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Effect of the addition of 123I-iomazenil single-photon emission computed tomography to brain perfusion single-photon emission computed tomography on the detection accuracy of misery perfusion in adult patients with ischemic moyamoya disease

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Abstract

Objective

The present prospective study aimed to determine whether the addition of 123I-iomazenil (IMZ) single-photon emission computed tomography (SPECT) to brain perfusion SPECT could improve the detection accuracy of misery perfusion on positron emission tomography (PET) in adult patients with ischemic moyamoya disease (MMD).

Methods

Oxygen extraction fraction (OEF) and brain perfusion were assessed using 15O gas PET and N-isopropyl-p-[123I]-iodoamphetamine (IMP) SPECT, respectively, in 137 patients. IMZ SPECT was also performed. Regions of interest (ROIs) were automatically placed in the five middle cerebral artery (MCA) territories ipsilateral to the symptomatic cerebral hemisphere and in the contralateral posterior cerebral artery territory using a three-dimensional stereotaxic ROI template. The radioactive count of the MCA ROI to the contralateral posterior cerebral artery ROI was calculated on IMP SPECT (relative SPECT-IMP uptake) and IMZ SPECT (relative SPECT-IMZ uptake). The relative SPECT-IMZ uptake to the relative SPECT-IMP uptake was also calculated (relative SPECT-IMZ/IMP uptake). Of the five MCA ROIs in the symptomatic cerebral hemisphere in each patient, the ROI with the highest PET-OEF value (one ROI per patient) was selected for analysis.

Results

Significant correlations were observed between the PET-OEF and relative SPECT-IMP uptake (correlation coefficient, – 0.683) and relative SPECT-IMZ/IMP uptake (correlation coefficient, 0.875). The area under the receiver operating characteristic curve for detecting misery perfusion (PET-OEF > 51.3%) was significantly greater for the relative SPECT-IMZ/IMP uptake than for the relative SPECT-IMP uptake (difference between areas, 0.080; p = 0.0004). The sensitivity, specificity, and positive- and negative-predictive values for the relative SPECT-IMZ/IMP uptake for detecting misery perfusion were 100%, 92%, 81%, and 100%, respectively. The specificity and positive-predictive value were significantly greater for the relative SPECT-IMZ/IMP uptake than for the relative SPECT-IMP uptake.

Conclusions

The addition of IMZ SPECT to brain perfusion SPECT improves the detection accuracy of misery perfusion on PET in adult patients with ischemic MMD.

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Data Availability

All data generated or analyzed during this study are not publicly available on ethical grounds. However, inquiries regarding these data can be directed to the corresponding author.

Abbreviations

AUC:

Area under the receiver operating characteristic curve

CBF:

Cerebral blood flow

CMRO2 :

Cerebral metabolic rate of oxygen

CI:

Confidence interval

ICA:

Internal carotid artery

123I-IMP:

N-Isopropyl-p-[123I]-iodoamphetamine

IMZ:

123I-iomazenil

MCA:

Middle cerebral artery

MMD:

Moyamoya disease

MRI:

Magnetic resonance imaging

OEF:

Oxygen extraction fraction

PET:

Positron emission tomography

ROC:

Receiver operating characteristic

ROI:

Region of interest

SD:

Standard deviation

SPECT:

Single-photon emission computed tomography

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Funding

This work was partly supported by Grants-in-Aids from the Scientific Research KAKEN from the Japan Society for the Promotion of Science (21K09108 and 21K09157) and Grants-in-Aids from the National Hospital Organization Kamaishi Hospital KENKYUHI.

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Authors and Affiliations

  1. Department of Neurosurgery, Iwate Medical University, Iwate, Japan

    Kuniaki Ogasawara, Tatsuhiko Takahashi, Suguru Igarashi, Masahiro Yabuki, Daisuke Omori, Yosuke Akamatsu, Kohei Chida, Masakazu Kobayashi & Shunrou Fujiwara

  2. Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan

    Kuniaki Ogasawara, Tatsuhiko Takahashi, Suguru Igarashi, Masahiro Yabuki, Daisuke Omori, Kohei Chida, Masakazu Kobayashi & Kazunori Terasaki

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  1. Kuniaki Ogasawara
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  2. Tatsuhiko Takahashi
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  3. Suguru Igarashi
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Correspondence to Kuniaki Ogasawara.

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The author (Kuniaki Ogasawara) declared the following potential conflict of interest with respect to the research, authorship, and/or publication of this article: Consigned research funds from Nihon Medi-Physics Co., Ltd.

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Ogasawara, K., Takahashi, T., Igarashi, S. et al. Effect of the addition of 123I-iomazenil single-photon emission computed tomography to brain perfusion single-photon emission computed tomography on the detection accuracy of misery perfusion in adult patients with ischemic moyamoya disease. Ann Nucl Med 37, 280–288 (2023). https://doi.org/10.1007/s12149-023-01825-0

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