European Journal of Nuclear Medicine

, Volume 16, Issue 1, pp 17–22 | Cite as

“Luxury perfusion” with99mTc-HMPAO and123I-IMP SPECT imaging during the subacute phase of stroke

  • Jean-Luc Moretti
  • Gilles Defer
  • Luc Cinotti
  • Pierre Cesaro
  • Jean-Denis Degos
  • Nadine Vigneron
  • Dominique Ducassou
  • B. Leonard Holman
Original Article


To compare the merits of123I-isopropyl-iodoam-phetamine (123I-IMP) and99mTc-HMPAO in showing abnormal brain uptake distribution during cerebral ischemia, we studied ten patients during the subacute phase of their stroke, a period where metabolism and blood flow are frequently uncoupled. SPECT imaging was performed using both radiopharmaceuticals in the 10 patients from 48 h to 4 weeks after onset of symptoms. Two patients out of the 10 had similar defects with123I-IMP and99mTc-HMPAO SPECT, the location of the defects corresponding to the area of infarction observed on CT. Six patients had normal99mTc-HMPAO SPECT and abnormal123I-IMP SPECT with defects in the area of infarction shown by CT. The remaining 2 patients had hyperactive abnormalities on99mTc-HMPAO in areas corresponding to defects on the123I-IMP images. Two of the patients with SPECT mismatches were studied again more than 1 month after onset. On reexamination,99mTc-HMPAO SPECT which was previously normal or hyperactive became hypoactive with a focal area of decreased activity corresponding to the defect on123I-IMP. Crossed cerebellar diaschisis was found in 7 patients with99mTc-HMPAO and was absent for both123I-IMP and99mTc-HMPAO in 3. We suggest that SPECT with99mTc-HMPAO could show transient hyperemia not demonstrated by123I-IMP whereas in some cases cerebral infarction would be more difficult to demonstrate with99mTc-HMPAO than with123I-IMP. SPECT with both tracers is recommended to follow the evolution of strokes in terms of regional cerebral blood flow and tissue metabolism.

Key words

99mTc-HMPAO 123I-IMP SPECT Stroke luxury perfusion 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Andersen AR, Friberg H, Lassen NA, Kristensen K, Neirinckx RD (1987) Serial studies of cerebral blood flow using99mTcm-HMPAO: a comparison with 133Xe. Nucl Med Commun 8:549–557PubMedGoogle Scholar
  2. Buell U, Krappel W, Schmiedek P (1985) I-123 amphetamine vs Xe-133 SPECT. A coparative study in patients with unilateral cerebrovascular disease. J Nucl Med 26:25Google Scholar
  3. Brott TG, Gelfand MJ, Williams CC (1986) Frequency and patterns of abnormality detected by iodine 123 amine emission CT after cerebral infarction. Radiology 158:729–734PubMedGoogle Scholar
  4. Bushnell DL, Gupta S, Mlcoch AG (1987) Demonstration of focal hyperemia in acute cerebral infarction with Iodine-123 Iodoamphetamine. J Nucl Med 28:1920–1923PubMedGoogle Scholar
  5. Cesaro P, Moretti JL, Defer D (1986) Comparison of SPELT with isopropyl (I-123) isodoamphetamine and CT scanner in reversible ischemia. In: Lassen NA, Symon L, Baron JC (eds) Cerebral ischemic penumbra. Libbey, London ParisGoogle Scholar
  6. Chang LT (1978) A method for attenuation correction in radionuclide computed tomography. IEEE Trans Nucl Sci 25:638–643Google Scholar
  7. Costa DC, Jones BE, Steiner TJ (1986) Relative Tc-99m-HMPAO and Sn-113 microsphere distribution in dog brain. Nuclearmedizin 25:A25-A53Google Scholar
  8. Defer G, Moretti JL, Cesaro P (1987) Early and late SPELT using N-isopropyl iodoamphetamine in cerebral ischemia. A prognostic index for clinical recovery. Arch Neurol 44:715–718PubMedGoogle Scholar
  9. Ell PJ, Cullum I, Jarritt PH (1983) Cerebral blood flow studies with 123-iodine-labelled amines. Lancet I:1348–1352Google Scholar
  10. Hill TC, Holman BL, Lovett R (1982) Initial experience with SPELT (single-photon computerized tomography) of the brain using N-isopropyl I-123 p-iodoamphetamine: Concise communication. J Nucl Med 23:191–195PubMedGoogle Scholar
  11. Hill TC, Magistretti PL, Holman BL (1986) Assessment of regional cerebral blood flow (RCBF) in stroke using SPECT and N-isopropyl-(I123)-p-iodoamphetamine (IMP). Stroke 15:40–45Google Scholar
  12. Kuhl DE, Barrio JR, Huang SC (1982) Quantifying local cerebral blood flow by N-isopropyl-p-(123-I) iodoamphetamine (IMP) tomography. J Nucl Med 23:196–203PubMedGoogle Scholar
  13. Lafrance ND, Wagner HN, Whitehouse R (1981) Decreased accumulation of isopropyl iodoamphetamine (I-123) in brain tumors. J Nucl Med 22:1081–1083PubMedGoogle Scholar
  14. Lassen NA (1966) The luxury perfusion syndrome and its possible relation to acute metabolic acidosis localized within the brain. Lancet ii:1113–1115Google Scholar
  15. Lassen NA (1968) Brain extracellular pH: the main factor controlling cerebral blood flow. Scand J Clin Lab Invest 22:247–251PubMedGoogle Scholar
  16. Lassen NA, Henriksen L, Holm S (1983) Cerebral blood flow tomography: Xenon-133 compared with isopropyl-amphetamine iodine-123: concise communication. J Nucl Med 24:7–21Google Scholar
  17. Lee RGL, Hill TC, Holman BL, Clouse ME (1982) N-isopropyl (I-123)-p-iodoamphetamine brain scans with single-photon emission tomography: discordance with transmission computed tomography. Radiology 145:795–799PubMedGoogle Scholar
  18. Lenzi GL, Frackowiack RS, Jones R (1982) Cerebral oxygen metabolism and blood flow in human cerebral ischemic infarction. J Cereb Blood Flow Metab 2:321–335PubMedGoogle Scholar
  19. Leonard JP, Nowotnik DP, Nerinckx RD (1986) Technetium-99m d,1-HM-PAO: A new radiopharmaceutical for imaging regional brain perfusion using SPECT — a comparison with iodine-123 HIPDM. J Nucl Med 27:1819–1823PubMedGoogle Scholar
  20. Ljuggren B, Norberg K, Siesjo BK (1974) Influence of tissue acidosis upon restitution of brain energy metabolism following total ischemia. Brain Research 77:173–186PubMedGoogle Scholar
  21. Magistretti P, Uren R, Shomer D (1982) Emission biographic scans of cerebral blood flow using I-123 iodoamphetamine in epilepsy. In: Raynaud C (ed) Proceeding of Third World Congress of Nuclear Medicine and Biology. Pergamon Press, Oxford, pp 139–163Google Scholar
  22. Moretti JL, Askienazy S, Raynauld C (1983) N-isopropyl-p-iodoamphetamine I-123 en tomographie cérébrale. Ann Radiol 26:59–67PubMedGoogle Scholar
  23. Moretti JL, Cesaro P, Louarn F (1984) N-isopropyl amphetamine I-123 et tomoscintigraphie monophotonique dans les affections ischémiques cérébrales. Cir Metab Cerv 2:63–75Google Scholar
  24. Moretti Jl, Askienazy S, Raynaud C, Sergent A, Cesaro P, Tardy M (1986) I-123-p-iodoisopropyl amphetamine (IAMP) for brain tumor diagnosis. In: Biersack HJ, Winekler C (eds) Amphetamine pH-shift agents for brain imaging. Walter de Gruyter, Berlin, pp 185–196Google Scholar
  25. Moretti JL, Holman BL, Delmon L, Johnson D, Moingeon P, Blau M (1987) The effect of antidepressant and narcoleptic drugs on N-isopropyl-p-iodoamphetamine biodistribution in animals. J Nucl Med 28:356–359Google Scholar
  26. Neirinckx RD, Canning LR, Piper IM (1987) Technetium-99m d,1 HMPAO: A new radiopharmaceutical for SPELT imaging of regional cerebral perfusion. J Nucl Med 28:191–202PubMedGoogle Scholar
  27. Nowotnik DP, Canning LR, Cummings SA (1985) Development of Tc-99m-labelled radiopharmaceutical for cerebral blood flow imaging. Nucl Med Commun 6:499–506PubMedGoogle Scholar
  28. Olsen TS, Larsen B, Skriver EB (1981) Focal cerebral hyperemia in acute stroke: evidence, pathophysiology and clinical significance. Stroke2:598–607Google Scholar
  29. Pardridge WM, Connor JD (1973) Saturable transport of amphetamine across the blood-brain barrier. Experientia 29:302–304PubMedGoogle Scholar
  30. Pardridge WM, Sakiyama R, Fierer G (1984) Blood-brain barrier transport and brain sequestration of propanolol and lidocaine. Am J Physiol 247:R582-R588PubMedGoogle Scholar
  31. Raynaud C, Rancurel G, Samson Y (1987) Pathophysiologic study of chronic infarcts with I-123-Isopropyl-iodoamphetamine (IMP). The importance of periinfarct area. Stroke 18:21–29PubMedGoogle Scholar
  32. Schulthess GK von, Ketz E, Schubiger PA (1985) Regional quantitative non invasive assessment of cerebral perfusion and function with N-isopropyl I-123-p-iodoamphetamine. J Nucl Med 26:9–16PubMedGoogle Scholar
  33. Severinghaus JW, Cotev S (1968) Carbonic acidosis and cerebral vasodilatation after diamox. Scand J Clin Lab Invest 1:E (Suppl 102)Google Scholar
  34. Sharp PF, Smith FW, Gemmel HG (1986) Technetium-99m-HMPAO stereoisomers as potential agents for imaging regional cerebral blood flow: human volunteer studies. J Nucl Med 27:171–177PubMedGoogle Scholar
  35. Sugiyama H, Christensen J, Olsen TS, Lassen NA (1986) Monitoring CBF in clinical routine by dynamic single photon emission tomography (SPELCT) of inhaled xenon-133. Stroke 17:1179–1182PubMedGoogle Scholar
  36. Szasz IJ, Lyster D, Morrison AT (1985) Iodine 123 IMP uptake in brain metastases from lung cancer. J Nucl Med 26:1342–1343PubMedGoogle Scholar
  37. Touya JJ, Rahimian J, Grubbs DE, Corbus HF, Bennet LR (1985) A non invasive procedure for in vivo assay of a lung amine endothelial receptor. J Nucl Med 26:1302–1307PubMedGoogle Scholar
  38. Trauble H (1971) The movement of molecules across lipid membranes: a molecular theory. J Membr Biol 4:193–208Google Scholar
  39. Vorstrup S, Henriksen L, Paulson OB (1984) Effect of acetazolamide on cerebral blood flow and cerebral metabolic rate for oxygen. J Clin Invest 74:1634–1639PubMedGoogle Scholar
  40. Winchell HS, Baldwin RM, Lin TH (1980) Development of I-123 labelled amines for brain studies. Localization of I-123 iodophenyalkyl amines in rat brain. J Nucl Med 21:940–946PubMedGoogle Scholar
  41. Yonekura Y, Tanada S, Senda M (1985) Regional distribution of N-isopropyl (I-123) iodoamphetamine in cerebrovascular disease compared with regional cerebral blood flow and oxygen metabolism. J Nucl Med 26:25Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • Jean-Luc Moretti
    • 1
  • Gilles Defer
    • 1
  • Luc Cinotti
    • 1
  • Pierre Cesaro
    • 1
  • Jean-Denis Degos
    • 1
  • Nadine Vigneron
    • 1
  • Dominique Ducassou
    • 2
  • B. Leonard Holman
    • 3
  1. 1.Department of Medical NeurosciencesC.H.U. Henri MondorCréteilFrance
  2. 2.Bordeaux UniversityBordeauxFrance
  3. 3.Department of RadiologyBrigham and Women's Hospital and Harvard Medical SchoolBostonUSA

Personalised recommendations