Application Of ^99mTc-MIBI SPECT/CT Muscle Imaging Aided Botulinum Toxin A Injection For Cervical Dystonia

Objective:By exploring the efficacy benefit of 99mTechnetium-sestamibi single photon emission computed tomography/computed tomography(99mTc-MIBI SPECT/CT)guided botulinum toxin A(BoNT-A)injection in cervical dystonia(CD)for motor symptoms and non-motor symptoms.To investigate the localization value of SPECT/CT muscle imaging on the responsible muscle in CD patients,and further analyze the quantitative significance of SPECT/CT maximum standardized uptake value(SUVmax)index in CD patients.Methods:102 patients with primary CD diagnosed at the Department of Neurology,The Second Affiliated Hospital of Soochow University from September 2020 to September 2022 were collected and completed the scale assessment at baseline,2 weeks,4 weeks.8 weeks,12 weeks,and 24 weeks after BoNT-A injection treatment.Tsui Scale and Toronto Western Spasmodic Torticollis Rating Scale(TWSTRS)Part Ⅰ were used to assess the severity of motor symptoms,using improvement rate to evaluate therapeutic effect.Hamilton depression scale-17(HAMD-17),Hamilton anxiety scale(HAMA)and visual analogue scale/score(VAS)were used to assess the non-motor symptoms.102 patients with CD,79 of whom underwent SPECT/CT as the SPECT/CT group and 23 of whom did not undergo SPECT/CT as the control group,both groups were treated with BoNT-A injection under electromyography(EMG)guidance,and to compare the efficacy of motor and non-motor symptoms between the groups.In 79 CD patients,the distribution of the responsible muscles on SPECT/CT muscle imaging and the relationship with clinical phenotype were statistically analyzed.And to further outline and measure the overall muscle SUVmax and the mean SUVmax of the responsible muscle and analyze the correlation with the severity of clinical motor symptoms in 51 CD patients.Result:1.In the Tsui scale,the SPECT/CT group(n=69)had a better overall improvement rate than the control group(n=23),with statistical differences between groups(F group(1.450)=9.990.P=0.002:F time(4.450)=2.768.P=0.027).In the TWSTRS scale.SPECT/CT(n=69)had a better overall improvement rate than the control group(n=23),ith statistical differences between groups(Fgroup(1.450)=7.737,P=0.006:F time(4.450)=8.679,P<0.001).There was no significant difference in non-motor symptoms between the two groups(P>0.050).2.In 79 CD patients.SPECT/CT muscle imaging showed that splenius capitis(78.48%).levator scapulae(73.42%).splenius cervicis(68.35%).semispinalis capitis(67.09%).obliquus capitis inferior(63.29%).and semispinalis cervicis(63.29%)were the commonly involved muscles,and the deflection direction in CD patients was mainly acted by the ipsilateral splenius capitis.splenius cervicis,levator scapulae,obliquus capitis inferior,longissimus cervicis and contralateral sternocleidomastoid muscle.3.In 51 CD patients,there was significantly and positively correlated between the overall muscle SUVmax and motor symptom scores(P Tsui=0.014,r Tsui=0.341;P TWSTRS=0.007.r TWSTRS=0.376),and there was significantly and positively correlated between the mean value of SUVmax of the responsible muscle and motor symptom scores(P Tsui=0.002,r Tsui=0.428;P TWSTRS=0.002,r TWSTRS=0.416).Conclusion:The application of 99mTc-MIBI SPECT/CT muscle imaging in BoNT-A injection for CD can significantly improve the motor symptoms,it is an effective examination tool to identify the responsible muscle for CD,and its SUVmax value can become an objective indicator of the severity of motor symptoms in CD patients.SPECT/CT is expected to become a new application tool for CD diagnosis and treatment.