Brain SPECT in patients with cognitive disorders - comparison with clinical diagnosis and significance for clinical practise - still valid possiblity?
Abstract
Introduction: The importance of brain perfusion examination using single photon emission computed tomography (SPECT) in the differential diagnosis of cognitive disorders is evaluated in this study. Methods: For a period of four years a retrospective analysis of the examined patient's data was performed in order to compare the conclusions of the brain SPECT examination with the clinical diagnosis. 68 patients with clinical diagnoses (33 patients with probable Alzheimer's disease (AD), 13 with mild cognitive impairment (MCI) and 22 with other diseases) were divided into 5 groups of perfusion patterns according to the second reading of their brain SPECT images without clinical information: Alzheimer's disease (AD - 19 patients), vascular dementia picture (VD - 17), mixed dementia picture (MIX - 18), other perfusion patterns (O - 11) and normal picture (N - 3).
Results: Thirty-three patients with probable Alzheimer's disease were studied. 87 % of them showed typical image of AD on SPECT scan and half of them showed an image of mixed type dementia. In 13 patients with MCI was found heterogeneous blood perfusion corresponding with miscellaneous population of patients with MCI.
In 25 right-handed patients with the SPECT pattern suggestive of AD or MIX, temporoparietal or temporal hypoperfusion was detected in the first examination of these patients on the left in 60 %, on the right in 8 % and bilaterally in 32 % of AD patients. The reliability of the radionuclide (RN) method was assessed by determining the inter (89%) and intrapersonal (87%) agreement of the conclusions of the brain perfusion examination using the SPECT technique.
Conclusion: In addition to supporting of the AD diagnosis, brain SPECT perfusion provides additional information about a possible combination with vascular mechanisms. Heterogeneous patterns correspond to a mixed population of individuals with MCI.