A discrepancy between Tc-99m HMPAO SPECT and Tc-99m ECD SPECT in Creutzfeldt-Jacob disease
Ichiro Sunada1, Toru Ishida, Shinichi Sakamoto
1Department of Neurosurgery, Saiseikai Ibaraki Hospital, Mitsukeyama, Ibaraki 567-0035, Japan.
Insights
Technetium-99m ethyl cysteinate dimer SPECT (ECD-SPECT) better correlated with Creutzfeldt-Jacob disease (CJD) pathology than technetium-99m hexamethyl propylene amine oxime SPECT (HMPAO-SPECT). ECD-SPECT revealed bifrontal hypoperfusion matching autopsy findings in CJD.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Creutzfeldt-Jacob disease (CJD) is a rapidly progressive neurodegenerative disorder.
- Cerebral perfusion imaging using single photon emission computed tomography (SPECT) can aid in diagnosing CJD.
- Technetium-99m hexamethyl propylene amine oxime (HMPAO) and technetium-99m ethyl cysteinate dimer (ECD) are common SPECT radiotracers.
Observation:
- A discrepancy was noted in SPECT perfusion patterns between HMPAO-SPECT and ECD-SPECT in an 84-year-old CJD patient.
- HMPAO-SPECT showed parieto-temporal hypoperfusion, particularly in the left temporal lobe.
- ECD-SPECT revealed significant bifrontal hypoperfusion.
Findings:
- Autopsy confirmed CJD pathology, with spongiform vacuolation most prominent in the bifrontal regions.
- The observed bifrontal hypoperfusion on ECD-SPECT correlated better with the pathological findings than the parieto-temporal findings on HMPAO-SPECT.
- This suggests ECD may be more sensitive in detecting the specific perfusion deficits associated with CJD.
Implications:
- ECD-SPECT may offer a more accurate assessment of CJD-related perfusion deficits compared to HMPAO-SPECT.
- Findings could influence diagnostic strategies and interpretation of SPECT imaging in CJD cases.
- Further studies are warranted to validate the differential utility of ECD and HMPAO in CJD diagnosis.
Abstract:
We observed a discrepancy between the perfusion patterns seen in single photon emission computed tomography (SPECT) images obtained using technetium-99m hexamethyl propylene amine oxime (HMPAO) and SPECT images obtained using technetium-99m ethyl cysteinate dimer (ECD) in an 84-year-old man with Creutzfeldt-Jacob disease (CJD). HMPAO-SPECT demonstrated a reduction in perfusion in the parieto-temporal regions, especially the left temporal area. However, ECD-SPECT revealed a significant reduction in the bifrontal regions. At autopsy, the characteristic pathological findings of CJD, spongiform vacuolation, were most prominent in the bifrontal regions. Thus, the clinical features and the pathological findings were more closely correlated with the ECD-SPECT images than the HMPAO-SPECT images.
