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The Diagnostic Value of ¹²³I-IMP SPECT in Non-Hodgkin's Lymphoma of the Central Nervous System

Department of Neurosurgery, Shimane Medical University, Izumo, Japan

N-isopropyl-p-[¹²³I]iodoamphetamine (IMP) SPECT is of low diagnostic value in patients with brain tumors, because brain tumors are visualized as uptake defects. Some reports have described non-Hodgkin's lymphoma of the central nervous system (CNS) as showing high uptake on delayed ¹²³I-IMP SPECT images, suggesting its usefulness in diagnosing CNS lymphoma. In this study, we investigated the clinical value of ¹²³I-IMP SPECT as a diagnostic tool for CNS lymphoma. Methods: Ninety-six patients with brain tumors, including 12 patients with CNS lymphoma, underwent ¹²³I-IMP SPECT. Eleven patients had primary CNS lymphoma, and 1 had a parenchymal brain metastasis from a breast lymphoma. The total number of lesions was 18, 14 of which were in the cerebral parenchyma, 3 in the brain stem, and 1 in the ventricle. Early SPECT images were initiated 15–30 min after intravenous injection of 111 MBq ¹²³I-IMP, and delayed images were collected 4 h later. SPECT images were visually analyzed with a color-grading scale. Tumor-to-normal activity ratio (T/N) and tumor-to-cerebellum activity ratio (T/C) were calculated for both early and delayed images for semiquantitative analysis. Results: By visual estimation, more than a 3- cm³ volume of CNS lymphoma was detected as an obvious focus of increased accumulation on delayed images. All other brain tumors tested appeared as decreased accumulation on delayed images. T/Ns and T/Cs on delayed images of CNS lymphomas, including tumors less than 3 cm³ in volume, were 1.48 ± 0.42 and 1.08 ± 0.16, respectively. These ratios in patients with glioma (0.30 ± 0.05 and 0.31 ± 0 07 respectively) or meningioma (0.34 ± 0.10 and 0.41 ± 0.17, respectively) showed a significant difference from those in patients with CNS lymphoma (P < 0.0005). Conclusion: ¹²³I-IMP SPECT is a helpful tool for diagnosing CNS lymphoma.

Key Words: brain neoplasm • non-Hodgkin's lymphoma • SPECT • N-isopropyl-p-[¹²³I]iodoamphetamine

Received Oct. 29, 1999; revision accepted Mar. 8, 2000.

For correspondence or reprints contact: Yasuhiko Akiyama, MD, PhD, 89-1 Enya-cho, Izumo Shimane 693-8501, Japan.

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