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![Shows a healthy 3D surface rendering of SPECT information , looking at the top 45% of brain perfusion, anything below that level shows up as a hole or a dent. The holes do not mean no perfusion , they mean low perfusion, compared to a healthy dataset. Activity below the top forty-fifth percentile is 3 standard deviations below normal [10]. A healthy scan shows full, even, symmetrical perfusion.](profile/Andrew-Newberg/publication/51591749/figure/fig1/AS:393917318090765@1470928615708/Fig-1-Shows-a-healthy-3D-surface-rendering-of-SPECT-information-looking-at-the-top.png)
Shows a healthy 3D surface rendering of SPECT information , looking at the top 45% of brain perfusion, anything below that level shows up as a hole or a dent. The holes do not mean no perfusion , they mean low perfusion, compared to a healthy dataset. Activity below the top forty-fifth percentile is 3 standard deviations below normal [10]. A healthy scan shows full, even, symmetrical perfusion.
Source publication
Over the past 20 years brain Single Photon Emission Computed Tomography (SPECT) imaging has developed a substantial, evidence-based foundation and is now recommended by professional societies for numerous indications relevant to psychiatric practice. Unfortunately, SPECT in clinical practice is utilized by only a handful of clinicians. This article...
Citations
... Those patients were selected using continuous transcranial Doppler ultrasound (TCD) monitoring with and without voluntary breath-holding and repeated single photon emission CT (SPECT) imaging paired with acetazolamide-challenge. While both modalities are specifically used for selecting patients who would likely benefit from EC-IC bypass, they are rarely used in practice due to their time-and resource-intensive nature [11]. We report a case of a patient who presented with episodic stroke symptoms that were blood pressure-dependent and in whom a CT perfusion (CTP) scan demonstrated persistent ischemic brain tissue. ...
The efficacy of extracranial-intracranial (EC-IC) bypass in preventing ischemic stroke progression and recurrence is controversial. As per the current hypothesis, EC-IC bypass is most beneficial for patients with persistent hemodynamic insufficiency. Hence, various approaches have been used to evaluate hemodynamic insufficiency, including repeated single photon emission CT (SPECT) imaging or continuous monitoring of cerebral flow with transcranial Doppler ultrasound (TCD). However, both modalities are time- and resource-intensive. In this report, we discuss how EC-IC bypass turned out to be beneficial for a patient presenting with blood pressure-dependent severe aphasia and right hemiparesis due to middle cerebral artery (MCA) occlusion that failed thrombectomy. CT perfusion (CTP) scan at admission demonstrated a persistent volume of delayed perfusion without core infarct. Following the superficial temporal artery‐to‐middle cerebral artery (STA-MCA) bypass, the patient's National Institute of Health Stroke Scale (NIHSS) score improved from 12 to 1. Ischemic penumbra, as seen on CTP imaging, also improved after the STA-MCA bypass. Our case suggests that persistent volume of delayed perfusion and blood pressure-dependent neurological deficits can be used in tandem as selection criteria for EC-IC bypass.
... Des méthodes existent également pour étudier spécifiquement les différents neurotransmetteurs, notamment en SPECT. Par exemple, la SPECT à 123 I-ioflupane (communément appelée DaTSCAN) permet d'acquérir des informations sur la transmission dopaminergique et peut être employée pour différencier le syndrome extrapyramidal secondaire aux antipsychotiques d'une maladie de Parkinson [43] . La Figure 1 illustre l'intérêt de l'imagerie cérébrale dans les situations de complexité et de résistance à partir de trois cas cliniques [44] . ...
Malgré les avancées des dernières décennies sur le plan de l'accès aux soins et des moyens thérapeutiques, une proportion considérable de personnes souffrant de troubles psychiatriques ne pré-sentent pas d'amélioration clinique satisfaisante, en dépit d'une prise en charge appropriée. L'expression « trouble psychiatrique résistant » est alors généralement utilisée. Le concept de résistance au traitement, bien que très hétérogène, est reconnu dans le cadre de plusieurs troubles : schizophrénie, dépression, trouble bipolaire et trouble obsessionnel compulsif. La résistance au traitement n'est pas sans consé-quence pour les patients concernés, puisqu'elle est associée à une majoration de la morbimortalité, avec augmentation du risque de décès par suicide, de la fréquence des comorbidités non psychiatriques, du handicap et des coûts de santé plus importants. Ainsi, les situations de résistance rencontrées en pratique clinique sont souvent particulièrement complexes et marquées par une longue évolution. L'expression « trouble psychiatrique complexe » désigne les situations de comorbidité entre un trouble psychiatrique et un (ou plusieurs) autre(s) trouble(s) psychiatrique(s), un (ou plusieurs) trouble(s) non psychiatrique(s) (ex : dépression bipolaire chez un patient souffrant d'une maladie de Parkinson), un syndrome spécifique (ex. : syndrome catatonique). Dans cet article, la problématique de la résistance au traitement est abor-dée sous un angle pratique, multiéchelle et transdiagnostique, l'objectif étant de fournir différents outils intégrant plusieurs niveaux d'analyse pour le clinicien, face à ces situations. D'abord, nous aborderons l'étape fondamentale de l'évaluation clinique, pharmacologique et paraclinique des situations résistantes et complexes. Puis seront développés les contextes de comorbidités, en particulier certaines situations fré-quentes mais insuffisamment reconnues : le syndrome catatonique et le syndrome sérotoninergique. Finalement, nous proposerons des principes de prise en charge dédiés.
... The end result: boosting their resilience. Neuroanatomical consciousness: The second level of consciousness is attained by educating people on each of these mental health problems and connecting it to a specific area of the brain, thus increasing neuroanatomic self-awareness (Amen et al., 2011). Functional magnetic resonance imaging (FMRI), PET, and SPECT scan studies revealed that even though our brain works with several areas interconnected most of the time, there are certain areas of the brain which have higher levels of activity, displayed by more blood and oxygen flow in the specific area when we are feeling specific emotions (i.e., due to certain mental health problems or other reasons). ...
In this paper, we present an original framework that applies the latest research in neuroscience and psychology to enhance the concept of resilience. We borrow and focus on the intersection of neurobiology and cognitive behavioural therapies in proposing an innovative angle to build resilience.
... SPECT-MR can be used to map changes in brain activity associated with specific tasks, such as language processing, memory encoding, and emotion regulation. This can help researchers understand how the brain works and how different regions of the brain interact with each other [12]. SPECT-MR also has potential applications in the study of drug development and pharmacology. ...
... КТ в гибридных обследованиях выполняет двойную функцию: это сопоставление анатомической картины с зонами нарушенной функциональной активности, а также коррекция затухания, позволяющая сделать поправки на ослабление излучения для структур, расположенных на разной глубине. За последние десятилетия ОФЭКТ головного мозга создала прочную доказательную базу и в настоящее время рекомендуется профессиональными сообществами для многочисленных показаний [4]. ОФЭКТ головного мозга на сегодняшний день широко используется для диагностики цереброваскулярных заболеваний, для оценки пациентов с подозрением на деменцию, для локализации эпилептических очагов, для определения прогноза у больных с хроническими нарушениями кровообращения, выбора тактики лечения и осуществления контроля эффективности проводимой терапии, для оценки смерти мозга [5]. ...
... ОФЭКТ головного мозга на сегодняшний день широко используется для диагностики цереброваскулярных заболеваний, для оценки пациентов с подозрением на деменцию, для локализации эпилептических очагов, для определения прогноза у больных с хроническими нарушениями кровообращения, выбора тактики лечения и осуществления контроля эффективности проводимой терапии, для оценки смерти мозга [5]. В то же время, по мнению ряда авторов, стоит помнить, что любой метод нейровизуализации, в том числе ОФЭКТ головного мозга, всегда должен применяться в сочетании с клинической оценкой, поскольку отдельно взятые диагностические данные все же несут только дополнительное второстепенное значение по отношению к клинической картине [4]. ...
... The improper selection of methodological parameters in clinical trial design [290] impeded the success of previous clinical trials [287][288][289]291]. In fact, the clinical trials dilemma in psychiatry, neurology, and AD has been discussed elsewhere by many researchers [292][293][294]. Issues including inaccuracy, incorrectness, and bias hindered clinical trials success [295,296]. ...
Alzheimer’s disease (AD) is a polygenic multifactorial neurodegenerative disease that, after decades of research and development, is still without a cure. There are some symptomatic treatments to manage the psychological symptoms but none of these drugs can halt disease progression. Additionally, over the last few years, many anti-AD drugs failed in late stages of clinical trials and many hypotheses surfaced to explain these failures, including the lack of clear understanding of disease pathways and processes. Recently, different epigenetic factors have been implicated in AD pathogenesis; thus, they could serve as promising AD diagnostic biomarkers. Additionally, network biology approaches have been suggested as effective tools to study AD on the systems level and discover multi-target-directed ligands as novel treatments for AD. Herein, we provide a comprehensive review on Alzheimer’s disease pathophysiology to provide a better understanding of disease pathogenesis hypotheses and decipher the role of genetic and epigenetic factors in disease development and progression. We also provide an overview of disease biomarkers and drug targets and suggest network biology approaches as new tools for identifying novel biomarkers and drugs. We also posit that the application of machine learning and artificial intelligence to mining Alzheimer’s disease multi-omics data will facilitate drug and biomarker discovery efforts and lead to effective individualized anti-Alzheimer treatments.
... rCBF fluctuates much over time [18]. Children's brains are more active than older people's [19]. ...
... 3 standard deviations under normal indicate activity underneath the top forty-fifth percentile. Perfusion is complete, even, and symmetrical in a healthy scan [19]. ...
... Outside the cerebellum, the commotion over these levels is 2 to 3 (SD) standard deviations more than regular (10). Increased perfusion in the cerebellum is shown in a healthy active MRI with HMPAO [19]. ...
... The path into the future will be paved with collaborations between nuclear medicine physicians, neurologists, and psychiatrists. Hopefully, enlightened clinicians in these fields will join together to deepen their clinical experience; hence, advancing and expand our understanding of the perfusion SPECT neuroimaging correlates in neurology and neuropsychiatry yielding improved treatment outcomes as has been demonstrated in several pilot studies (109,110,302,349,400). ...
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970's. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was originally approved in 1988, but was unstable. As a result, the quality of SPECT images varied greatly based on technique until 1993, when a method of stabilizing HMPAO was developed. In addition, most SPECT perfusion studies pre-1996 were performed on single-head gamma cameras. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. Although the TTASAAN report was published in January 1996, it was approved for publication in October 1994. Consequently, the reported brain SPECT studies relied upon to derive the conclusions of the TTASAAN report largely pre-date the introduction of stabilized HMPAO. While only 12% of the studies on traumatic brain injury (TBI) in the TTASAAN report utilized stable tracers and multi-head cameras, 69 subsequent studies with more than 23,000 subjects describe the utility of perfusion SPECT scans in the evaluation of TBI. Similarly, dementia SPECT imaging has improved. Modern SPECT utilizing multi-headed gamma cameras and quantitative analysis has a sensitivity of 86% and a specificity of 89% for the diagnosis of mild to moderate Alzheimer's disease—comparable to fluorodeoxyglucose positron emission tomography. Advances also have occurred in seizure neuroimaging. Lastly, developments in SPECT imaging of neurotoxicity and neuropsychiatric disorders have been striking. At the 25-year anniversary of the publication of the TTASAAN report, it is time to re-examine the utility of perfusion SPECT brain imaging. Herein, we review studies cited by the TTASAAN report vs. current brain SPECT imaging research literature for the major indications addressed in the report, as well as for emerging indications. In Part II, we elaborate technical aspects of SPECT neuroimaging and discuss scan interpretation for the clinician.
... However, SPECT imaging is underutilized in clinical practice despite a growing, evidence-based foundation for its application in numerous indications relevant to psychiatric practice (14)(15)(16)(17)(18)(19)(20)(21)(22)(23). This underutilization is particularly unfortunate as SPECT is an easy-to-perform, non-invasive procedure and remains among the least expensive neuroimaging tools available (24,25). ...
The difficulties of evaluating patients with complex neuropsychiatric conditions and prescribing appropriate treatments are well known. Imaging complements clinical assessments and allows a clinician to narrow the differential diagnosis by facilitating accurate and efficient evaluation. This is particularly relevant to neuropsychiatric conditions that are often diagnosed using a trial-and error process of exclusion. Single Photon Emission Computed Tomography (SPECT) is a functional brain imaging procedure that allows practitioners to measure the functional changes of gray matter structures based on regional cerebral blood flow (rCBF). The accurate diagnosis and treatment selection in psychiatry is challenging due to complex cases and frequent comorbidities. However, such complex neuropsychiatric conditions are increasingly benefitting from new treatment approaches, in addition to established medications. Among these are combination transcranial magnetic stimulation with ketamine infusions (CTK), hyperbaric oxygen therapy (HBOT) and perispinal administration of etanercept (PSE). This article provides readers with six case study examples that demonstrate how brain SPECT imaging can be used, both as a diagnostic tool, and as a potential biomarker for monitoring and evaluating novel treatments for patients with complex neuropsychiatric conditions. Six patients were assessed in our clinic and baseline brain SPECT imagesTourettes and a long history of alcohol were visually compared with SPECT images collected after periods of treatment with CTK or HBOT followed by PSE. This retrospective review demonstrates the clinical utility of these novel treatments and describes how SPECT imaging can complement standard diagnostic assessments. A novel display technique for SPECT images is described and we argue that SPECT imaging can be used for monitoring biomarker for clinical change.
... Certain programs have included neuroimaging to some extent during the preliminary year of the internal medicine neurology rotation. The further development of this field will need to be taken on by the Resident Review Committee for the psychiatry branch of the Accreditation Council for Graduate Medical Education (88). ...
In the past three decades, brain single-photon-emission-computed-tomography (SPECT) imaging has garnered a significant, evidence-based foundation for a wide array of indications relevant to the field of clinical psychiatry, including dementia, traumatic brain injuries, seizures, cerebrovascular disease, complex neuropsychiatric presentations, and treatment-resistant disorders. In clinical psychiatric practice, however, SPECT remains underutilized. Only a small percentage of psychiatric clinicians use brain imaging technology. In this article, the authors provide a rationale for shifting the paradigm to one that includes broader use of SPECT in the clinical psychiatric setting, primarily for patients with complex conditions. This paper will outline seven specific clinical applications. Adding neuroimaging tools like SPECT to day-to-day clinical practice can help move psychiatry forward by transforming mental health care, which can be stigmatizing and often shunned by the general public, to brain health care, which the authors argue will be more likely to be embraced by a larger group of people in need.
