Abstract
Lesions in acute herpes simplex encephalitis (HSE) have been reported to show decreased uptake of Tc-99m ethyl cysteinate dimer (ECD). A patient with acute HSE displaying a lesion in the left temporal lobe was evaluated by means of Tc-99m ECD single-photon emission computed tomography (SPECT). Dynamic SPECT images indicated regionally increased uptake of tracer in the ipsilateral temporal lobe in early phases, followed by slight washout of Tc-99m ECD from the lesion. Static SPECT images revealed increased tracer uptake in the same region. MRI later demonstrated that the HSE lesion involved the whole cortex of the temporal lobe on the affected side. These findings suggest that acute HSE lesions do not always exhibit hypoactivity on static Tc-99m ECD SPECT, and that dynamic Tc-99m ECD SPECT may help physicians diagnose acute HSE.
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Lester JW Jr, Carter MP, Reynolds TL. Herpes encephalitis: MR monitoring of response to acyclovir therapy. J. Comput Assist Tomogr 1988; 12: 941–943.
Whitley RJ, Alford CA, Hirsch MS, Schooley RT, Luby JP, Aoki FY, et al. Vidarabine versus acyclovir therapy in herpes simplex encephalitis. N Engl J Med 1986; 314: 144–149.
Launes J, Nikkinen P, Lindroth L, Brownell AL, Liewendahl K, Iivanainen M. Diagnosis of acute herpes simplex encephalitis by brain perfusion single photon emission computed tomography. Lancet 1988; 2: 1188–1191.
Schmidbauer M, Podreka I, Wimberger D, Oder W, Koch G, Wenger S, et al. SPECT and MR imaging in herpes simplex encephalitis. J Comput Assist Tomogr 1991; 15: 811–815.
McEwan JR, Park CH, Kim SM, Zhang JJ, Intenzo CM. Technetium-99m exametazime brain SPECT and magnetic resonance images in the diagnosis of herpes simplex encephalitis. Clin Nucl Med 1994; 19: 66–68.
Kao CH, Wang SJ, Mak SC, Shian WJ, Chi CS. Viral encephalitis in children: detection with technetium-99m HMPAO brain single-photon emission CT and its value in prediction of outcome. Am J Neuroradiol 1994; 15: 1369–1373.
Fazekas F, Roob G, Payer F, Kapeller P, Strasser-Fuchs S, Aigner RM. Technetium-99m-ECD SPECT fails to show focal hyperemia of acute herpes encephalitis. J Nucl Med 1998; 39: 790–792.
Tohyama Y, Sako K, Daita G, Yonemasu Y, Shuke N, Aburano T. Dissociation of 99mTc-ECD and 99mTc-HMPAO distributions in herpes simplex encephalitis. Childs Nerv Syst 1997; 13: 352–355.
Rieck H, Adelwohrer C, Lungenschmid K, Deisenhammer E. Discordance of technetium-99m-HMPAO and technetium-99m-ECD SPECT in herpes simplex encephalitis. J Nucl Med 1998; 39: 1508–1510.
Thajeb P, Shih BF, Wu MC. Crossed cerebellar diaschisis in herpes simplex encephalitis. Eur J Radiol 2001; 38: 55–58.
Walovitch RC, Cheesman EH, Maheu LJ, Hall KM. Studies of the retention mechanism of the brain perfusion imaging agent 99mTc-bicisate (99mTc-ECD). J Cereb Blood Flow Metab 1994; 14 (Suppl 1): S4-S11.
Ogasawara K, Ogawa A, Ezura M, Konno H, Doi M, Kuroda K, et al. Dynamic and static 99mTc-ECD SPECT imaging of subacute cerebral infarction: comparison with 133Xe SPECT. J Nucl Med 2001; 42: 543–547.
Ogasawara K, Ogawa A, Doi M, Konno H, Suzuki M, Yoshimoto T. Prediction of acute embolic stroke outcome after local intraarterial thrombolysis: value of pretreatment and posttreatment 99mTc-ethyl cysteinate dimer single photon emission computed tomography. J Cereb Blood Flow Metab 2000; 20: 1579–1586.
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Ogasawara, K., Yasuda, S., Yukawa, H. et al. Atypical finding of brain Tc-99m-ECD SPECT imaging in herpes simplex encephalitis. Ann Nucl Med 16, 347–350 (2002). https://doi.org/10.1007/BF02988619
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DOI: https://doi.org/10.1007/BF02988619