title: Brain MRI and SPECT in the diagnosis of early neurological involvement in Wilson's disease.
abstract: OBJECTIVE
  To evaluate the impact of brain MRI and single-photon emission computed tomography (SPECT) in early detection of central nervous system abnormalities in patients affected by Wilson's disease (WD) with or without neurological involvement.
  
  
  METHODS
  Out of 25 consecutive WD patients, 13 showed hepatic involvement, ten hepatic and neurological manifestations, and twp hepatic, neurological, and psychiatric symptoms, including mainly movement disorders, major depression, and psychosis. Twenty-four healthy, age-gender matched subjects served as controls. All patients underwent brain MRI and (99m)Tc-ethyl-cysteinate dimer (ECD) SPECT before starting specific therapy. Voxel-by-voxel analyses were performed using statistical parametric mapping to compare differences in (99m)Tc-ECD brain uptake between the two groups.
  
  
  RESULTS
  Brain MRI showed T2-weighted hyperintensities in seven patients (28%), six of whom were affected by hepatic and neurological forms. Brain perfusion SPECT showed pathological data in 19 patients (76%), revealing diffuse or focal hypoperfusion in superior frontal (Brodmann area (BA) 6), prefrontal (BA 9), parietal (BA 40), and occipital (BA 18, BA 39) cortices in temporal gyri (BA 37, BA 21) and in caudatus and putamen. Moreover, hepatic involvement was detected in nine subjects; eight presented both hepatic and neurological signs, while two exhibited WD-correlated hepatic, neurological, and psychiatric alterations. All but one patient with abnormal MRI matched with abnormal ECD SPECT. Pathologic MRI findings were obtained in six out of ten patients with hepatic and neurological involvement while abnormal ECD SPECT was revealed in eight patients. Both patients with hepatic, neurological, and psychiatric involvement displayed abnormal ECD SPECT and one displayed an altered MRI.
  
  
  CONCLUSIONS
  These findings suggest that ECD SPECT might be useful in detecting early brain damage in WD, not only in the perspective of assessing and treating motor impairment but also in evaluating better the less investigated disorders in the cognitive domain.
authors.affiliation: Nuclear Medicine, Department of Medical Science, Policlinico Universitario, University of Cagliari, Cagliari, Italy. pigam@pacs.unica.it
authors.forename: Mario
authors.initials: M
authors.lastname: Piga
authors.forename: Alessandra
authors.initials: A
authors.lastname: Murru
authors.forename: Loredana
authors.initials: L
authors.lastname: Satta
authors.forename: Alessandra
authors.initials: A
authors.lastname: Serra
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sias
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Loi
authors.forename: Francesco
authors.initials: F
authors.lastname: Marrosu
authors.forename: Luigi
authors.initials: L
authors.lastname: Demelia
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology*; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D001931:Brain Mapping / Q000379:methods; D005260:Female; D006527:Hepatolenticular Degeneration / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*