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Split Dose Iodine-123-IMP SPECT: Sequential Quantitative Regional Cerebral Blood Flow Change with Pharmacological Intervention

Department of Nuclear Medicine, First Department of Internal Medicine, Department of Neurology, Division of Tracer Kinetics, Osaka University Medical School, Osaka, Japan

Correspondence: For correspondence or reprints contact: Kazuo Hashikawa, MD, First Department of Internal Medicine, Osaka University Medical School, 2-2 Yamadaoka, Suita 565, Japan.

ABSTRACT

At least two quantitative rCBF measurements are needed to evaluate rCBF changes with pharmacological intervention. We have developed the split dose ¹²³I-IMP SPECT method, which enables measurement of rCBF to be repeated in a short time. Methods: Thirty-one cerebrovascular disease patients were investigated to assess reproducibility and vasoreactivity to acetazolamide. During 44-min dynamic SPECT imaging, ¹²³I-IMP injection and respective arterial sampling were performed twice at an interval of about 25 min. The rCBF values were calculated using a microsphere model in which the washout of ¹²³I-IMP from the brain can be negligible in the first several minutes after injection. For the second rCBF measurement, the remaining activity due to the first ¹²³I-IMP injection was estimated and subtracted from the total brain activity. Results: In ten patients, two consecutive resting mean rCBF values in the MCA territory (CBF1 and CBF2) had good correlation (CBF1 = 47.4 ± 4.0 (ml/min/100 ml: mean ± s.d.), CBF2 = 45.2 ± 8.2, CBF2 = 0.900*CBF1 + 2.9, r = 0.915). In 11 patients with occlusive lesions in the unilateral ICA system, mean rCBF in the MCA territory was increased by only 27.7% ± 14.0% in the affected side by a 1-g intravenous acetazolamide injection, while 44.5% ± 12.3% increase was found in the nonaffected side. In 10 patients without a major arterial lesion, a 49.7% ± 17.0% increase of rCBF was demonstrated. Conclusions: This split dose method ¹²³I-IMP SPECT can be useful to estimate vascular reserve.

Key Words: SPECT • cerebral blood flow • perfusion reserve • N-isopropyl-[I-123]p-iodoamphetamine • acetazolamide

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