Skip to main content

Advertisement

SpringerLink
Log in

Super-early images of brain perfusion SPECT using 123I-IMP for the assessment of hyperperfusion in stroke patients

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

With the advancement of reperfusion therapy in stroke patients, assessment of perfusion status after therapy is gaining importance. Hyperperfusion tends to be underestimated by the conventional early imaging of 123I-IMP brain perfusion SPECT. We evaluated the utility of super-early imaging as an adjunct to early imaging for the assessment of postischemic hyperperfusion in stroke patients.

Methods

Sixty-seven patients who underwent 123I-IMP brain perfusion SPECT within 14 days after the onset of cerebral infarction were retrospectively analyzed. Super-early (4–10 min) and early (15–45 min) images were acquired using a dual-headed gamma camera. Postischemic hyperperfusion was visually assessed using the early images alone and then using both the super-early and early images, and the frequency of postischemic hyperperfusion and the confidence level of the judgement were evaluated. For quantitative evaluation of image contrast, the contrast ratios (the count ratios of the hyperperfused to normal areas) were calculated.

Results

The frequency of postischemic hyperperfusion was significantly higher using both the super-early and early images (28/67 patients) than using the early images alone (17/67 patients, p < 0.001). In 56 patients in whom judgement regarding the presence or absence of postischemic hyperperfusion was unchanged, the confidence level was increased in 8 patients using both image sets. The addition of the super-early SPECT images was judged to be useful and marginally useful in 14 and 15 patients, respectively. The contrast ratio was significantly higher on the super-early images (1.48 ± 0.25) than on the early images (1.26 ± 0.18, p < 0.001).

Conclusions

The addition of super-early imaging to the conventional early imaging aids assessment of postischemic hyperperfusion by 123I-IMP brain perfusion SPECT and may contribute to management of stroke patients in the era of reperfusion therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. A guideline for healthcare professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49:e46–110.

    Article  Google Scholar 

  2. Soares BP, Chien JD, Wintermark M. MR and CT monitoring of recanalization, reperfusion, and penumbra salvage: everything that recanalizes does not necessarily reperfuse! Stroke. 2009;40:24–7.

    Article  Google Scholar 

  3. De Silva DA, Fink JN, Christensen S, Ebinger M, Bladin C, Levi CR, et al. Assessing reperfusion and recanalization as markers of clinical outcomes after intravenous thrombolysis in the echoplanar imaging thrombolytic evaluation trial (EPITHET). Stroke. 2009;40:2872–4.

    Article  Google Scholar 

  4. Abumiya T, Katoh M, Moriwaki T, Yoshino M, Aoki T, Imamura H, et al. Utility of early post-treatment single-photon emission computed tomography imaging to predict outcome in stroke patients treated with intravenous tissue plasminogen activator. Stroke Cerebrovasc Dis. 2014;23:896–901.

    Article  Google Scholar 

  5. Okazaki S, Yamagami H, Yoshimoto T, Morita Y, Yamamoto H, Toyoda K, et al. Cerebral hyperperfusion on arterial spin labeling MRI after reperfusion therapy is related to hemorrhagic transformation. J Cereb Blood Flow Metab. 2017;37:3087–90.

    Article  Google Scholar 

  6. Yu S, Liebeskind DS, Dua S, Wilhalme H, Elashoff D, Qiao XJ, et al. Postischemic hyperperfusion on arterial spin labeled perfusion MRI is linked to hemorrhagic transformation in stroke. J Cereb Blood Flow Metab. 2015;35:630–7.

    Article  Google Scholar 

  7. Matsuda H, Li YM, Higashi S, Sumiya H, Tsuji S, Kinuya K, et al. Comparative SPECT study of stroke using Tc-99m ECD, I-123 IMP, and Tc-99m HMPAO. Clin Nucl Med. 1993;18:754–8.

    Article  CAS  Google Scholar 

  8. Tsuchida T, Nishizawa S, Yonekura Y, Sadato N, Iwasaki Y, Fujita T, et al. SPECT images of technetium-99m-ethyl cysteinate dimer in cerebrovascular diseases: comparison with other cerebral perfusion tracers and PET. J Nucl Med. 1994;35:27–31.

    CAS  PubMed  Google Scholar 

  9. Yonekura Y, Fujita T, Nishizawa S, Iwasaki Y, Mukai T, Konishi J. Temporal changes in accumulation of N-isopropyl-p-iodoamphetamine in human brain: relation to lung clearance. J Nucl Med. 1989;30:1977–81.

    CAS  PubMed  Google Scholar 

  10. Lassen NA, Henriksen L, Holm S, Barry DI, Paulson OB, Vorstrup S, et al. Cerebral blood-flow tomography: xenon-133 compared with isopropyl-amphetamine-iodine-123: concise communication. J Nucl Med. 1983;24:17–21.

    CAS  PubMed  Google Scholar 

  11. Nishizawa S, Tanada S, Yonekura Y, Fujita T, Mukai T, Saji H, et al. Regional dynamics of N-isopropyl-(123I)p-iodoamphetamine in human brain. J Nucl Med. 1989;30:150–6.

    CAS  PubMed  Google Scholar 

  12. Takeshita G, Toyama H, Nakane K, Maeda H, Katada K, Takeuchi A, et al. Minor changes in regional cerebral blood flow revealed by the early distribution of I-123 IMP in brain. Radiat Med. 1991;9:196–201.

    CAS  PubMed  Google Scholar 

  13. Yonekura Y, Nishizawa S, Mukai T, Iwasaki Y, Fukuyama H, Ishikawa M, et al. Functional mapping of flow and back-diffusion rate of N-isopropyl-p-iodoamphetamine in human brain. Nucl Med. 1993;34:839–44.

    CAS  Google Scholar 

  14. Namba H, Yanagisawa M, Yui N, Togawa T, Kinoshita F, Iwadate Y, et al. Quantifying brain tumor blood flow by the microsphere model with N-isopropyl-p-[123I]iodoamphetamine super-early SPECT. Ann Nucl Med. 1996;10:161–4.

    Article  CAS  Google Scholar 

  15. Moretti JL, Defer G, Cinotti L, Cesaro P, Degos JD, Vigneron N, et al. “Luxury perfusion” with 99mTc-HMPAO and 123I-IMP SPECT imaging during the subacute phase of stroke. Eur J Nucl Med. 1990;16:17–22.

    Article  CAS  Google Scholar 

  16. Crone C. The permeability of capillaries in various organs as determined by use of the ‘indicator diffusion’ method. Acta Physiol Scand. 1963;58:292–305.

    Article  CAS  Google Scholar 

  17. Okamoto K, Ushijima Y, Okuyama C, Nakamura T, Nishimura T. Measurement of cerebral blood flow using graph plot analysis and I-123 iodoamphetamine. Clin Nucl Med. 2002;27:191–6.

    Article  Google Scholar 

  18. Ichihara T, Ogawa K, Motomura N, Kubo A, Hashimoto S. Compton scatter compensation using the triple-energy window method for single- and dual-isotope SPECT. J Nucl Med. 1993;34:2216–21.

    CAS  PubMed  Google Scholar 

  19. Sperling B, Lassen NA. Hyperfixation of HMPAO in subacute ischemic stroke leading to spuriously high estimates of cerebral blood flow by SPECT. Stroke. 1993;24:193–4.

    Article  CAS  Google Scholar 

  20. Lassen NA, Sperling B. 99mTc-bicisate reliably images CBF in chronic brain diseases but fails to show reflow hyperemia in subacute stroke: report of a multicenter trial of 105 cases comparing 133Xe and 99mTc-bicisate (ECD, neurolite) measured by SPECT on same day. J Cereb Blood Flow Metab. 1994;14(Suppl 1):44–8.

    Google Scholar 

  21. Ogasawara K, Sakai N, Kuroiwa T, Hosoda K, Iihara K, Toyoda K, et al. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg. 2007;107:1130–6.

    Article  Google Scholar 

  22. Devous Sr MD, Thisted RA, Morgan GF, Leroy RF, Rowe CC. SPECT brain imaging in epilepsy: a meta-analysis. J Nucl Med. 1998;39:285–93.

    PubMed  Google Scholar 

  23. Launes J, Sirén J, Valanne L, Salonen O, Nikkinen P, Seppäläinen AM, et al. Unilateral hyperfusion in brain-perfusion SPECT predicts poor prognosis in acute encephalitis. Neurology. 1997;48:1347–51.

    Article  CAS  Google Scholar 

  24. Ito H, Mori K, Kagami S. Neuroimaging of stroke-like episodes in MELAS. Brain Dev. 2011;33:283–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Yusuke Inoue, Toshimasa Hara & Tomomi Ikari

  2. Department of Radiology, Kitasato University Hospital, Sagamihara, Japan

    Keita Takahashi, Hiroki Miyatake & Yutaka Abe

Authors
  1. Yusuke Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshimasa Hara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomomi Ikari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keita Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroki Miyatake
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yutaka Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yusuke Inoue.

Ethics declarations

Conflict of interest

There is no conflict of interest in relation to this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Inoue, Y., Hara, T., Ikari, T. et al. Super-early images of brain perfusion SPECT using 123I-IMP for the assessment of hyperperfusion in stroke patients. Ann Nucl Med 32, 695–701 (2018). https://doi.org/10.1007/s12149-018-1293-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-018-1293-5

Keywords

Search

Navigation