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Early evaluation of cerebral metabolic rate of glucose (CMRglu) with 18F-FDG PET/CT and clinical assessment in idiopathic normal pressure hydrocephalus (INPH) patients before and after ventricular shunt placement: preliminary experience

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Abstract

Purpose

We evaluated the relationships between the cerebral metabolic rate of glucose (CMRglu) measured by dynamic 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the clinical and neuropsychological assessment before and after the surgical procedure in idiopathic normal pressure hydrocephalus (INPH) patients.

Methods

Eleven selected INPH patients underwent clinical assessment (modified Rankin scale, Krauss scale, Larsson categorization system and Stein-Langfitt scale), cognitive evaluation (Mini-Mental State Examination, MMSE) and dynamic 18F-FDG PET/CT scan 3 days before and 1 week after ventricular shunt placement.

Results

After shunting, the global CMRglu significantly increased (2.95 ± 0.44 vs 4.38 ± 0.68, p = 10−7) in all INPH patients with a mean percentage value of 48.7%. After shunting, no significant change was found in the Evans ratio whereas a significant decrease in all clinical scale scores was observed. Only a slight reduction in the MMSE was found. After shunting, a significant correlation between the global CMRglu value and clinical assessment was found (R 2 = 0.75, p = 0.024); indeed all clinical scale scores varied (decreasing) and the CMRglu value also varied (increasing) in all INPH patients.

Conclusion

Our preliminary data show that changes in the CMRglu are promptly reversible after surgery and that there is a relationship between the early metabolic changes and clinical symptoms, independently from the simultaneous changes in the ventricular size. The remarkable and prompt improvement in the global CMRglu and in symptoms may also have important implications for the current concept of “neuronal plasticity” and for the cells’ reactivity in order to recover their metabolic function.

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Authors and Affiliations

  1. Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Maria Lucia Calcagni, Mariadea Lavalle, Lucia Leccisotti & Alessandro Giordano

  2. Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Annunziato Mangiola, Pasquale De Bonis & Carmelo Anile

  3. Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy

    Camillo Marra

  4. Institute of Physics, Università Cattolica del Sacro Cuore, Rome, Italy

    Luca Indovina

  5. Istituto Nazionale per l’Assicurazione contro gli Infortuni sul Lavoro (INAIL), Rome, Italy

    Armando Pelliccioni

Authors
  1. Maria Lucia Calcagni
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  2. Mariadea Lavalle
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  3. Annunziato Mangiola
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  4. Luca Indovina
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  5. Lucia Leccisotti
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  6. Pasquale De Bonis
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  7. Camillo Marra
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  8. Armando Pelliccioni
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  9. Carmelo Anile
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  10. Alessandro Giordano
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Correspondence to Maria Lucia Calcagni.

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Calcagni, M.L., Lavalle, M., Mangiola, A. et al. Early evaluation of cerebral metabolic rate of glucose (CMRglu) with 18F-FDG PET/CT and clinical assessment in idiopathic normal pressure hydrocephalus (INPH) patients before and after ventricular shunt placement: preliminary experience. Eur J Nucl Med Mol Imaging 39, 236–241 (2012). https://doi.org/10.1007/s00259-011-1950-6

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  • DOI: https://doi.org/10.1007/s00259-011-1950-6

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