Tc-99m HMPAO Brain Perfusion SPECT in Acute Aphasia Correlation With Clinical and Structural Findings

Prospective and retrospective language evaluations and single photon emission computed tomography (SPECT) scans were performed in order to study the relationship between post-stroke recovery from aphasia and changes in cerebral blood flow (CBF) in groups of patients who had made a good recovery and those who had not. For the prospective study, 20 right-handed patients with aphasia secondary to an acute cerebrovascular accident (CVA) in the left middle cerebral artery territory received language evaluations with a Japanese Standard Language Test of Aphasia (SLTA), and SPECT scans performed twice, at a mean of 3.2 and a mean of 9.2 months post-onset. Only one slice of SPECT data was analysed. A significant correlation was observed between the severity of the initial language deficit and initial CBF on the left side, but not the right. Initial CBF was not a predictor for future language recovery in either hemisphere. There was a correlation between the change in the left mean hemispheric CBF (but not the right) and the change in the overall SLTA severity rating from 3 to 9 months post-stroke. In the retrospective study, 16 right-handed patients with residual aphasia secondary to CVA in the left middle cerebral artery territory received SLTA and SPECT at a mean of 82.8 months post-onset. The patients had also received initial language evaluation with SLTA at a mean of 6.5 months post-onset. In contrast to the prospective study, the results demonstrated that the mean left hemispheric CBF at approximately 7 years post-onset did not differ between good and poor recovery groups. However, the mean right hemispheric CBF of the good recovery group was higher than that of the poor recovery group in the frontal and the thalamic regions, and also in the left frontal region. The results of these complementary studies suggest that the initial language recovery within the first year post-onset may be linked primarily to functional recovery in the dominant hemisphere, where an increase in CBF was observed at 9 months post-onset. The increased perfusion adjacent to the lesion may be crucial for early recovery in aphasia. Subsequent language recovery and the long-term recovery in aphasia may be related to slow and gradual compensatory functions in the contralateral hemisphere, specifically in the homotopic frontal and thalamic areas.

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Prospective and retrospective studies of recovery in aphasia. Changes in cerebral blood flow and language functions

Mimura

Kato

Sano

et al. 1998

Brain

122

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The Value of 99mTc ECD SPECT With Statistical Image Analysis on Enhancing the Early Diagnosis of Primary Progressive Aphasia

Wei

Chiu

Hou

et al. 2017

Clinical Nuclear Medicine

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A 64-year-old woman with poor short-term memory was first suspected as early Alzheimer disease. Tc ECD brain SPECT was arranged for differential diagnosis. A small area of mild hypoperfusion was noted in the left temporal lobe on conventional display. Further statistical analysis of SPECT with an easy Z-score imaging system showed large areas of distinct hypoperfusion in left precentral and perisylvian cortical areas, compatible with typical pictures of nonfluent variant primary progressive aphasia (PPA), but no involvement in areas characteristic for Alzheimer disease. Further detailed neuropsychological examination and 6 months of clinical follow-up confirmed the final diagnosis of PPA.

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Brain SPECT imaging in transcortical aphasias: the functional status of the left perisylvian language cortex*

Berthier¹,

Posada

Puentes

et al. 1997

Euro J of Neurology

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Single photon emission computerized tomography (SPECT) with 99mTc-HMPAO was used to examine the functional status of the left perisylvian language cortex (PLC) in eight patients with transcortical aphasias (TAs) due to cerebrovascular accidents. According to the lesion location within the left hemisphere, the aphasic patients were divided into two groups: (a) patients with corticosubcortical lesions involving portions or the whole PLC (perisylvian group, n = 4); (b) patients with corticosubcortical lesions sparing the PLC (extraperisylvian group, n = 4). Results showed that, as expected, the perisylvian group had significant decrements in regional cerebral blood flow (rCBF) in structurally damaged regions of the left PLC, although some morphologically spared regions of the left PLC (Wernicke's area) also had perfusion defects in one patient. Among the extraperisylvian group, there was structural and functional damage to the posterior association areas, but two patients additionally had significant decrements of rCBF in morphologically spared regions of the PLC (Wernicke's area, sensorimotor cortex, Broca's area). These findings demonstrate not only that the left PLC may be structurally and functionally damaged among patients with TAs, but additionally suggest a major contribution of the right hemisphere in the mediation of residual language repetition.

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Tc-99m HMPAO Brain Perfusion SPECT in Acute Aphasia Correlation With Clinical and Structural Findings

Cited by 4 publications

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Prospective and retrospective studies of recovery in aphasia. Changes in cerebral blood flow and language functions

Prospective and retrospective studies of recovery in aphasia. Changes in cerebral blood flow and language functions

The Value of 99mTc ECD SPECT With Statistical Image Analysis on Enhancing the Early Diagnosis of Primary Progressive Aphasia

Brain SPECT imaging in transcortical aphasias: the functional status of the left perisylvian language cortex*

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