title: Tc99m-sestamibi thigh SPECT/CT images for noninvasive assessment of skeletal muscle injury in carbon monoxide intoxication with clinical and pathological correlation.
abstract: OBJECTIVE
  Muscle weakness has been repeatedly reported in patients with carbon monoxide (CO) intoxication. In animal models, CO intoxication has been linked with mitochondrial electron transport dysfunction. The objectives of the present study were to use Tc-99m sestamibi thigh single-photon emission computed tomography/computed tomography (SPECT/CT) to evaluate the mitochondrial status in patients with CO intoxication, correlate this with clinical parameters, and compare with age-matched controls.
  
  
  METHODS
  A total of 25 patients with delayed sequelae after CO intoxication (range: 1-60 months) and 17 sex- and age-matched healthy volunteers underwent Tc-99m sestamibi thigh SPECT/CT. Cognitive evaluation and muscle power according to medical research council (MRC) grading were collected. Both visual scoring from planar images and automatic volumetric analysis were used to rate the Tc-99m sestamibi uptake level.
  
  
  RESULTS
  The visual scores showed that 14 patients (56.0%) were scored as moderate-to-severe decrement. Volumetric analysis showed that a significant Tc99m-sestamibi uptake decrement was found in the CO intoxication group as compared with the controls, and 16 patients (64.0%) had uptakes below 1 standard deviation of the control group. In the CO group, the muscle power but not the cognitive evaluation correlated with Tc-99m sestamibi uptake in muscles. The decrement of muscle Tc99m-sestamibi uptake was related to mitochondria swelling, increased mitochondrial numbers, and type II muscle atrophy in 1 patient.
  
  
  CONCLUSIONS
  In this study, we demonstrated that patients with CO intoxication sustained defective mitochondrial metabolism in skeletal muscles as revealed by a decrement in Tc-99m sestamibi uptake either by visual or semiquantification of thigh SPECT/CT. Tc-99m sestamibi scanning provided noninvasive measurement of mitochondrial injury in muscles after CO intoxication and the correlation with clinical parameters was good.
authors.affiliation: Department of Nuclear Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Shu-Hua
authors.initials: SH
authors.lastname: Huang
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Chen
authors.forename: Pei-Wen
authors.initials: PW
authors.lastname: Wang
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Lui
authors.forename: Min-Chien
authors.initials: MC
authors.lastname: Tu
authors.forename: Chen-Chang
authors.initials: CC
authors.lastname: Lee
authors.forename: Yung-Cheng
authors.initials: YC
authors.lastname: Huang
authors.forename: Bor-Tau
authors.initials: BT
authors.lastname: Hung
authors.forename: Ssu-Wei
authors.initials: SW
authors.lastname: Chen
authors.forename: Chiung-Chih
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D044963:Biopsy, Fine-Needle; D002249:Carbon Monoxide Poisoning / Q000000981:diagnostic imaging*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology*; D017256:Technetium Tc 99m Sestamibi; D013848:Thigh / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D017256:Technetium Tc 99m Sestamibi