Bl. Holman et al., REGIONAL CEREBRAL BLOOD-FLOW IMPROVES WITH TREATMENT IN CHRONIC COCAINE POLYDRUG USERS, The Journal of nuclear medicine, 34(5), 1993, pp. 723-727
Brain perfusion is abnormal in chronic cocaine users. To determine whe
ther these perfusion abnormalities are reversible following treatment,
we studied 10 cocaine-dependent polydrug users with Tc-99m-HMPAO SPEC
T 2 to 3 days after admission to an inpatient treatment facility and a
t 7 to 8 days and 17 to 29 days after abstinence from drugs. The patie
nts also received buprenorphine, an opioid mixed agonist-antagonist, b
eginning 10 days after admission and continuing to the end of the stud
y. Imaging began 10-15 min after injection of Tc-99m-HMPAO (20 mCi) us
ing an annular gamma camera system. MRI was performed during hospitali
zation using a 1.5 Tesla system. SPECT and MRI were merged and five ax
ial SPECT slices centered at the level of the basal ganglia were selec
ted for analysis. Activity ratios were derived for cortical regions re
lative to cerebellar activity and were corrected for linearity with re
spect to regional cerebral blood flow. The cortical regions were class
ified as abnormal (activity ratio < 0.6), borderline (0.6-0.72) and no
rmal (> 0.72) based on the results of the first SPECT study. In abnorm
al zones, regional cerebral blood flow (rCBF) increased 1 1.0% +/- 9.0
% at 7 to 8 days and 23.8% +/- 9.4% at 17 to 29 days after initiation
of treatment. The increase in rCBF was 4.8% +/- 7.1% (7 to 8 days) and
11.1% +/- 8.0% (17 to 29 days) in borderline cortex and decreased 2.9
% +/- 6.3% (7 to 8 days) and increased only 2.7% +/- 13.4% (17 to 29 d
ays) in normal cortex. The increase in rCBF did not vary significantly
by location. The perfusion defects observed in chronic cocaine polydr
ug users are partially reversible with short-term abstinence and bupre
norphine treatment.