Brain

• what is the principle of BBB scintigraphy?

  use hydrophilic RF which normally would not be able to penetrate the blood-brain barrier
• what Rf is used in BBB scintigraphy?

  • 99mTcO4-pertechnetate,
  • 99mTc-DTPA
• what are the disadvantages of BBB scintigraphy?

  • lower sensitivity (unable to locate small lesions <15mm),
  • low specificity (can’t be distinguished from other metastasis smaller lesions)
• what is the principle of regional cerebral blood flow?

  use lipophilic RF which are able to pass through blood-brain barrier which accumulate in brain tissue depending on the rate of capillary blood flow.
• what Rf is used for regional cerebral blood flow?

  • 99mTc-HMPAO (correlated with metabolic activity),
  • 99mTc-ECD (correlated with metabolic activity) – 550-750 MBq
• how is the patient prepped for regional cerebral blood flow?

  stop taking caffeine, alcohol or other drugs known to affect cerebral blood flow at least 1–3 days before the study
• what is the procedure for regional cerebral blood flow?

  1. The patient is lying dark room and has closed eyes for 15-20 minutes. Sometimes we apply ACETAZOLAMID to evaluate cerebrovascular perfusion reserve
  2. Silence during IV applications of RF
  3. SPECT performed 15-30 minutes after injection
  4. The examination is about 40-60 minutes long
• indications for regional cerebral blood flow

  • Assessment of brain death
  • Presurgical lateralization and localization of epileptogenic foc
  • Evaluation of cerebrovascular disease (chronic ischemia)
  • Evaluation of suspected dementia
  • Evaluation of traumatic brain injury
  • Evaluation of suspected inflammation
• Fill the blanks

  A) brain death

  B) no cerebellar activity

  C) brainstem activity

  
• what are examples of brain receptor scintigraphy for Parkinson's disease?

  • DaT Scan (Dopamine Transporter Scan)
  • myocardial scintigraphy
  • IMZB
• how is DaT Scan effective in diagnosing Parkinson's disease?

  DaT Scan (Dopamine Transporter Scan) is a diagnostic method to investigate if there is a loss of dopaminergic neurons in striatum and degeneration of the dopaminergic neurons in the corpus striatum plays a role in the development of Parkinson's disease.
• what Rf is used in DaT Scan?

  Ioflupane (123I FP-CIT) – binds to dopamine transporters
• how is the patient prepped for DaT Scan?

  stop the use of medication that can affect the function

  • CNS stimulants,
  • drugs for anorexia and obesity,
  • drugs for ADHD,
  • antidepressants,
  • anticholinergic)
• what is the procedure for DaT Scan?

  1. Take Chlorigen 60min before application of RF
  2. IV injection of Ioflupane 185 MBq
  3. Take a break, examination starts after 4h and it takes 40-60min
• what to do after a positive DaT Scan?

  MIBG scan
• what does a positive DaT Scan diagnose?

  • Parkinson disease,
  • progressive supranuclear palsy,
  • multisystem degeneration
• what does a negative DaT Scan diagnose?

  • Parkinson syndrome,
  • essential tremor
• what Rf is used in myocardial scintigraphy?

  123-Iodine-MIBG
• indications for myocardial scintigraphy in neurology?

  differential diagnosis between Parkinson's and multisystemic atrophy
• what to do after positive MIBG scan?

  IMZB scan
• what does a positive MIBG scan diagnose?

  • Parkinson disease,
  • progressive supranuclear palsy
• what does a negative MIBG scan diagnose?

  multisystem degeneration
• what is the indication for IMZB?

  differential diagnosis between parkinson and atypical parkinsonisms
• what Rf is used for IMZB?

  Iodobenzamid (123-Iodine-IBZM)
• what receptors are affected duringt an IMZB scan?

  D2 receptors
• how is a patient prepped for IMZB scan?

  stop medications that can affect the function

  • CNS stimulants,
  • drugs for anorexia and obesity,
  • drugs for ADHD,
  • antidepressants,
  • anticholinergic
• procedure for IMZB

  1. Take Chlorigen 60min before application of RF
  2. IV injection of Iodobenzamid 185 MBq in washing with saline break
  3. Take a break, examination starts after 3-4h and it takes 40-60min
• what does a positive IMZB scan diagnose?


  progressive supranuclear palsy
• what does a negative IMZB scan diagnose?


  Parkinson disease
• Alzheimer disease is progressive neurodegenerative disease characterized by progressive loss of memory. It is the most common cause of dementia.
• what Rf is used with PET/CT or PET/MRI to diagnose Alzheimer's?

  18F-FDG
• Indications for PET/CT(MRI) are:

  1. Differentiation of some intracranial tumors, and planning for the external bean therapy, proton therapy or stereotactic surgery
  2. Evaluation of patients with suspected dementia
  3. Detection and evaluation of cerebrovascular disease
  4. Pre-surgical localization of epileptic foci
  5. Differential diagnosis of encephalitis or other unclear pathology
• Glucose metabolism (18F-FDG - fluorodeoxyglucose) vs amyloid (11C-PIB)

  • accumulation of protein and amyloid imaging 11C-PIB => frontal lobe.
  • glucose metabolism of 18F-FDG and 99mTc-HMPAO decrease => parietal and temporal lobes.
• Imaging methods for Alzheimer’s:

  CT, MRI, SPECT, 18F-FDG
• Imaging methods for Parkinson's:

  MRI, SPECT, DaT, Myocardial scintigraphy using 123I-MIBG, IMZB
• Structural MRI is useful to differentiate Parkinson from secondary and atypical forms of parkinsonism
• what are the two major PET studies for Alzheimer's?

  PET with 18F-FDG of cerebral glucose and amyloid metabolism
• Tests for dementia?

  Regional cerebral blood flow test, SPECT, FDG, PET, DaT scan, PET/CT, PET/MRI
• What are the main indication methods in brain examinations?

  MRI, SPECT/CT and PET/CT
• Anatomy of basal ganglia?

  group of subcortical nuclei in the corpus striatum responsible for motor control, motor learning, executive functions and behaviors, and emotions.