title: Isotopic Scintigraphy Coupled With Computed Tomography for the Investigation of Intrathecal Baclofen Device Malfunction.
abstract: OBJECTIVE
  To assess the potential use of indium-111 diethylenetriamine pentaacetic acid ((111)In-DTPA) scintigraphy coupled with computed tomography (CT) for the investigation of intrathecal baclofen (ITB) device malfunction.
  
  
  METHODS
  Retrospective study of a case series of patients.
  
  
  METHODS
  Neurosurgical and physical and rehabilitation medicine departments.
  
  
  METHODS
  Patients (N=7) with reduced ITB effectiveness in whom prior conventional radiographs were inconclusive.
  
  
  METHODS
  Nine (111)In-DTPA scintigraphic studies and 8 CT scans. Planar acquisitions were followed by tomoscintigraphy combined with CT.
  
  
  METHODS
  Progression of the radiotracer in the pump, catheters, and in the subarachnoid space.
  
  
  RESULTS
  In 7 cases, scintigraphy coupled with CT showed leakage behind the pump, lack of activity outside the pump reservoir, abrupt interruption of activity in the catheter, or abnormal distribution of the radiotracer, thus demonstrating that the drug did not reach its target. Surgical revision confirmed these findings in 5 cases. In 1 case, combined imagery ruled out device dysfunction. In the remaining case, only planar acquisitions were performed, showing correct diffusion of the radiotracer.
  
  
  CONCLUSIONS
  The combination of scintigraphy and CT provides simultaneous functional and anatomic imagery of the device. The slow infusion of the radioisotope mimics the diffusion of baclofen, and this could be a useful method to explore intrathecal device malfunction. Further studies are required to compare scintigraphy coupled with CT, to radiopaque injection followed by fluoroscopy or CT.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Angers, Angers, France. Electronic address: ffremondiere@les-capucins-angers.fr.
authors.forename: Flavie
authors.initials: F
authors.lastname: Frémondière
authors.affiliation: Department of Nuclear Medicine, University of Angers, Angers, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Lacoeuille
authors.affiliation: Department of Nuclear Medicine, University of Angers, Angers, France.
authors.forename: Avigaelle
authors.initials: A
authors.lastname: Sher
authors.affiliation: Department of Nuclear Medicine, University of Angers, Angers, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Couturier
authors.affiliation: Department of Neurosurgery, University of Angers, Angers, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Menei
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Angers, Angers, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Richard
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Angers, Angers, France.
authors.forename: Mickaël
authors.initials: M
authors.lastname: Dinomais
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001418:Baclofen / Q000008:administration & dosage; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology; D004369:Pentetic Acid / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D009125:Muscle Relaxants, Central; C109600:indium benzyldiethylenetriaminepentaacetic acid; D004369:Pentetic Acid; D001418:Baclofen
keywords: Baclofen; Cerebral palsy; Equipment failure; Indium; Infusion pumps, implantable; Multiple sclerosis; Muscle spasticity; Radionuclide imaging; Rehabilitation; Spinal cord injuries