagnosis of dementia, CT and SPECT showed equal sensitivity (82.7%) and statistically similar specificity (63.8 and 81.8%, respectively). The specificity of SPECT in diagnosing Alzheimer's disease (100%) was statistically superior to CT (69%). However, both methods showed similar sensitivity in detecting Alzheimer's disease. In conclusion, SPECT and CT showed similar accuracy in the diagnosis of dementia. The quite high specificity of SPECT in Alzheimer's disease may be useful for confirming that diagnosis, particularly for patients with presenile onset of the disease.

SPECT; computed tomography; dementia; Alzheimer's disease; HMPAO-Tc99m

O objetivo deste estudo foi comparar a acurácia da tomografia computadorizada (TC) e da tomografia computadorizada por emissão de fóton único (SPECT) no diagnóstico de demência. Cinquenta e dois pacientes com diagnóstico clínico de demência e 11 controles foram estudados. Os exames foram interpretados por um neuroradiologista e um radiologista nuclear, ambos cegos quanto aos dados clínicos. No diagnóstico de demência, a TC e a SPECT mostraram sensibilidades iguais (82,7%) e estatisticamente especificidades semelhantes (63,8 e 81,8%, respectivamente). A especificidade da SPECT no diagnóstico da doença de Alzheimer (100%) foi significativamente superior à da TC (69%). Contudo, ambos os métodos mostraram sensibilidades semelhantes na detecção de doença de Alzheimer. Em conclusão, TC e SPECT mostraram acurácia similar no diagnóstico de demência. A alta especificidade observada no diagnóstico de doença de Alzheimer pode ser útil na confirmação do diagnóstico clínico, especialmente na forma pré-senil da doença.

SPECT; tomografia computadorizada; demência; doença de Alzheimer; HMPAO-Tc99m

Brain SPECT in dementia a clinical-scintigraphic correlation

SPECT cerebral na demência: uma correlação clínico-cintilográfica

Carlos A. Buchpiguel^II; Sandra C. Mathias^I; Liliam Y. Itaya^II; Nélio G. Barros^II; Luis A.P. Portela^I; Jose M. M. Freitas^I; Paulo Caramelli^I; Paulo E. Carrilho^I; Luiz A. Bacheschi^I; Fausto H. Hironaka^II; Ricardo Nitrini^I

^IDepartment of Neurology of São Paulo University School of Medicine

^IICentro de Medicina Nuclear - Department of Radiology

ABSTRACT

The aim of this study was to compare the accuracy of computed tomography (CT) and single photon emission computerized tomography (SPECT) in the diagnosis of dementia. Fifty-two patients with clinical diagnosis of dementia and 11 controls were studied. The scans were interpreted by one experienced neuroradiologist and one nuclear radiologist, both blinded to the clinical data. In the diagnosis of dementia, CT and SPECT showed equal sensitivity (82.7%) and statistically similar specificity (63.8 and 81.8%, respectively). The specificity of SPECT in diagnosing Alzheimer's disease (100%) was statistically superior to CT (69%). However, both methods showed similar sensitivity in detecting Alzheimer's disease. In conclusion, SPECT and CT showed similar accuracy in the diagnosis of dementia. The quite high specificity of SPECT in Alzheimer's disease may be useful for confirming that diagnosis, particularly for patients with presenile onset of the disease.

Key words: SPECT, computed tomography, dementia, Alzheimer's disease, HMPAO-Tc99m.

RESUMO

O objetivo deste estudo foi comparar a acurácia da tomografia computadorizada (TC) e da tomografia computadorizada por emissão de fóton único (SPECT) no diagnóstico de demência. Cinquenta e dois pacientes com diagnóstico clínico de demência e 11 controles foram estudados. Os exames foram interpretados por um neuroradiologista e um radiologista nuclear, ambos cegos quanto aos dados clínicos. No diagnóstico de demência, a TC e a SPECT mostraram sensibilidades iguais (82,7%) e estatisticamente especificidades semelhantes (63,8 e 81,8%, respectivamente). A especificidade da SPECT no diagnóstico da doença de Alzheimer (100%) foi significativamente superior à da TC (69%). Contudo, ambos os métodos mostraram sensibilidades semelhantes na detecção de doença de Alzheimer. Em conclusão, TC e SPECT mostraram acurácia similar no diagnóstico de demência. A alta especificidade observada no diagnóstico de doença de Alzheimer pode ser útil na confirmação do diagnóstico clínico, especialmente na forma pré-senil da doença.

Palavras-chave: SPECT, tomografia computadorizada, demência, doença de Alzheimer, HMPAO-Tc99m.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 4-março-1996.

Dr. Carlos A. Buchpiguel - Centro de Medicina Nuclear, Departamento de Radiologia, Universidade de São Paulo - Caixa Postal 11136 - 05422-970 São Paulo SP - Brasil.

¹
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Ed3 rev. Washington,DC: American Psychiatric Association, 1987.
2. Benson DF, Kuhl DE, Hawkins RA, Phelps ME, Cummings JL, Tsai SY. The fluorodeoxyglucose F-18 scan in Alzheimer's and multi-infarct dementia. Arch Neurol 1983;40:711-714.
3. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797-811.
4. Bonte FJ, Horn J, Tintner R, Weiner MF. Single photon tomography in Alzheimer's disease and the dementias. Semin Nucl Med 1990;4:342-352.
5. Cohen MB, Metter FJ, Grahan LS, Wasterlain C, Spolter L, Lake RR, Rose G, Yumada L, Chang CC. Differential diagnosis of dementia with "pure" 1-123 iodoamphetamine and a clinical camera. J Nucl Med 1983;24:P106.
6. Cummings JL, Benson F. Dementia of the Alzheimer type: an inventory of diagnostic clinical features. J Am Geriatr Soc 1986;34:12-19.
7. Dauru R, Grady C, Haxby J, Saudaram M, Cutler M, Heston L, Moore A, Schlageter N, Larson S, Rapoport SI. Positron emission tomography in Alzheimer's disease. Neurology 1986;36:879-887.
8. Deutsch G, Tweedy JR. Cerebral blood flow in severity-matched Alzheimer and multi-infarct patients. Neurology 1987,37:431-438.
9. Devous MD Sr, Bonte FJ. Initial evaluation of cerebral blood flow imaging with a high-resolution, high-sensitivity three-headed SPECT system (PRISM). J Nucl Med 1988,29:912.
10. Fazekus F, Alavi A, Chawluk JB, Zimmerman RA, Hackney D, Bilaniuk L, Rosen M, Alves WM, Hurtig HI, Jamieson DG, Kushner MJ, Reivjch M. Comparison of CT, MR, and PET in Alzheimer's dementia and normal aging. J Nucl Med 1989;30:1607-1615.
11. Folstein SE, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-198.
12. Foster NL, Chase TN, Fedio P, Patronas NJ, Brooks RA, Di Chiro G. Alzheimer's disease: focal cortical changes shown by positron emission tomography. Neurology 1983;33:961-965.
13. Friedland RP, Brun A, Budinger TF. Pathological and positron emission tomographic correlations in Alzheimer's disease [ letter]. Lancet 1985,1:228.
14. Hachinski VC, Linette D, Phil M, Zilhka E, Boulay GH, McAllister VL, Marshall J, Russel RWR, Simon L. Crerebral blood flow in dementia. Arch Neurol 1975;32:632-637.
15. Holman BL, Johnson KA, Gerada B, Carvalho PA, Satlin A. The scintigraphic appearance of Alzheimer's disease: a prospective study using technetium-99m-HMPAO SPECT. J Nucl Med 1992;33:181 -185.
16. Ingvar DH, Risberg J. Increase of regional cerebral blood flow during mental effort in normals and in patients with focal brain disorders. Exp Brain Res 1967;3:195-211.
17. Jagust WJ, Budinger TF, Reed BR. The diagnosis of dementia with single photon emission computed tomography. Arch Neurol 1987;44:258-262.
18. Jagust WJ, Eberling JL. MRI, CT, SPECT, PET: their use in diagnosing dementia. Geriatrics 1991 ;46:28-35.
19. Kuwabara Y, Ichiya Y, Otsuka M, Tuhara T, Fukumura T, Gunasekera R, Masuda K.. Differential diagnosis of bilateral parietal abnormalities in 1-123 IMP SPECT imaging. Clin Nucl Med 1990;10:893-899.
20. McGeer PL, Kamo H, Harrop R, McGeer EG, Martin WRW, Pate BD, Li DKB. Comparison of PET, MRI and CT with pathology in a proven case of Alzheimer's disease. Neurology 1986;36:1569-1574.
21. McKhannG, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.
22. Obrist WD, Chivian E, Cronquist S, Ingvar DH. Regional cerebral blood flow in senile and presenile dementia. Neurology 1970;20:315-322.
23. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A, Moody DM, Obrien MD, Yamagushi J, Grafman J, Drayer BP, Bennet DA, Fisher M, Ogata J, Kokmen E, Bermejo F, Woff PA, Gorelick PB, Bick KL, Pejeau AK, Bell MA, De Carli C, Culebras A, Korczyn AD, Bogousslavsky J, Hartamnn A, Sheinberg P. Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology 1993,43: 250-260.
24. Simard D, Olensen OB, Paulson OB, Lassen NA, Skinhoj E.. Regional cerebral blood flow and its regulation in dementia. Brain 1971;94:273-288.
25. Yamaguchi MD, Meyer JS, Yamamoto M, Sakai F, Shaw T. Noninvasive regional blood flow measurements in dementia. Arch Neurol 1980;7:410-418.

Publication Dates

Publication in this collection
10 Nov 2010
Date of issue
Sept 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] ¹
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Ed3 rev. Washington,DC: American Psychiatric Association, 1987.

[2] 2. Benson DF, Kuhl DE, Hawkins RA, Phelps ME, Cummings JL, Tsai SY. The fluorodeoxyglucose F-18 scan in Alzheimer's and multi-infarct dementia. Arch Neurol 1983;40:711-714.

[3] 3. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797-811.

[4] 4. Bonte FJ, Horn J, Tintner R, Weiner MF. Single photon tomography in Alzheimer's disease and the dementias. Semin Nucl Med 1990;4:342-352.

[5] 5. Cohen MB, Metter FJ, Grahan LS, Wasterlain C, Spolter L, Lake RR, Rose G, Yumada L, Chang CC. Differential diagnosis of dementia with "pure" 1-123 iodoamphetamine and a clinical camera. J Nucl Med 1983;24:P106.

[6] 6. Cummings JL, Benson F. Dementia of the Alzheimer type: an inventory of diagnostic clinical features. J Am Geriatr Soc 1986;34:12-19.

[7] 7. Dauru R, Grady C, Haxby J, Saudaram M, Cutler M, Heston L, Moore A, Schlageter N, Larson S, Rapoport SI. Positron emission tomography in Alzheimer's disease. Neurology 1986;36:879-887.

[8] 8. Deutsch G, Tweedy JR. Cerebral blood flow in severity-matched Alzheimer and multi-infarct patients. Neurology 1987,37:431-438.

[9] 9. Devous MD Sr, Bonte FJ. Initial evaluation of cerebral blood flow imaging with a high-resolution, high-sensitivity three-headed SPECT system (PRISM). J Nucl Med 1988,29:912.

[10] 10. Fazekus F, Alavi A, Chawluk JB, Zimmerman RA, Hackney D, Bilaniuk L, Rosen M, Alves WM, Hurtig HI, Jamieson DG, Kushner MJ, Reivjch M. Comparison of CT, MR, and PET in Alzheimer's dementia and normal aging. J Nucl Med 1989;30:1607-1615.

[11] 11. Folstein SE, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-198.

[12] 12. Foster NL, Chase TN, Fedio P, Patronas NJ, Brooks RA, Di Chiro G. Alzheimer's disease: focal cortical changes shown by positron emission tomography. Neurology 1983;33:961-965.

[13] 13. Friedland RP, Brun A, Budinger TF. Pathological and positron emission tomographic correlations in Alzheimer's disease [ letter]. Lancet 1985,1:228.

[14] 14. Hachinski VC, Linette D, Phil M, Zilhka E, Boulay GH, McAllister VL, Marshall J, Russel RWR, Simon L. Crerebral blood flow in dementia. Arch Neurol 1975;32:632-637.

[15] 15. Holman BL, Johnson KA, Gerada B, Carvalho PA, Satlin A. The scintigraphic appearance of Alzheimer's disease: a prospective study using technetium-99m-HMPAO SPECT. J Nucl Med 1992;33:181 -185.

[16] 16. Ingvar DH, Risberg J. Increase of regional cerebral blood flow during mental effort in normals and in patients with focal brain disorders. Exp Brain Res 1967;3:195-211.

[17] 17. Jagust WJ, Budinger TF, Reed BR. The diagnosis of dementia with single photon emission computed tomography. Arch Neurol 1987;44:258-262.

[18] 18. Jagust WJ, Eberling JL. MRI, CT, SPECT, PET: their use in diagnosing dementia. Geriatrics 1991 ;46:28-35.

[19] 19. Kuwabara Y, Ichiya Y, Otsuka M, Tuhara T, Fukumura T, Gunasekera R, Masuda K.. Differential diagnosis of bilateral parietal abnormalities in 1-123 IMP SPECT imaging. Clin Nucl Med 1990;10:893-899.

[20] 20. McGeer PL, Kamo H, Harrop R, McGeer EG, Martin WRW, Pate BD, Li DKB. Comparison of PET, MRI and CT with pathology in a proven case of Alzheimer's disease. Neurology 1986;36:1569-1574.

[21] 21. McKhannG, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.

[22] 22. Obrist WD, Chivian E, Cronquist S, Ingvar DH. Regional cerebral blood flow in senile and presenile dementia. Neurology 1970;20:315-322.

[23] 23. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A, Moody DM, Obrien MD, Yamagushi J, Grafman J, Drayer BP, Bennet DA, Fisher M, Ogata J, Kokmen E, Bermejo F, Woff PA, Gorelick PB, Bick KL, Pejeau AK, Bell MA, De Carli C, Culebras A, Korczyn AD, Bogousslavsky J, Hartamnn A, Sheinberg P. Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology 1993,43: 250-260.

[24] 24. Simard D, Olensen OB, Paulson OB, Lassen NA, Skinhoj E.. Regional cerebral blood flow and its regulation in dementia. Brain 1971;94:273-288.

[25] 25. Yamaguchi MD, Meyer JS, Yamamoto M, Sakai F, Shaw T. Noninvasive regional blood flow measurements in dementia. Arch Neurol 1980;7:410-418.