A dopamina (DA) é um neurotransmissor sintetizado nos neurônios dopaminérgicos da substância nigra, possuindo efeito importante sobre o Sistema Nervoso Central (SNC), dentre as quais a sensação de prazer e a motivação. Uma alteração nos transportadores de dopamina (DATs) se caracteriza por uma desordem progressiva do movimento devido à disfunção dos neurônios secretores de dopamina, gerando a Doença de Parkinson (DP). Por ser um distúrbio mais comum entre um espectro de doenças neurológicas, é necessário um estudo mais aprofundado para melhor diagnóstico. Esta dissertação apresenta um estudo do desempenho do filtro butterworth passa-baixa na reconstrução analítica Filtered Backprojection - FBP e reconstrução iterativa Ordered Subsets Expectation Maximization - OSEM, para garantir a qualidade da imagem de SPECT cerebral, adquirida pelo fantoma antropomórfico estriatal. Por avaliação interindividual de quatro especialistas em medicina nuclear, foram aplicadas notas para a análise visual das imagens, garantindo a qualidade da resolução espacial, contraste, ruído e diferenciação anatômica do corpo estriado. Para cada tipo de reconstrução, houve 49 imagens do corpo estriado, variando os valores das covariáveis apresentadas pelos algoritmos (iteração, subsets, ordem e frequência de corte). A fim de resultados consistentes, foram utilizados a regressão linear e o teste T-Student pareado. Os dados coletados demonstraram que é necessário utilizar um intervalo confiável de frequência de corte para FBP (0,9 a 1,6) e para OSEM (1,2 a 1,5) e variar a ordem de 0 a 10 que não influenciará a imagem. Para a reconstrução OSEM, ficou comprovado que o valor de iteração (i) e o número de subsets (s) que garantem melhor qualidade foram os mesmos que a empresa do algoritmo utilizado sugeriu (3i 8s). Esta, também, mostrou evidências de melhor qualidade da imagem, quando comparada à reconstrução FBP. Para uma imagem de qualidade, representando uma reconstrução confiável e uma análise visual segura, é necessário utilizar o intervalo de valores encontrados das covariáveis ordem e frequência de corte do filtro butterworth passa-baixa na reconstrução FBP e OSEM. Também é necessário utilizar o valor de iteração e subsets que a empresa sugeriu, e a reconstrução OSEM mostrou superioridade nas imagens comparadas à FBP, mas se o serviço não utilizar ainda este tipo de algoritmo, a imagem com FBP no intervalo proposto também garantirá a qualidade. / Dopamine is a synthesized neurotransmitter in dopaminergic neurons of the substantia nigra where it has an important effect on the central nervous system (CNS), such as the feeling of pleasure and motivation. A change in the dopamine transporters (DATs) is characterized by a progressive disorder of movement due to a dysfunction of the dopamine secreting neurons, causing Parkinson\'s Disease (PD). As it is a more common disorder among a spectrum of neurological diseases, further studies are necessary for a better diagnosis. This study presents an investigation on the performance of the low-pass butterworth filter in the Filtered Backprojection analytic reconstruction - FBP and Ordered Subsets Expectation Maximization iterative reconstruction - OSEM to ensure the quality of brain SPECT image, acquired by the anthropomorphic striatal phantom. By individual evaluation of four nuclear medicine specialists, grades were applied to the visual analysis of the images, ensuring the quality of the spatial resolution, contrast, noise and anatomical differentiation striatum. For each type of reconstruction, there were 49 pictures of the striatum, varying the values of covariates submitted by the algorithms (iteration, subsets, order and cutoff frequency). In order to obtain consistent results, we used linear regression and T-Student paired test. The collected data showed that it is necessary to use a reliable interval of cutoff frequency for both the FBP (0.9 to 1.6), and OSEM (1.2 to 1.5), and varying the order of 0 to 10, which does not influence the image. For OSEM reconstruction, it has been verified that the iteration value (i) and the number of subsets (s) ensuring best quality was the same as the company\'s algorithm suggested (3i 8s). This also showed evidence of better image quality when compared to FBP reconstruction. For an image quality, representing a reliable reconstruction and a safe visual analysis, you must use the range of values found of covariates order and cutoff frequency of the butterworth low-pass filter on the FBP and OSEM reconstruction. You must also use the iteration value and subsets that the company suggested and the OSEM reconstruction showed superiority on the images compared to FBP, but if the service does not use this type of algorithm, the image with FBP in the proposed range, also ensures quality.

Στην παρούσα εργασία μελετήθηκαν 15 ασθενείς με νόσο Parkinson (8 γυναίκες, 7 άνδρες, μέσος όρος ηλικίας τα 62χρόνια, μέση διάρκεια της νόσου από τη διάγνωση τα 11 χρόνια), σε διάφορα στάδια της νόσου (τέσσερις ασθενείς σταδίου 2, δύο ασθενείς σταδίου 2.5, 2 ασθενείς σταδίου 3, πέντε ασθενείς σταδίου 4, ένας σταδίου 4.5 και ένας ασθενής σταδίου 5 κατά Hoehn & Yahr ). Και στους 15 ασθενείς πραγματοποιήθηκε διπλός απεικονιστικός έλεγχος με τομογραφία εκπομπής μονήρους φωτονίου (SPECT). Στην πρώτη SPECT απεικόνιση μελετούμε τον βαθμό της ακεραιότητας της μελανοραβδωτής οδού, με τη χρήση ειδικού ραδιοφαρμάκου που προσδένεται εκλεκτικά στον μεταφορέα της ντοπαμίνης (DA Transporter – DAT). Στη δεύτερη SPECT απεικόνιση μελετούμε την αιματική εγκεφαλική ροή των ασθενών σε συνθήκες ηρεμίας, η οποία αντικατοπτρίζει και το βαθμό μεταβολικής ενεργότητας της κάθε περιοχής του εγκεφάλου. Για την αντικειμενική εκτίμηση της μελέτης αιμάτωσης πραγματοποιήθηκε στατιστική παραμετρική σύγκριση με βάση δεδομένων φυσιολογικών ατόμων της ίδιας ηλικίας. Σκοπός μας ήταν να δούμε ποιες περιοχές του εγκεφάλου υποαιματώνονται και συνεπώς επηρεάζονται, στη νόσο του Parkinson. Πράγματι είδαμε ότι η διαταραχή που προκαλείται στο κύκλωμα των βασικών γαγγλίων από την έλλειψη της ντοπαμίνης (DA), προκαλεί διαταραχές στη φλοιοραβδωτή οδό κάτι που αντικατοπτρίζεται στην υποαμάτωση κυρίως του μετωπιαίου λοβού και ειδικότερα της προκινητικής και συμπληρωματικής περιοχής και των συνειρμικών περιοχών του μετωπιαίου λοβού. Επίσης στα πιο προχωρημένα στάδια της νόσου, παρατηρήθηκε στατιστικά σημαντική υποαιμάτωση και σε περιοχές του βρεγματικού και κροταφικού λοβού. Τα ευρήματα αυτά είναι πολύ σημαντικά και μας βοηθούν να κατανοήσουμε καλύτερα τα κινητικά και μη-κινητικά συμπτώματα (διαταραχές της νόησης) στη συγκεκριμένη νόσο. / In the present study we examined 15 Parkinson disease patients (8 females, 7 males, mean age = 62years, mean duration of the disease from diagnosis = 11years) in various stages (according to Hoehn & Yahr staging system) of the disease (stage2: 4 pts, stage2.5: 2 pts, stage3: 2pts, stage 4: 5pts, stage 4.5:1pt, stage 5: 1 pt). Each patient underwent two different SPECT studies. First was performed a SPECT study with the radiopharmaceutical DaTSCAN, that is specifically bind to the Dopamine Transporter (DAT), a protein on the presynaptic dopaminergic nerve terminal. In that way we can image and also quantify the degeneration of the nigrostriatal pathway, that is afflicted in PD. Secondly we performed a brain perfusion SPECT study with the radiopharmaceutical ECD, in order to find out if there were regions of hypoperfusion in the cerebral cortex of the patients. We used an objective and dependable statistical program that enables the comparison of each perfusion study with an age-matched data base o normal perfusions. We found in all 15 patients statistically significant differences in areas of Frontal lobes and especially in the PRE-SMA (pre-motor and supplementary motor cortex) and association areas of frontal cortex. In progressive stages of the disease there were also other areas of the cerebral cortex hypoperfused (parietal and temporal lobes). These findings seem to be very useful for better understanding motor and non-motor (cognitive and affective) symptoms in PD.

Corticobasal Syndrome (CBS) is a rare movement and cognitive disorder. There is significant heterogeneity observed in it clinical presentation, neuroimaging, pathology and genetics. Understanding this heterogeneity is a priority and may help to shed light on underlying pathogenic mechanisms. We first demonstrated that truncating mutations in the progranulin gene (PGRN) can cause familial CBS associated with frontotemporal lobar degeneration (FTLD)-ubiquitin pathology. This study identified a mutation in PGRN (Intervening Sequence 7+1 guanine > adenine [IVS7+1G>A]) that segregated with CBS in a family. The mutation was predicted to result in a shortened messenger RNA (mRNA) sequence and the absence of the mutant PGRN allele was confirmed in the reverse transcriptase-polymerase chain reaction (RT-PCR) product, which supported the model of haploinsufficiency for PGRN-linked disease. In a second familial study, clinical, radiological, genetic, and pathological studies were performed to contrast clinical features of the affected members. Sequencing PGRN revealed a novel, heterozygous cytosine-adenine dinucleotide deletion in exon 11 (g.2988_2989delCA, P439_R440fsX6). The proband`s clinical diagnosis was frontotemporal dementia and parkinsonism (FTDP). The proband’s brother with the same mutation presented initially as a progressive non-fluent aphasia (PNFA), and later evolved into a CBS. Pathological analysis revealed Frontotemporal Lobar Degeneration-Ubiquitin (FTLD-U)/ TAR DNA-binding protein 43 (TDP43) positive pathology. The next studies shift away from pathogenic mechanisms to focus on brain-behavioural correlations and phenotypic heterogeneity in a prospective sample of 31 CBS cases. We provide the first direct correlative analysis between the severity of ideomotor apraxia, a common sign in CBS, and cerebral SPECT perfusion imaging. Reductions in perfusion within the left inferior parietal lobule (t=5.7, p=0.03, Family-Wise Error [FWE] corrected), including the left angular gyrus (t=5.7, p=0.02, FWE corrected), were associated with more severe ideomotor apraxia. We stratified the sample into CBS presenting with early motor features (CBS-M; n=9) or early dementia (CBS-D; n=22), which identified that CBS-M were more likely to have cortical sensory loss than CBS-D (p=0.005). In contrast, the presence of aphasia was found to be more common and severe in CBS-D compared to CBS-M (p=0.02). CBS-M patients had significantly reduced perfusion in the right supplementary and premotor areas compared to CBS-D (p<0.05).

Corticobasal Syndrome (CBS) is a rare movement and cognitive disorder. There is significant heterogeneity observed in it clinical presentation, neuroimaging, pathology and genetics. Understanding this heterogeneity is a priority and may help to shed light on underlying pathogenic mechanisms. We first demonstrated that truncating mutations in the progranulin gene (PGRN) can cause familial CBS associated with frontotemporal lobar degeneration (FTLD)-ubiquitin pathology. This study identified a mutation in PGRN (Intervening Sequence 7+1 guanine > adenine [IVS7+1G>A]) that segregated with CBS in a family. The mutation was predicted to result in a shortened messenger RNA (mRNA) sequence and the absence of the mutant PGRN allele was confirmed in the reverse transcriptase-polymerase chain reaction (RT-PCR) product, which supported the model of haploinsufficiency for PGRN-linked disease. In a second familial study, clinical, radiological, genetic, and pathological studies were performed to contrast clinical features of the affected members. Sequencing PGRN revealed a novel, heterozygous cytosine-adenine dinucleotide deletion in exon 11 (g.2988_2989delCA, P439_R440fsX6). The proband`s clinical diagnosis was frontotemporal dementia and parkinsonism (FTDP). The proband’s brother with the same mutation presented initially as a progressive non-fluent aphasia (PNFA), and later evolved into a CBS. Pathological analysis revealed Frontotemporal Lobar Degeneration-Ubiquitin (FTLD-U)/ TAR DNA-binding protein 43 (TDP43) positive pathology. The next studies shift away from pathogenic mechanisms to focus on brain-behavioural correlations and phenotypic heterogeneity in a prospective sample of 31 CBS cases. We provide the first direct correlative analysis between the severity of ideomotor apraxia, a common sign in CBS, and cerebral SPECT perfusion imaging. Reductions in perfusion within the left inferior parietal lobule (t=5.7, p=0.03, Family-Wise Error [FWE] corrected), including the left angular gyrus (t=5.7, p=0.02, FWE corrected), were associated with more severe ideomotor apraxia. We stratified the sample into CBS presenting with early motor features (CBS-M; n=9) or early dementia (CBS-D; n=22), which identified that CBS-M were more likely to have cortical sensory loss than CBS-D (p=0.005). In contrast, the presence of aphasia was found to be more common and severe in CBS-D compared to CBS-M (p=0.02). CBS-M patients had significantly reduced perfusion in the right supplementary and premotor areas compared to CBS-D (p<0.05).

A dopamina (DA) é um neurotransmissor sintetizado nos neurônios dopaminérgicos da substância nigra, possuindo efeito importante sobre o Sistema Nervoso Central (SNC), dentre as quais a sensação de prazer e a motivação. Uma alteração nos transportadores de dopamina (DATs) se caracteriza por uma desordem progressiva do movimento devido à disfunção dos neurônios secretores de dopamina, gerando a Doença de Parkinson (DP). Por ser um distúrbio mais comum entre um espectro de doenças neurológicas, é necessário um estudo mais aprofundado para melhor diagnóstico. Esta dissertação apresenta um estudo do desempenho do filtro butterworth passa-baixa na reconstrução analítica Filtered Backprojection - FBP e reconstrução iterativa Ordered Subsets Expectation Maximization - OSEM, para garantir a qualidade da imagem de SPECT cerebral, adquirida pelo fantoma antropomórfico estriatal. Por avaliação interindividual de quatro especialistas em medicina nuclear, foram aplicadas notas para a análise visual das imagens, garantindo a qualidade da resolução espacial, contraste, ruído e diferenciação anatômica do corpo estriado. Para cada tipo de reconstrução, houve 49 imagens do corpo estriado, variando os valores das covariáveis apresentadas pelos algoritmos (iteração, subsets, ordem e frequência de corte). A fim de resultados consistentes, foram utilizados a regressão linear e o teste T-Student pareado. Os dados coletados demonstraram que é necessário utilizar um intervalo confiável de frequência de corte para FBP (0,9 a 1,6) e para OSEM (1,2 a 1,5) e variar a ordem de 0 a 10 que não influenciará a imagem. Para a reconstrução OSEM, ficou comprovado que o valor de iteração (i) e o número de subsets (s) que garantem melhor qualidade foram os mesmos que a empresa do algoritmo utilizado sugeriu (3i 8s). Esta, também, mostrou evidências de melhor qualidade da imagem, quando comparada à reconstrução FBP. Para uma imagem de qualidade, representando uma reconstrução confiável e uma análise visual segura, é necessário utilizar o intervalo de valores encontrados das covariáveis ordem e frequência de corte do filtro butterworth passa-baixa na reconstrução FBP e OSEM. Também é necessário utilizar o valor de iteração e subsets que a empresa sugeriu, e a reconstrução OSEM mostrou superioridade nas imagens comparadas à FBP, mas se o serviço não utilizar ainda este tipo de algoritmo, a imagem com FBP no intervalo proposto também garantirá a qualidade. / Dopamine is a synthesized neurotransmitter in dopaminergic neurons of the substantia nigra where it has an important effect on the central nervous system (CNS), such as the feeling of pleasure and motivation. A change in the dopamine transporters (DATs) is characterized by a progressive disorder of movement due to a dysfunction of the dopamine secreting neurons, causing Parkinson\'s Disease (PD). As it is a more common disorder among a spectrum of neurological diseases, further studies are necessary for a better diagnosis. This study presents an investigation on the performance of the low-pass butterworth filter in the Filtered Backprojection analytic reconstruction - FBP and Ordered Subsets Expectation Maximization iterative reconstruction - OSEM to ensure the quality of brain SPECT image, acquired by the anthropomorphic striatal phantom. By individual evaluation of four nuclear medicine specialists, grades were applied to the visual analysis of the images, ensuring the quality of the spatial resolution, contrast, noise and anatomical differentiation striatum. For each type of reconstruction, there were 49 pictures of the striatum, varying the values of covariates submitted by the algorithms (iteration, subsets, order and cutoff frequency). In order to obtain consistent results, we used linear regression and T-Student paired test. The collected data showed that it is necessary to use a reliable interval of cutoff frequency for both the FBP (0.9 to 1.6), and OSEM (1.2 to 1.5), and varying the order of 0 to 10, which does not influence the image. For OSEM reconstruction, it has been verified that the iteration value (i) and the number of subsets (s) ensuring best quality was the same as the company\'s algorithm suggested (3i 8s). This also showed evidence of better image quality when compared to FBP reconstruction. For an image quality, representing a reliable reconstruction and a safe visual analysis, you must use the range of values found of covariates order and cutoff frequency of the butterworth low-pass filter on the FBP and OSEM reconstruction. You must also use the iteration value and subsets that the company suggested and the OSEM reconstruction showed superiority on the images compared to FBP, but if the service does not use this type of algorithm, the image with FBP in the proposed range, also ensures quality.

Introduction: Internal Carotid Stump Syndrome may be one of the possible causes of ischemic stroke (iCMP), as well as retinal infarction (RI). Syndrome of the occluded internal carotid (ACI) (stump syndrome) is a nosological unit, which is characterized by an onset of ipsilateral iCMP or RI of thromboembolic ethiology in patients with occlusion of ACI via the externa carotid or arteria ophthalmica. In my thesis, I have concentrated upon the specification of the stump syndrome, its diagnostics and treatment; furthermore I have assessed the appropriateness of surgical approach in comparison with conservative approach. Material and methods: A total of 621 patients with occlusion were treated in two centres in the course of five years. In a group of 40 patients, the ACI occlusion was detected sonographically, the length of the occluded ACI being >5 mm, with normal vasoreactivity based upon SPECT CO2 and excluded cardiogenic cause of iCMP. The patients were divided in two groups - surgical and conservative. Patients were monitored in 6-month intervals for the total period of four years. Results: No RI or iCMP were detected in the surgical group; one patient died six months after surgery. We observed one case of amaurosis fugax in the conservative group. Conclusion: Ultrasound examination is a fully sufficient...

Introduction: Internal Carotid Stump Syndrome may be one of the possible causes of ischemic stroke (iCMP), as well as retinal infarction (RI). Syndrome of the occluded internal carotid (ACI) (stump syndrome) is a nosological unit, which is characterized by an onset of ipsilateral iCMP or RI of thromboembolic ethiology in patients with occlusion of ACI via the externa carotid or arteria ophthalmica. In my thesis, I have concentrated upon the specification of the stump syndrome, its diagnostics and treatment; furthermore I have assessed the appropriateness of surgical approach in comparison with conservative approach. Material and methods: A total of 621 patients with occlusion were treated in two centres in the course of five years. In a group of 40 patients, the ACI occlusion was detected sonographically, the length of the occluded ACI being >5 mm, with normal vasoreactivity based upon SPECT CO2 and excluded cardiogenic cause of iCMP. The patients were divided in two groups - surgical and conservative. Patients were monitored in 6-month intervals for the total period of four years. Results: No RI or iCMP were detected in the surgical group; one patient died six months after surgery. We observed one case of amaurosis fugax in the conservative group. Conclusion: Ultrasound examination is a fully sufficient...