Nuclear medicine

diagnostic
in neurology
N.Mlachkov
In the field of neurology, the following scintigraphic studies
of the brain are performed by means of SPECT / single
photon emission computed tomography / gamma camera:
 Perfusion scintigraphy
 Tumor scintigraphy
 Receptor scintigraphy.

Positron emission tomography/ PET / displayed the

metabolism of the brain main fuel used - glucose labeled
with 18F or some amino acids labeled with 11C, 13N, 15O.
Perfusion scintigraphy of the brain is performed using a
lipophilic radiopharmaceutical passing the blood-brain
barrier - 99mTc-hexamethylpropylene amine oxime
(HMPAO) and reflects regional cerebral blood flow.

Indications for conducting perfusion brain scintigraphy are:

 Cerebrovascular diseases - carotid stenosis, cerebral

infarction.
Indications for conducting perfusion brain scintigraphy

 Dementia - to diagnose Alzheimer's disease in which is

found reduced blood circulation bilaterally rear-
temporally and parietally while occipital lobe, sensory-
motor cortex and cerebellum have preserved perfusion.

 Epilepsies - detection of the trigger zone/starter/. It is best

injection to be carried out during the attack and scan is
performed after 30 minutes.
Displayed focal increased accumulation.
Indications for conducting perfusion brain scintigraphy

 For proving of brain death /relevant in organ

transplantation/. Displayed internal carotid circulation to
the base of the skull, but the absence of the cerebral
circulation and parenchyma.

 Infection / inflammation. Intracerebral abscess can be

visualized as a zone with an increase, sometimes missing
in the center / doughnut sign / uptake.
Тumor scintigraphy
It is done with so-called. "tumor seeking radiofarmaceuticals" -
eg. 99mTc-MIBI.
The depiction of tumors in the brain and tracking is performed
most often by CT or MRI, but tracking them after surgery and
radiotherapy those two good morphological imaging
methods can not distinguish reliably postoperative connective
tissue changes or radiation necrosis from tumor recurrence.
Tumor seeking radiopharmaceuticals accumulate only in vital
tumor tissue but not in necrotic and thus serve to differential
diagnosis between relapse and necrosis.
Receptor scintigraphy

To display functioning dopaminergic neurons in the basal

ganglia and the extent of their depletion in Parkinsonism is
developed radiopharmaceutical 123I-Ioflupan / DatScan /. It
reliably distinguish Parkinsonism from Essential tremor and other
parkinsonian syndromes, which is crucial for their treatment.
The concept of Parkinsonism includes the most common
neurodegenerative disease - Parkinson's disease, but also
Multisystem atrophy and Progressive supranuclear palsy.
Receptor scintigraphy

Basal ganglia - striatums consist of nucleus caudatus and

putamen. They are normally displayed as a comma shaped or
lunar. In their depletion in Parkinsonism they become oval and
at later stages the activity blurs in brain substance outside the
basal ganglia.