Tc-99m HMPAO BRAIN SPECT IN PATIENTS WITH ALUMINUM INTOXICATION AND NEUROTOXICITY OCCURING DUE TO LONG TERM HEMODIALYSIS

In this study, Tc-99m Hexamethylpropyleneamine oxime (HMPAO) brain perfusion single photon emission computed tomography (SPECT) was performed in patients with aluminum intoxication (AI) and expectable aluminum neurotoxicity (AN) occuring due to the treatment with long term hemodialysis. Because accumulation of aluminum in brain gray matter is the main cause of AN, we would like to determine if there is any detonation in brain perfusion and to localize the perfusion abnormalities in patients with AN and AI. Nine patients with AI, 2 with AN and 10 control subjects were included in the study. Tc-99m HMPAO brain SPECT were performed in all patients and control subjects. All patients were evaluated by neurological andpsycological examination and neuropsycological testing. Computerized tomography (CT) and Electroencephalography (EEG) were performed and serum aluminum levels were measured in all patients. Basal aluminium levels of the patients were above normal value. CT findings were normal in all patients. Pathologic and pathognomonic EEG was found in one patient with AN. In semiquantitative brain analysis, multiple regional decreased brain perfusion abnormalities were detected in 2 patients and multiple regional increased perfusion in 3 patients. Regional perfusion abnormalities were also observed in the other 5 patients but only in a few regions. Total 16 regions were hypo-perfused and 56 regions were hyper-perfused. We think that Tc-99m HMPAO brain perfusion SPECT study may help to explain the pathogenesis of some neuropsicological findings of AN