Zulkifli, Nurul Nadiah (2023) Elucidating The Effect Of Kratom On Striatal Dopamine Transporter Level Using 99mtc Trodat-1 Spect-ct In Kratom Users. Masters thesis, Universiti Sains Malaysia.
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Abstract
Objective: To evaluate and compare striatal dopamine transporter (DAT) level in kratom users and healthy controls utilizing 99mTc-TRODAT-1 single photon emission computed tomography with computed tomography (SPECT-CT) and brain MRI. Methods: A cross-sectional study involving 12 kratom users and 13 healthy controls was done at Unit Perubatan Nuklear, Institut Perubatan dan Perubatan Termaju (IPPT) USM. All subjects were male, aged between 18 to 55 years old without neurological or psychological diseases. kratom users were dependent on kratom for more than a year period and were free from illicit drugs abuse. Urine toxicology was done to exclude illicit drug abuse. They were also screened using DSM-V criteria for opioid dependence along with PHQ-9 and MMSE questionnaires. All subjects underwent 99mTc-TRODAT-1 SPECT-CT and brain MRI. The standard uptake value corrected with body weight (SUVbw) of bilateral caudate, putamen and striatum as well as occipital were drawn guided structurally by brain MRI images which were co-registered with processed SPECT-CT images. SUVr was calculated by dividing the target SUV with the occipital SUV. Results: Qualitative evaluation by two nuclear medicine physician showed almost perfect agreement that there were reduced tracer uptake in the right putamen (κ=0.824, p=0.004) and left caudate (κ=0.824, p=0.004), consequently abnormal finding in the overall image (κ=1.0, p<0.001). Semiquantitative evaluation revealed significantly higher right caudate SUVr of 2.06±0.67 in kratom users compared to 1.51±0.31 in healthy controls (p=0.019), accordingly higher right striatum SUVr of 1.98±0.50 in kratom user compared to 1.62±0.37 in healthy controls (p=0.055). The right caudate to putaminal ratio was also significantly higher at 1.09±0.25 compared to 0.89±0.14 (p=0.026) accordingly. The caudate AI% was high at 32.97% in kratom users versus 14.37% in healthy controls (p=0.04). The questionnaires parameter showed no significant difference between group. Conclusions:In conclusion, chronic kratom usage causes significantly higher right caudate SUVr, mimicking a pattern more like a cocaine-stimulant effect rather than the chronic heroin pioid effect. Although the effect of smoking in kratom users on striatal DAT binding is inevitable in this study, 99mTc-TRODAT-1 SPECT-CT-MRI may still be used as a potential imaging modality to assess the effect of chronic kratom use with further investigations in the future.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine |
| Divisions: | Institut Perubatan & Pergigian Termaju (Advanced Medical & Dental Institute (AMDI)) > Thesis |
| Depositing User: | MUHAMAD AMIN BIN AZMI |
| Date Deposited: | 17 Jul 2026 01:32 |
| Last Modified: | 17 Jul 2026 01:32 |
| URI: | http://eprints.usm.my/id/eprint/64669 |
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