Regional cerebral blood flow single-photon emission tomography with 99mTc-HMPAO and the acetazolamide test in the evaluation of vascular and Alzheimer's dementia

László Pávics, Frank Grünwald, Karl Reichmann, Rolf Horn, Anna Kitschenberg, Alexander Hartmann, Christian Menzel, Axel G. Schomburg, Bettina Overbeck, László Csernay, Hans J. Biersack

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

The diagnostic potential of technetium-99m hexamethylpropylene amine oxime (HMPAO) following systemic administration of the cerebral vasodilator acetazolamide (acetazolamide test) was evaluated by regional cerebral blood flow (rCBF) single-photon emission tomography (SPET) in patients with Alzheimer's disease (AD) or vascular dementia (VD). An initial, high-resolution SPET study was performed with 99mTc-HMPAO, and after 2 days the patients were re-evaluated with 99mTc-HMPAO following systemic administration of acetazolamide. Reconstructed SPET slices were evaluated visually and semiquantitatively by a semi-automatic rCBF map method. When 99mTc-HMPAO alone was used, bilateral hypoperfusion was found in the temporal and/or parietal regions in 33% (6/18) of the VD patients and in 70% (23/33) of the AD patients. The corresponding data obtained by quantitative evaluation were 41% (7/17) and 71% (15/21), respectively. The vascular reserve capacity, as determined with the acetazolamide test, was preserved visually in 22% (4/18) and quantitatively in 29% (5/17) of the VD patients, but in 73% (24/33) and 76% (16/21) of the AD patients. The differences in the perfusion patterns between the VD and AD patients were statistically significant (P < 0.01, Fischer's exact test). Of the VD patients with hypoperfusion (bilateral temporal and/or parietal), 4/6 (67%, visual evaluation) and 4/7 (57%, quantitative evaluation) had a decreased vascular reserve capacity as determined with the acetazolamide test. In the AD group of patients the corresponding results were 3/23 (13%) and 4/15 (27%). It is concluded that the acetazolamide test is promising in rCBF SPET to differentiate VD from AD.

Original languageEnglish
Pages (from-to)239-245
Number of pages7
JournalEuropean Journal of Nuclear Medicine
Volume26
Issue number3
DOIs
Publication statusPublished - Mar 31 1999

Keywords

  • Acetazolamide test
  • Alzheimer's disease
  • Regional cerebral blood flow single-photon emission tomography
  • Technetium-99m hexamethyl-propylene amine oxime
  • Vascular dementia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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