A comparative study of simple methods to quantify cerebral blood flow with acetazolamide challenge by using iodine-123-IMP SPECT with one-point arterial sampling.

The aim of this study was to compare the accuracy of simplified methods for quantifying rCBF with acetazolamide challenge by using 123I-N-isopropyl-p-iodoamphetamine (IMP) and SPECT with one-point arterial sampling. After acetazolamide administration we quantified rCBF in 12 subjects by the following three methods: (a) the modified microsphere method, (b) the IMP-autoradiographic (ARG) method based on a two-compartment one-parameter model, and (c) the simplified method based on a two-compartment two-parameter model (functional IMP method). The accuracy of these methods was validated by comparing rCBF values with those obtained by the standard method: the super-early microsphere method with continuous withdrawal of arterial blood. On analyzing rCBF in each flow range (0-0.25, 0.25-0.5, 0.5-0.75 and more than 0.75 ml/g/min), rCBF values obtained by both methods (a) and (c) showed significant correlations (p < 0.01) with those obtained by the standard method in every range, but rCBF values obtained by method (b) did not significantly correlated in the high flow range (0.5-0.75 and more than 0.75 ml/g/min). Method (c) was found to be the most accurate, even though it needs two serial SPECT scans. When requiring one SPECT scan, method (a) was considered to be superior to method (b) because of its accuracy, especially in high flow regions loaded with acetazolamide.

Noninvasive quantification of cerebral blood flow using 99mTc-ECD and SPECT.

UNLABELLED: The aim of this study was to develop a simple, noninvasive method for quantifying regional cerebral blood flow (rCBF) using 99mTc-ethyl cysteinate dimer (ECD) by a single SPECT scan and single venous sampling. METHODS: Using a three-compartment model, we introduced the regional brain fractionation index (BFI), Cb(Ts)/integral of 0-Ts Ca(tau)dtau [Ca(t), arterial input; Cb(t), brain activity]. Regional BFI obtained at the optimum time Ts (min) was converted to rCBF using an exponential function, which was obtained by analyzing the relationship between regional BFI and rCBF (= F) obtained by the standard 133Xe inhalation SPECT method. The integral of the concentration of 99mTc-ECD in arterial blood corrected for physical decay [Ca(t)] in BFI was estimated from a single venous blood sample obtained at the optimum time Tv using the regression line obtained by analyzing the relationship between the integral of Ca(t) and venous sample data. The data come from three groups of patients. The first group of patients (n = 16) underwent a complete 99mTc-ECD BFI study with measurement of Ca(t) and dynamic SPECT scanning, as well as a 133Xe inhalation study to measure rCBF The results were used to analyze the relationship between regional BFI and rCBF (obtained with 133Xe) and to determine the optimum time Ts for obtaining BFI. Data from the second group of patients (n = 15) were used to analyze the relationship between the integral of Ca(t) and venous sample data and to determine the optimum time Tv for one-point venous blood sampling. Finally, the third group of patients (8 patients, 10 studies) was used to validate the current method by comparing the results with 133Xe inhalation SPECT. RESULTS: Regional BFI obtained at time Ts = 20 min showed good agreement (r = 0.907; a = 0.552, b = 0.962) with rCBF. The venous sample data obtained at time Tv = 6 min showed a good correlation (r = 0.988) with BFI. In comparing rCBF values thus obtained and those obtained by the 133Xe method, we found a good correlation (r = 0.917, slope = 1.01). CONCLUSION: The proposed method has three advantages: (a) accurate quantification of rCBF without underestimation in the high flow range, (b) simplicity and noninvasiveness and (c) the ability to use any type of SPECT camera for the study.

Quantification of cerebral blood flow using technetium-99m ethyl cysteinate dimer and single-photon emission tomography.

The aim of this study was to develop a new method for quantifying regional cerebral blood flow (rCBF) with technetium-99m ethyl cysteinate dimer (ECD) and single-photon emission tomography (SPET). Employing a three-compartment model, we introduced a parameter, regional brain fractionation index (BFI), that reflects rCBF values and is obtained by a single SPET scan at optimum time T (min) after tracer injection and the integral of arterial input. By analysing the dynamic SPET and arterial blood sampling data of 15 subjects, including the results of acetazolamide challenges, with the graphical plot method, optimum time T was determined to be approximately 20 min post injection. Regional BFI values of each subject were calculated from the single SPET data at 20 min and arterial input. The relationship between the values of regional BFI and rCBF obtained by xenon-133 inhalation SPET was analysed by approximation with an exponential function, resulting in good agreement (r = 0.907). In the present method, rCBF values were determined from regional BFI values by using the inverse exponential function as a non-linear regression curve. To validate the method, we applied it to six other subjects, in whom acetazolamide challenges were also performed. In comparing rCBF values thus obtained and those obtained by 133Xe inhalation SPET, we found a good correlation (r = 0.901) with an inclination approximating 1 (= 1.02) and without underestimation of rCBF in the high-flow range. Since the present method does not require dynamic planar imaging or dynamic SPET scanning, it can be applied to any type of SPET scanner and is useful in clinical SPET studies.

[Quantification of cerebral blood flow with 99mTc-ECD SPECT based on a 3-compartment model].

In the present study we developed a method for quantifying regional cerebral blood flow (rCBF) using 99mTc-ECD SPECT based on a 3-compartment model. The dynamic SPECT scanning and sequential sampling of arterial blood were performed on 12 subjects with cerebrovascular diseases and etc. We defined brain fractionation index (BFI) as a parameter of rCBF, which was obtained from a single SPECT data and arterial input. The relationship between the values of BFI and rCBF obtained by the 133Xe inhalation method was analyzed by approximation with exponential function. In this method, rCBF was calculated from the values of BFI using the inverse function of the exponential function as a regression curve. The method was applied seven other patients with cerebrovascular diseases and the values of rCBF were compared with those obtained by the 133Xe inhalation method. We observed a good correlation (r = 0.854), and the inclination was approximately 1. This method can be applied to not only large field SPECT cameras but also conventional SPECT cameras.

[A study on accuracy of rCBF measurements loaded with acetazolamide based on the microsphere model using iodine-123-IMP SPECT].

We studied the accuracy of the method for measuring regional cerebral blood flow (rCBF) loaded with acetazolamide based on the microsphere model using iodine-123-IMP (IMP) SPECT. Two methods were examined, the super-early microsphere method with continuous withdrawal of arterial blood using the SPECT image obtained 5 min after tracer injection and the early microsphere method with one-point arterial sampling using the SPECT image obtained 30 min postinjection. On five subjects, after acetazolamide administration we measured rCBF by the analysis based on the two-compartment model using the data derived from dynamic SPECT scans and the sequential arterial blood sampling after IMP injection. Values of rCBF obtained by both super-early microsphere method and early microsphere method were significantly correlated with those obtained by the two-compartment model analysis (r = 0.982, 0.930, respectively). We conclude that it is possible to use the method based on the microsphere model in measuring rCBF loaded with acetazolamide. The early microsphere method with one-point sampling should be used clinically because of its simplicity and less-invasiveness.

[Quantification of regional cerebral blood flow at the control state and loaded with diamox using split-dose 99mTc-ECD SPECT and venous blood samples].

The purpose of the study is to develop a simple and less invasive method for quantifying regional cerebral blood flow (rCBF) at pre- and post Diamox test using split-dose 99mTc-ECD and SPECT. By employing a microsphere model, integral of input function was calculated by the one-point venous sampling method previously reported. The study was performed on 5 subjects with cerebrovascular diseases. A split dose of 99mTc-ECD was injected pre- and post Diamox injection, and rCBF was measured by two SPECT scans and single venous samples, respectively. Mean CBF obtained by the present method was 0.47 +/- 0.07 ml/g/min at the control state, and 0.63 +/- 0.12 ml/g/min loaded with Diamox (mean % increase; 35%), showing good agreement with those obtained by the 133Xe-inhalation method. Since the present method does not require arterial blood sampling, dynamic data acquisition and dose corrections, it is simple, less invasive and useful in clinical SPECT studies.

Quantification of cerebral blood flow and partition coefficient using iodine-123-iodoamphetamine.

UNLABELLED: The aim of this study was to develop a simple, noninvasive method for quantifying both regional cerebral blood flow (rCBF) and the partition coefficient (lambda) using N-isopropyl-p[123I]iodoamphetamine and SPECT. METHODS: By employing a two-compartment model (influx, K1: outflux, k2), a new method was introduced that requires two serial SPECT scans at 30 min and 60 min, and a single arterial sample 5 min after tracer injection. The integral of the arterial input function is inferred from the sample by using the correlation obtained from 25 subjects. Two original mathematical functions, phi for K1 and gamma for lambda (= K1/k2), were obtained from the input functions of 12 subjects. The values of K1 and lambda are determined from the two scans and the single arterial sample by using these functions. The values obtained for K1 (= rCBF) and lambda were compared with those obtained by nonlinear least-squares fitting analysis and the 133Xe inhalation SPECT method. RESULTS: K1 and lambda were in good agreement with the values obtained by nonlinear least-squares fitting analysis (r = 0.873 in K1 and r = 0.825 in lambda), and rCBF values were closely correlated with those obtained by the 133Xe method (r = 0.843). CONCLUSION: The proposed method has three advantages: (a) accurate, simultaneous quantification of both rCBF and the partition coefficient; (b) simplicity and noninvasiveness; and (c) a relatively short period (approximately 70 min) for the study.

125I-iomazenil binding shows stress- and/or diazepam-induced reductions in mouse brain: supporting data for 123I-iomazenil SPECT study of anxiety disorders.

Effects of repeated swim stress on the binding of 125I-iomazenil were examined in the brains of diazepam-treated and non-treated mice. The mice were orally administered diazepam or vehicle (0.5% ethylene glycol) and subjected to daily swim stress (at 20 degrees C for 10 min) for seven consecutive days. The distribution and the amount of 125I-iomazenil binding were analyzed autoradiographically after in vivo and in vitro binding experiments. Repeated swim stress decreased the in vivo binding in the hippocampus (p < 0.05) and cerebral cortex (p < 0.05) of vehicle-treated mice but caused no significant changes in diazepam-treated mice. Subchronic treatment with diazepam decreased the in vivo binding approximately 50% in all brain regions examined (p < 0.01). The in vitro experiment, however, revealed no significant changes except in the hippocampus, where a small but significant decrease in the binding was observed after subchronic treatment with diazepam (p < 0.01). The stress- or diazepam-induced reductions seem to represent alterations in the in vivo environment related to 125I-iomazenil binding. These results suggest that we can investigate the pathophysiology of stress and anxiety with 123I-iomazenil SPECT. Care must be taken concerning the effects of benzodiazepines.

[A limitation of the split-dose method for evaluating rCBF changes using 99mTc-ECD and SPECT].

The purpose of the study is to validate the split-dose method corrected with dose ratio of 99mTc-ECD for brain perfusion scan. A dose of 600 MBq of 99mTc-ECD was divided into two with various dose ratios from 1:1 to 1:4, and injected to eleven patients with various cerebral diseases. A lesser dose of 99mTc-ECD was injected under a control state for the first SPECT scan, and 15 min SPECT scan was performed 10 min after injection with a triple-head high resolution gamma camera. After the scan, the other dose of 99mTc-ECD was injected under the same control state and the second SPECT scan was performed as same as above. A ratio of the activity of the first scan to the net activity of the second scan corrected by dose ratio, defined as K, was measured in brain regions of each subject. Expected value of K was 1, but the value was distributed with large variations in each subject. The mean % error of the K value was 10.4 +/- 4.9%. Hence it is considered that activity changes by more than 20% from the control values should be required to detect a significant rCBF change in an activation SPECT study. Then, we proposed a new method in which the activity of both two SPECT scans was normalized by cerebellar or occipital activity and compared. The ratio obtained by the proposed method came closer to 1 with less variations and with less mean % error in comparison with those of K value obtained by the dose-correction method. Although the proposed method has a limitation in the use of an activation study loaded with Diamox, it may be useful to evaluate an alteration of rCBF in the study such as postural testing or finger-moving test.

A comparative study of simple methods to measure regional cerebral blood flow using iodine-123-IMP SPECT.

UNLABELLED: The aim of this study was to compare the accuracy and reliability of simple methods of quantifying regional cerebral blood flow (rCBF) with 123I-labeled N-isopropyl-p-iodoamphetamine (IMP) and SPECT and to determine which method was best. METHODS: Four methods were examined: (a) the microsphere method with continuous withdrawal of arterial blood, which was based on a microsphere model using the SPECT image obtained 5 min after tracer injection, (b) the microsphere method with one-point sampling, which was the same as the first method except that one-point sampling was used instead of continuous withdrawal, (c) the modified microsphere method with one-point sampling, which was the same as the second method except that a later SPECT image (30-min postinjection) with correction was used and (d) a table look-up method based on a two-compartment model with one-point arterial blood sampling and two SPECT scans obtained 40- and 180-min postinjection. The accuracy of these methods was validated by comparing the rCBF values with those obtained by nonlinear least squares fitting analysis based on the two-compartment model in 15 subjects. RESULTS: Regional cerebral blood flow values obtained by the first method correlated most closely with those obtained by nonlinear least squares fitting analysis (error, 6.8%). The second method estimated rCBF with a mean error of 10.4%. The third method estimated rCBF with a mean error of 13.1%, even though it tended to slightly overestimate rCBF. The fourth method was inclined to underestimate rCBF with a mean error of 17.1%, and it greatly overestimated regional distribution volume. CONCLUSION: The first method was the most accurate and reliable. For less invasiveness, the first method should be combined with one-point sampling instead of continuous withdrawal, which was used in the second method. When using a delayed SPECT image with a conventional SPECT scanner, the third method was considered to be superior to the fourth method.

[A comparative study of the quality of SPECT images obtained by 123I-IMP, 99mTc-HMPAO and 99mTc-ECD].

The purpose of this study was to comparatively evaluate the quality of SPECT images for the mapping of rCBF using three tracers, 123I-IMP, 99mTc-HMPAO and 99mTc-ECD. We performed three SPECT studies on seven patients with various cerebral diseases under the same conditions. An effect of Lassen's correction on SPECT images obtained by HMPAO was also evaluated. The same irregular regions of interest were placed on the four transaxial SPECT images. To quantitatively evaluate the pattern of tracer uptake and image contrast, the uptake ratio, regional count/mean count of the cerebrum, and its coefficient variations (CV) were defined, respectively. The order of the value of CV was HMPAO with correction > IMP > ECD > HMPAO without correction. HMPAO with correction showed the best image contrast, but HMPAO without correction was the worst. Uptake ratios of ECD and HMPAO with correction were decreased in the brain stem and thalamus in comparison with those of IMP. Both uptake ratios of ECD and HMPAO without correction were increased in the occipital cortex. IMP provides high quality SPECT images. Images obtained by HMPAO should be modified by Lassen's correction to increase image contrast. ECD or HMPAO should not be used to evaluate patients with spinocerebellar degeneration.

[Quantification of cerebral blood flow with 99mTc-ECD SPECT by a single arterial or venous blood sample].

The purpose of the study is to develop a simple and less invasive method for quantifying regional cerebral blood flow (rCBF) using 99mTc-ECD and SPECT. By employing a microsphere model, a new method to measure rCBF was developed, which required a single arterial or venous sample instead of continuous withdrawal of arterial blood. Using a regression line, the integral of input function of arterial blood from 0 to 30 min was inferred by activity of arterial blood sampled at time t; A(t), by activity multiplied by its octanol extraction rate; AN(t), by activity of venous blood at time t; V(t), and by activity multiplied by its octanol extraction rate; VN(t). The optimum sampling time of arterial or venous blood was examined when mean % error for inference became minimum. Consequently, minimum error of AN(6 min) was 5.5%, A(3 min) was 8.9%, VN(6 min) was 5.9%, and V(20 min) was 10.0%. Quantitative measurement of rCBF using the value of VN(6 min) was performed on other 6 subjects with dementia etc. To validate the method, 133Xe inhalation SPECT studies were also performed on the same subjects. We found a good agreement between them (r = 0.851). The presented one-point sampling methods were simple and less invasive for quantifying rCBF.

A multicenter validation of regional cerebral blood flow quantitation using [123I]iodoamphetamine and single photon emission computed tomography.

Recently, two methods have been proposed for regional cerebral blood flow (rCBF) quantitation using [123I]iodoamphetamine (IMP) and single-photon emission computed tomography (SPECT). The table look-up (TLU) method has been shown to provide both rCBF and volume of distribution, Vd, images from two SPECT scans, while a single-scan autoradiographic (ARG) technique provided rCBF using a fixed and assumed Vd. In both methods, a single blood sample was referred to calibrate the previously determined standard input function. The present multicenter project was designed to evaluate the accuracy of both methods for use as clinical investigative tools. Ten independent institutions performed [123I]IMP-SPECT studies according to both methods in 76 subjects (10 normal volunteers, 32 patients with cerebrovascular disease, and 34 patients with other diseases). Calculated rCBF values were compared with those obtained by the following reference methods available in the participating institutions; [15O] H2O positron emission tomography (PET) (five institutions), [133Xe]SPECT (four institutions), and the [123I]IMP microsphere method (three institutions). Both ARG and TLU methods provided rCBF values that were significantly correlated with those measured by the [15O] H2O PET technique (p < 0.001 for all subjects; overall regression equation, y = 15.14 + 0.54x) and those measured by the [123I]IMP-microsphere method (p < 0.001 for all subjects: y = 2.0 + 0.80x). Significant correlation (p < 0.05) was observed in 18 of 24 subjects studied with the [133Xe] SPECT reference technique (overall regression equation, y = 15.0 + 0.55x). Mean cortical gray matter rCBF in a group of normal subject was 43.9 +/- 3.3 and 43.4 +/- 2.0 ml/min/100 g for the ARG and TLU methods, respectively. Regional Vd of [123I]IMP estimated by the TLU method was 45 ml/ml +/- 20% in the normal cortical region. Close agreement between ARG and TLU rCBF values was observed (y = -3.21 + 1.07x, r = 0.97), confirming the validity of assuming a fixed Vd in the ARG method. Results of this study demonstrate that both the ARG and TLU methods accurately and reliably estimate rCBF in a variety of clinical settings.

[A functional diagnostic method by measuring of distribution volume of 123I-IMP with SPECT].

To measure distribution volume of 123I-IMP with one-point sampling of arterial blood and 2 times SPECT scans using the Magic square method (Rate constant square method), we introduced a program on a SPECT computer system. In this program four functional images; distribution volume, CBF (K1), k2 and delayed/early ratio, and absolute values with S.D. are obtained on the computer. We have been using the program on daily SPECT studies. In this study we discussed the usefulness of the method. Redistribution phenomenon of 123I-IMP, which is not exactly enough investigated, can be transformed into a functional parameter, distribution volume. Since distribution volume represents an extent of retention of 123I-IMP in brain tissue, it can play an important role to evaluate functional activity in the brain and to diagnose cerebral diseases.

[Validation study in quantitative measurement of regional cerebral blood flow using N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) and SPECT].

We validated following five methods to quantitate regional cerebral blood flow (rCBF) using 123I-IMP and SPECT; 1) microsphere method, which is based on a microsphere model using the SPECT image at five minutes after 123I-IMP injection with continuous withdrawal of arterial blood, 2) microsphere+ one-point sampling method, which is the same as the microsphere method except for using one-point sampling instead of continuous withdrawal, 3) conventional microsphere + one-point sampling method, which is the same as the microsphere + one-point sampling method except for using a later SPECT image corrected with the ratio of alteration of measured entire brain activity, 4) Table look-up method, which is based on a two-compartment model (influx; K1 and outflux; k2) using one arterial blood sample taken at 10 min and two SPECT images at 30 min and 180 min post-injection, and 5) functional IMP SPECT, which is based on the two-compartment model using one arterial blood sample taken at 5 min and two SPECT images at 30 min and 60 min post-injection. Those methods were applied to six patients with cerebral infarction and degenerative diseases, and rCBF results were compared with those estimated by non-linear least squares fitting (NLLSF) analysis based on the two-compartment model. The rCBF values obtained by the microsphere method was best correlated with those by NLLSF analysis (r = 0.940), followed by the microsphere+one-point sampling method (r = 0.885) and the functional IMP SPECT (r = 0.882). The table look-up method underestimated rCBF especially at the high flow level, however showed good correlation (r = 0.859). The conventional microsphere + one-point sampling method overestimated rCBF, however showed good correlation (r = 0.849). Distribution volume (Vd = K1/k2) was also estimated by both the table look-up method and the functional IMP SPECT. While values of Vd by the functional IMP SPECT were significantly correlated with those by NLLSF analysis (r = 0.785), the table look-up method overestimated Vd (43.4 +/- 6.6 ml/g) and showed not good correlation (r = 0.287).

Decrease in benzodiazepine receptor binding in a patient with Angelman syndrome detected by iodine-123 iomazenil and single-photon emission tomography.

A receptor mapping technique using iodine-123 iomazenil and single-photon emission tomography (SPET) was employed to examine benzodiazepine receptor binding in a patient with Angelman syndrome (AS). AS is characterized by developmental delay, seizures, inappropriate laughter and ataxic movement. In this entity there is a cytogenic deletion of the proximal long arm of chromosome 15q11-q13, where the gene encoding the GABAA receptor beta3 subunit (GABRB3) is located. Since the benzodiazepine receptor is constructed as a receptor-ionophore complex that contains the GABAA receptor, it is a suitable marker for GABA-ergic synapsis. To determine whether benzodiazepine receptor density, which indirectly indicates changes in GABAA receptor density, is altered in the brain in patients with AS, we investigated a 27-year-old woman with AS using 123I-iomazenil and SPET. Receptor density was quantitatively assessed by measuring the binding potential using a simplified method. Regional cerebral blood flow was also measured with N-isopropyl-p-[123I]iodoamphetamine. We demonstrated that benzodiazepine receptor density is severely decreased in the cerebellum, and mildly decreased in the frontal and temporal cortices and basal ganglia, a result which is considered to indicate decreased GABAA receptor density in these regions. Although the deletion of GABRB3 was not observed in the present study, we indirectly demonstrated the disturbance of inhibitory neurotransmission mediated by the GABAA receptor in the investigated patient. 123I-iomazenil with SPET was useful to map benzodiazepine receptors, which indicate GABAA receptor distribution and their density.

[A new method for measurement of both regional cerebral blood flow and distribution volume using N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) and SPECT].

We developed a new method (functional IMP SPECT) to quantitate both regional cerebral blood flow (rCBF) and distribution volume (Vd) using 123I-IMP and SPECT based on a 2- compartment model (influx; K1 =rCBF and outflux; k2). This method requires one arterial blood sampling at 5 min after injection of the tracer and two SPECT scans at 30 min and 60 min. It takes approximately 60 min for total measurements. The integration of arterial input function is estimated by one blood sample taken at 5 min after injection of the tracer without octanol treatment, by using the correlation between one blood sample and the integration, which was obtained from studies on 25 subjects. With the value of integration, K1 and Vd are calculated from the data of two SPECT scans by using the mathematical functions based on the 2-compartment model, which were obtained from studies on 12 subjects. In the practical range of K1 (0.3-0.7 ml/g/min) and Vd (15-35 ml/g) given in the 2-compartment model, statistical errors of K1 and Vd obtained by the functional IMP SPECT were evaluated at approximately 14.0% and 17.2%, respectively. In clinical studies for eight subjects including two healthy volunteers, three patients with cerebral infarction and three patients with degenerative disease, K1 and Vd values estimated by the functional IMP SPECT were significantly correlated with those estimated by non-linear least squares fitting analysis based on the 2-compartment model, and the mean errors of K1 and Vd estimated by the functional IMP SPECT were approximately 8.0% and 11.2% respectively, suggesting the validity of the new method. We conclude that the functional IMP SPECT is clinically useful because of the accuracy, less-invasiveness and convenience.

Redistribution on I-123 IMP SPECT in children and adolescents with partial seizures.

To evaluate the redistribution phenomenon on delayed I-123 IMP SPECT images of children and adolescents with partial seizures, 25 patients were selected and investigated in the interictal state. Early and delayed SPECT were performed 15-20 minutes and 5 hours, respectively, after I-123 IMP injection. Redistribution patterns were classified into three groups: 1) redistribution (RD) (-) group (n = 5), in which a low-uptake area on the early image persisted or was enlarged on the delayed image, 2) RD (+) group (n = 14), in which a low-uptake area on the early image changed to normal distribution on the delayed image, and 3) marked redistribution (MRD) (+) group (n = 6), In which a low-uptake area on the early image changed to a high uptake area on the delayed image. Among the patients who were followed for at least 12 months after the SPECT scans, the short-term clinical outcome tended to be good in the RD (+) group, intermediate in the MRD (+) group, and poor in the RD (-) group. These results of our preliminary comparative study indicate that the redistribution pattern of I-123 IMP may be related to the clinical aspects in patients with partial seizures and that it may play an important role in predicting their short-term clinical outcome.

[A study on accuracy of rCBF measurements using the conventional microsphere method with N-isopropyl-p-[123I]iodoamphetamine and SPECT].

To evaluate the accuracy of conventional microsphere method for the measurement of regional cerebral blood flow (rCBF) based on the microsphere model with N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) and SPECT, we performed simulation analysis and clinical studies. Although the microsphere method requires early SPECT scan at a few minutes after injection of the tracer for the accurate measurement of rCBF, the conventional microsphere method, which is generally used, requires more delayed SPECT scan with long scan-duration. In the conventional microsphere method, the delayed SPECT image is corrected to the image at a few minutes after injection of the tracer by using the monitored entire brain activity. By the simulation analysis based on the 2-compartment model (influx; K1 and outflux; k2) using the input function and the entire brain activity obtained from eight subjects respectively, it was found that the conventional microsphere method overestimated the rCBF in the practical range of rCBF and Vd (= K1/k2) given in the 2-compartment model. When the values of rCBF and Vd in the 2-compartment model were given at 0.5 (ml/g/min) and 30 (ml/g) respectively, the rate of overestimation of rCBF by the conventional microsphere method was determined to be 17.3 +/- 0.7% (mean +/- S.D.). Also in clinical studies for eight subjects, the conventional microsphere method overestimated the rCBF compared with those evaluated by non-linear least squares fitting (NLLSF) analysis based on the 2-compartment model. Those results agreed well with the simulation analysis, suggesting the validity of the simulation. The rCBF values clinically estimated by the conventional method were, however, significantly correlated with those calculated by NLLSF analysis, and there were not so much difference between the two quantitative rCBF images obtained by the conventional microsphere method and the microsphere method. Therefore, we conclude that the conventional microsphere method is clinically useful in spite of the overestimation of rCBF.

Can the microsphere model by applied to cerebral blood flow measurement using N-isopropyl-p-[123I]iodoamphetamine with SPET regardless of washout from brain tissue?

The microsphere model and the continuous withdrawal of arterial blood have commonly been used in clinical studies when measuring regional cerebral blood flow (rCBF) by N-isopropyl-p-[123I]iodoamphetamine (IMP) single photon emission tomography. The method is considered to underestimate rCBF because of the washout of tracer from brain tissue; however, the extent of this underestimation is not known. To assess whether this underestimation can be determined quantitatively, we performed simulation analysis based on the microsphere model and the two-compartment model [influx, K1(rCBF); and outflux, k2(washout)] using the time-activity curves of 123I-IMP in arterial blood [Ca(t)] of 10 subjects. With the microsphere method, rCBF values fell as time post-injection increased. The extent of underestimation of rCBF was 4.7 +/- 0.28% (mean +/- S.D.) at 5 min, 10.2 +/- 0.42% at 10 min and 15.2 +/- 0.55% at 15 min. There was little variation in the extent of underestimation and it was not dependent on the Ca(t) of the subjects. We therefore considered the results to be generally applicable to various studies of the microsphere model. As 4.7% is considered to be negligible in clinical studies, we conclude that the microsphere model can be applied to obtain accurate measurement of rCBF up to 5 min regardless of washout.