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S. Bose, S. Potkin, J. Fallon; Functional Brain Imaging using PET scan in Non–Arteritic Ischemic Optic Neuropathy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):249.
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Purpose: Non–arteritic ischemic optic neuropathy (NAION), a result of impaired optic disc perfusion is associated with increased white matter lesions on MRI representing ischemia to the brain. In an attempt to treat this ischemia, Pentoxifylline (Trental®), (a methylxanthine derivative widely used in the treatment of peripheral arterial occlusive disease that influences erythrocyte deformability and plasma viscosity) is being used emperically for the treatment of NAION. In this study we attempt to provide objective information regarding functional and metabolic changes in the brain in NAION and following treatment with pentoxifylline using positron emission tomography (PET) scanning. Methods: Ten patients clinically diagnosed with NAION underwent laboratory evaluation, brain MRI and PET scan with fluoride–18 fluorodeoxyglucose (FDG). All patients were enrolled in an IRB approved protocol and were treated with pentoxifylline 400 mg TID p.o. for at least a period of three months and underwent repeat FDG PET scanning. Results: At baseline, white matter changes in the brain MRI were seen in 40% of cases while PET scan revealed bilateral metabolic changes in all patients compared with 56 controls. Metabolic increases were seen in the dorsal stream areas 17, 18 and 19 (9/10 patients), cerebellar region (7/10), dorsolateral prefrontal cortex (6/10), medial temporal lobe (5/10) and frontal eye fields areas 8 and 6 (4/10). After treatment, 5 of 10 patients showed partial normalization of the baseline hypermetabolism. Conclusion: Metabolic imaging with FDG–PET in NAION provides functional information not attainable with conventional brain MRI.metabolic changes are observed in the visual cortex and association areas, frontal, temporal lobes and the cerbellum. Pentoxifylline treatment appears to reverse the changes in about half the NAION patients. The exact relevance of these results needs to be confirmed by a randomized trial.
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