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Iodine-123-Iomazenil and Iodine-123-lodoamphetamine SPECT in Major Cerebral Artery Occlusive Disease

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

Correspondence: For correspondence or reprints contact: Hiroshi Moriwaki, MD, Cerebrovascular Division, Department of Internal Medicine, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita 565, Japan.

ABSTRACT

Iodine-123-iomazenil (IMZ) is a SPECT ligand for central-type benzodiazepine receptors, which are located only on neurons. We evaluated the feasibility of using IMZ SPECT for identifying neuronal damage in patients with the chronic phase of thrombotic cerebral ischemia. Methods: We studied 15 patients with angiographically-confirmed unilateral severe occlusive lesions (occlusion or > 70% stenosis) in the carotid system. IMZ SPECT images obtained 180 min after injection of 167–222 MBq IMZ were analyzed. The regional cerebral blood flow and perfusion reserve were evaluated for com parison with IMZ SPECT findings, using the split-dose ¹²³I-odoamphetamine (IMP) SPECT method, coupled with intravenous injection of 1 g acetazolamide. On both SPECT images, the count ratio of the affected to the nonaffected whole MCA territory (A/NA ratio) and of the contralateral to the ipsilateral cerebellar cortex (C/I ratio) were determined. Results: The A/NA ratio with IMZ was significantly higher than that with IMP (94.5% ± 6.2%versus 91.4% ± 6.6%, p < 0.005), although a significantly positive correlation was found between these two ratios (r = 0.854, p < 0.0001). The C/I ratio with IMP was decreased significantly in 5 patients compared with that in normal subjects, whereas the C/I ratio with IMZ was decreased in only 1 patient. There was no significant correlation between the A/NA ratio with IMZ and the perfusion reserve in the affected MCA territory. In 2 of 5 patients with a decreased A/NA ratio (<90%) with IMZ, decreased blood flow with preserved perfusion reserve and cerebral hemispheric atrophy were observed, which suggested the influence of neuronal loss due to chronic ischemia. Conclusion: These findings indicate that IMZ SPECT, which provides new information regarding neuronal damage after ischemie insult to the brain, is useful for evaluating thrombotic cerebral ischemia.

Key Words: iodine-123-iomazenil • SPECT • cerebral ischemia • diaschisis • perfusion reserve

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