Regional Cerebral Blood Flow Analysis in Patients with Multiple Sclerosis Using TC-99M Hmpao and a Three - Spect System.

The purpose of the present study was to determine the changes in regional cerebral blood flow (rCBF) with a cognitive task of semantic word retrieval (verbal fluency) in patients with multiple sclerosis (MS) and compare with the rCBF distribution of normal controls. Two groups of patients with low and high verbal fluency scores and two groups of normal controls were selected to determine a relationship between rCBF and verbal performance. A three-detector gamma camera (TRIAD 88) was used with radiotracer Tc-99m HMPAO and single photon emission computed tomography (SPECT) to obtain 3D rCBF maps. The performance characteristics of the camera was comprehensively studied before being utilized for clinical studies. In addition, technical improvements were implemented in the form of scatter correction and MRI-SPECT coregistration to potentially enhance the quantitative accuracy of the rCBF data. The performance analysis of the gamma camera showed remarkable consistency among the three-detector heads and yielded results that were consistent with the manufacturer's specification. Measurements of physical objects also showed excellent image quality. The coregistration of SPECT and MRI images allowed more accurate anatomical localization for extraction of regional blood flow information. The validation of the scatter correction technique with physical phantoms indicated marked improvements in quantitative accuracy. There was marked difference in activation patterns between patients and normals. In normals, individually subjects showed either an increase or a decrease in blood flow to left frontal and temporal, however, on average, there was not a statistically significant change. The lack of significant change may suggest large variability among subjects chosen or that the individual changes are not large enough to be significant. The results from MS patients showed several left cortical areas with statistically significant change in blood flow after cognitive activation, especially in the low fluent group, with decreased flow. Scatter corrected data yielded mostly right sided significant increases in blood flow. Further studies must be conducted to further evaluate the scatter correction technique. Additional studies on MS patients must focus on correlating lesion volume, location and number to the rCBF distribution.