PMC5498210_01
Brain MRI and CT images of the patient. a: MRI T1-weighted axial (upper) and fluid-attenuated inversion recovery (FLAIR) coronal (lower) images obtained two years after onset revealed slight atrophy of the bilateral superior parietal lobule, b: Brain CT images obtained seven years after onset showed bilateral atrophy of the frontal lobe with enlargement of the anterior horn of the lateral ventricles and Sylvian fissures.
1349-7235-56-1421-g001.jpg
PMC5498210_01_1349-7235-56-1421-g001.jpg
g001
MRI showed slight atrophy of the bilateral superior parietal lobule (Fig. 1a). Brain CT revealed bilateral atrophy of the frontal lobe with enlargement of the anterior horn of the lateral ventricles and Sylvian fissures (Fig. 1b).
99mTc- ECD-SPECT images at two and four years after onset. Hypoperfusion of the bilateral posterior superior parietal and right middle and inferior occipital areas was noted at two years after onset (left). Over the following two years, hypoperfusion extended to the lateral occipital gyri (right). Areas of significant hypoperfusion were determined with the easy Z-score Imaging System (eZIS) version 3.4 and Statistical Parametric Mapping version 2 (SPM 2). Significance was based on the two-sample t-test (patient vs. healthy men, aged over 70 years old, n=20, uncorrected p<0.001).
1349-7235-56-1421-g002.jpg
PMC5498210_01_1349-7235-56-1421-g002.jpg
g002
Single photon emission computed tomography with a 99mTc-ethylcysteinate dimer (ECD-SPECT) revealed hypoperfusion of the bilateral posterior superior parietal area, and the right middle and inferior occipital areas in three-dimensional brain surface images, which were constructed with the easy Z-score Imaging System (eZIS) version 3.4 and Statistical Parametric Mapping version 2 (SPM 2) (Fig. 2; two-sample t-test, patient vs. healthy men aged over 70 years old, uncorrected p<0.001). 123I-meta-iodobenzylguanidine (123I-MIBG) myocardial scintigraphy showed a lowered early (1.39) and delayed (1.35) heart-to-mediastinum (H/M) ratio [normal mean (SD): early, 2.1 (0.16); delayed, 2.42 (0.30)], thus suggesting either Parkinson disease or DLB. Follow-up ECD-SPECT performed four years after onset revealed hypoperfusion that extended from the bilateral posterior parietal to lateral occipital gyri (Fig. 2).