Brain SPECT with 123I-IMP for the early diagnosis of Creutzfeldt–Jakob disease

doi:10.1016/S0022-510X(00)00468-8

Journal of the Neurological Sciences

Volume 183, Issue 1, 15 January 2001, Pages 5-12

https://doi.org/10.1016/S0022-510X(00)00468-8 Get rights and content

Abstract

We performed brain CT and single-photon emission computed tomography (SPECT) using N-isopropyl-p-[¹²³I] iodoamphetamine (¹²³I-IMP) as a tracer in the early stage of seven patients with Creutzfeldt–Jakob disease (CJD). In four of the patients, we determined absolute values of regional cerebral blood flow (rCBF) in the frontal, temporal, parietal and occipital lobes, thalamus and cerebellum using an autoradiographic method with a single blood sample. Brain CT demonstrated no abnormal findings other than a mild age-related atrophy in all patients except for one patient with a low-density area in the left cerebellar hemisphere due to an old hemorrhage, whereas SPECT revealed a decreased uptake of the tracer in various parts of the cerebral cortex of all patients, sometimes in an asymmetrical pattern. Absolute values of rCBF showed a significant decrease in all examined regions of the patients as against healthy controls (P<0.0001). In three patients, SPECT demonstrated a decreased uptake throughout the cerebral cortex on visual inspection, whereas absolute values of rCBF revealed an obvious decrease of the uptake also in the thalamus and cerebellum. These results suggest that SPECT with quantification of rCBF using ¹²³I-IMP might be a sensitive and useful technique not only for detecting a focal metabolic dysfunction but also for diagnosis in the early stage of CJD.

Introduction

Creutzfeldt–Jakob disease (CJD) is included among the prion diseases, leading to dementia, extrapyramidal tract signs, cerebellar symptoms and myoclonus usually in middle-aged and elderly patients [1]. Computed tomography (CT) or magnetic resonance imaging (MRI) demonstrates a rapidly progressive brain atrophy in the late stage of CJD, while we usually cannot detect any significant changes using these neuroimaging methods in the early stage of the illness [2]. Recently, several case reports showed a decreased uptake of the tracer on single-photon emission computed tomography (SPECT) with no atrophy on CT or MRI in patients with CJD [3], [4], [5], [6], [7]. We performed SPECT with quantification of regional cerebral blood flow (rCBF) using N-isopropyl-p-[¹²³I] iodoamphetamine (¹²³I-IMP) in seven patients with CJD to investigate whether this technique is clinically useful for diagnosis in the early stage.

Section snippets

Subjects

We performed SPECT with 167 MBq of ¹²³I-IMP and brain CT at the same time in seven patients (two men and five women) with early-stage CJD who had been hospitalized in our department since 1989. In cases 1 and 2, SPECT was performed also in the late stage (8 months and 1 year after onset, respectively). Clinical details of the seven patients are shown in Table 1. They had no history of living abroad or special medical treatment including corneal transplantation, injection of pituitary extracts

Brain CT and SPECT imaging

Brain CT and SPECT were performed 1–4 months after the onset of CJD (1.9±1.0 months on average). In visual inspection of SPECT double evaluations by the two raters correlated very well, but there was sometimes a discrepancy of one grade on the quartile rating scale. With respect to the intra- and inter-rater reliability, correlation coefficients for double evaluations by one rater with an interval of 2 months and by two separate raters were 0.98 and 0.90, respectively. Findings are summarized

Discussion

To make a diagnosis of CJD we do not necessarily need to do an invasive examination such as a brain biopsy, because CJD has characteristic clinical features and EEG findings [1]. Among our patients, case 1 was diagnosed as having definite CJD based on autopsy findings with spongiform degeneration of the brain, whereas the other cases were clinically considered to be probable CJD because of PSD on EEG and clinical symptoms including rapidly progressive dementia, extrapyramidal signs, myoclonus

Acknowledgements

The authors thank Mr. S. Yoshimoto, Saku Central Hospital, for help in preparing the manuscript.

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Brain SPECT with 123I-IMP for the early diagnosis of Creutzfeldt–Jakob disease

Abstract

Introduction

Section snippets

Subjects

Brain CT and SPECT imaging

Discussion

Acknowledgements

Lancet

Lancet

Prion diseases

Cerebral MR and CT imaging in Creutzfeldt–Jakob disease

J Comput Assist Tomogr

Brain SPECT imaging with Tc-99m HM-PAO in Creutzfeldt–Jakob disease

Clin Nucl Med

Tc-99m HMPAO brain SPECT findings in Creutzfeldt–Jakob disease

Clin Nucl Med

SPECT diagnosis of Creutzfeldt–Jacob disease

J Nucl Med

Brain SPECT of Creutzfeldt–Jakob disease

Clin Nucl Med

M: The role of 99m-Tc HMPAO SPECT in the diagnosis of Creutzfeldt–Jacob disease

AJNR Am J Neuroradiol

Quantitative mapping of regional cerebral blood flow using iodine-123-IMP and SPECT

J Nucl Med

A method to quantitate cerebral blood flow using a rotating gamma camera and iodine-123 iodoamphetamine with one blood sampling

Eur J Nucl Med

Referentially oriented cerebral MRI anatomy. Atlas of stereotaxic anatomical correlations for gray and white matter

Brain SPECT with ¹²³I-IMP for the early diagnosis of Creutzfeldt–Jakob disease

M: The role of ^99m-Tc HMPAO SPECT in the diagnosis of Creutzfeldt–Jacob disease