title: Brain perfusion imaging with voxel-based analysis in secondary progressive multiple sclerosis patients with a moderate to severe stage of disease: a boon for the workforce.
abstract: BACKGROUND
  The present study was carried out to evaluate cerebral perfusion in multiple sclerosis (MS) patients with a moderate to severe stage of disease. Some patients underwent hyperbaric oxygen therapy (HBOT) and brain perfusion between before and after that was compared.
  
  
  METHODS
  We retrospectively reviewed 25 secondary progressive (SP)-MS patients from the hospital database. Neurological disability evaluated by Expanded Disability Status Scale Score (EDSS). Brain perfusion was performed by (99 m) Tc-labeled bicisate (ECD) brain SPECT and the data were compared using statistical parametric mapping (SPM). In total, 16 patients underwent HBOT. Before HBOT and at the end of 20 sessions of oxygen treatment, 99mTc-ECD brain perfusion single photon emission computed tomography (SPECT) was performed again then the results were evaluated and compared. Brain perfusion was performed by (99 m) Tc-labeled bicisate (ECD) brain SPECT and the data were compared using statistical parametric mapping (SPM).
  
  
  RESULTS
  A total of 25 SP-MS patients, 14 females (56 %) and 11 males (44 %) with a mean age of 38.92 ± 11.28 years included in the study. The mean disease duration was 8.70 ± 5.30 years. Of the 25 patients, 2 (8 %) had a normal SPECT and 23 (92 %) had abnormal brain perfusion SPECT studies. The study showed a significant association between severity of perfusion impairment with disease duration and also with EDSS (P <0.05). There was a significant improvement in pre- and post-treatment perfusion scans (P <0.05), but this did not demonstrate a significant improvement in the clinical subjective and objective evaluation of patients (P >0.05).
  
  
  CONCLUSIONS
  This study depicted decreased cerebral perfusion in SP-MS patients with a moderate to severe disability score and its association with clinical parameters. Because of its accessibility, rather low price, practical ease, and being objective quantitative information, brain perfusion SPECT can be complementing to other diagnostic modalities such as MRI and clinical examinations in disease surveillance and monitoring. The literature on this important issue is extremely scarce, and follow up studies are required to assess these preliminary results.
authors.affiliation: Department of Nuclear Medicine, Kasra Hospital, Tehran, Iran.
authors.forename: Mina
authors.initials: M
authors.lastname: Taghizadeh Asl
authors.affiliation: Division of Neuroscience, The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran.|Department of Neurology, Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Nemati
authors.affiliation: Division of Biomedical Engineering (BME), The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran.
authors.forename: Negar
authors.initials: N
authors.lastname: Chabi
authors.affiliation: Department of Neurology, Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran.
authors.forename: Hooman
authors.initials: H
authors.lastname: Salimipour
authors.affiliation: The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, 3631, Iran.
authors.forename: Iraj
authors.initials: I
authors.lastname: Nabipour
authors.affiliation: Division of Neuroscience, The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran. assadipoya@yahoo.com.|Division of Biomedical Engineering (BME), The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran. assadipoya@yahoo.com.|Department of Molecular Imaging and Radionuclide Therapy (MIRT), Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran. assadipoya@yahoo.com.
authors.forename: Majid
authors.initials: M
authors.lastname: Assadi
mesh_terms: D000328:Adult; D003545:Cysteine / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000000981:diagnostic imaging*; D059906:Neuroimaging / Q000379:methods*; D015609:Organotechnetium Compounds; D055420:Perfusion Imaging / Q000379:methods*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine
keywords: 99mTc-ECD brain perfusion SPECT; Hyperbaric oxygen therapy (HBOT); Multiple sclerosis (MS)