Basics and Recommendations for Brain SPECT^[*]

Zusammenfassung

In diesem Artikel werden von der Arbeitsgruppe »Neurologie« der Europäischen Gesellschaft für Nuklearmedizin (EANM) Richtlinien für die SPECT des Gehirns gegeben. In den einzelnen Kapiteln werden die pathophysiologischen Grundlagen verschiedener Krankheiten des Gehirns, die Pharmakokinetik und -dynamik verschiedener Radiopharmaka, die physikalischen Grundlagen, die computerisierte Datenverarbeitung, die klinischen Aufzeichnungen und die Auswertung der SPECT-Ergebnisse besprochen.

Summary

In this article guidelines for single-photon emission computerized tomography (SPECT) of the brain are presented by the Task Group “Neurology” of the European Association of Nuclear Medicine (EANM). Under separate headings are discussed: the pathophysiologic principles of various brain diseases, pharmacokinetics and pharmacodynamics of various radiopharmaceuticals, physical principles of SPECT imaging, computerized data processing, clinical protocols and the evaluation of SPECT results.

Schlüsselwörter

SPECT - zerebraler Blutfluß - Blutvolumen - Neurorezeptoren - Dosimetrie - SPECT Kameras - MeßwertVerarbeitungssysteme

Key words

SPECT - cerebral blood flow - cerebral blood volume - neuroreceptors - dosimetry - SPECT cameras - computers

^* The authors are members or coworkers of the Task Group “Neurology” of the European Association of Nuclear Medicine (EANM).

• REFERENCES

• 1 Andersen AR, Friberg HH, Schidt JF, Hasselbalch SG. Quantitative measurements of cerebral blood flow using SPECT and 99mTc-HM-PAO compared to xenon-133. J Cereb Blood Flow Mctab 1988; 08: 69-81.
• 2 Askienazy SA, Habert MO, Vallee E. Methodology of emission tomography: SPECT and PET. In: Focal epilepsy: Clinical use of emission tomography. Baldy-Moulinicr M, Lassen NA. et al. eds. London: John Libbcy; 1990
• 3 Ballinger JR, Reid RH, Gulcnchyn KY. Technetium-99m HMPAO stereoisomeres: differences in interaction with glutathion. J Nucl Med 1988; 29: 1998-2000.
• 4 Bartenstein P, Ludolph A, Schober O. et al. Benzodiazepine receptors and cerebral blood flow in partial epilepsy. Eur J Nucl Med 1991; 18: 111-8.
• 5 Beer HF, Bläuenstein PA, Hasler PH. et al. In vitro and in vivo evaluation of iodinc-123-Ro 16-0154: A new imaging agent for SPECT investigations of benzodiazepine receptors. J Nucl Med 1990; 31: 1007-14.
• 6 Bobeldijk M, Verhoeff NPLG, Vekemans JAJM. et al. A simple and high-yield synthesis os (S)-BZM, (R)-BZM and (S)-IBZM for the preparation of (S)-¹²³I-IBZM. J Lab Comp Radiopharm 1990; 28: 1247-56.
• 7 Bonte FJ, Devous MD, Reisch JS. The effect of acetazolamidc on regional cerebral blood flow in normal human subjects as measured by SPECT. Invest Radiol 1988; 23: 564-8.
• 8 Brücke T, Podrcka I, Angclbcrgcr P. et al. Dopamine D2 receptor imaging with SPECT: Studies in different ncuropsychiatric disorders. J Cereb Blood Flow Mctab 1991; 11: 220-8.
• 9 Buell U, Braun H, Fcrbcrt A. et al. Combined SPECT imaging of regional cerebral blood flow (^99mTc HMPAO) and blood volume (^99mTc-RBC) to assess regional cerebral perfusion reserve in patients with cerebrovascular disease. Nucl-Med 1988; 27: 51-6.
• 10 Buell U, Schicha H. Tomographische Funktionsdiagnostik in der Nuklearmedizin: Erfassung regionaler Reserven und Bilanzen. Nucl-Med 1989; 28: 45-8.
• 11 Buell U, Schicha H. Nuclear medicine to image applied pathophysiology: evaluation of reserves by ECT (editorial). Eur J Nucl Med 1990; 16: 129-35.
• 12 Choksey MS, Costa DC, lannotti F, Ell PJ, Crockard HA. Tcm-HMPAO SPECT and cerebral blood flow: a study of CO₂ reactivity. Nucl Med Commun 1989; 10: 609-18.
• 13 Cooper JR, Bloom FE, Roth RH. The biochemical basis of neuropharmacology. Fifth Edition. Oxford: University Press; 1986: 140-1. 197, 290-1. 294-5, 339-40..
• 14 Costa DC, Jones BE, Steiner TJ. et al. Experimental studies of Tc-99m HMPAO with a rCBF model. Nucl Med Commun 1986; 07: 282-3.
• 15 Costa DC, Verhoeff NPLG, Cullum ID. et al. In vivo characterisation of 3-iodo-6-methoxybenzamidc ¹²³I in humans. Eur J Nucl Med 1990; 16: 813-6.
• 16 Creutzig H, Schober O, Gielow P. et al. Cerebral dynamics of N-isopropyl-(l-123)p-iodoamphetamine. J Nucl Med 1986; 27: 178-83.
• 17 Cullum ID. SPECT methodology. In: rCBF atlas. The clinical application of rCBF imaging by SPECT. Ell PJ, Costa DC, Cullum ID, Jarritt PH, Lui D. eds. Little Chalfont: Amersham International; 1987: 19-26.
• 18 D’Agincourt L. Three-head scanning earns new credibility for SPECT. In: Diagnostic Imaging. Miller Freeman Publications; 1990
• 19 De Brume JF, Van Royen EA, Vyth A, De Jong JMBV, Van der Schoot JB. Thallium-201 diethyl dithiocarbamatc: an alternative to iodine-123 N-isopropyl-p-iodoamphctamine. J Nucl Med 1985; 26: 925-30.
• 20 De Jong BM, Feenstra MGP, Ruijter JJ, Van Royen EA. Serotonin uptake in cerebral cortex cultures: imipraminc-likc inhibition by N-isopropyl-p-iodoamphctaminc. Exp Neurol 1989; 103: 297-9.
• 21 De Jong BM, Van Royen EA. Uptake of SPECT radiopharmaccuticals in ncocortical brain cultures. Eur J Nucl Med 1989; 15: 16-20.
• 22 Dominguez PMontero, Aasard PE, Britton KE. et al. Quality assurance of regional cerebral blood flow by radionuclide tomography. Working Group 4. COST Projcct B2. Commission of the European Communities. European Co-Operation in the Field of Scicntific and Technical Research. 2nd Annual Report 1990; January 1991: 46-54.
• 23 Frackowiak RSJ, Wise RJS. Positron tomography in ischemic ccrcbrovascular disease. Neurol Clin 1983; 01: 183-200.
• 24 Friberg L. Methods for manipulation of regional brain perfusion, intracranial artery diameter and cerebral blood volume. In: Stimulated cerebral blood flow. Heidelberg - Berlin - New York: Springer; 1991. (in press).
• 25 Gachtgcns P, Marx P. Hcmorhcological aspects of the pathophysiology of cerebral ischemia. J Ccrcbr Blood Flow Mctab 1987; 07: 259-65.
• 26 Genna S, Smith AP. The development of ASPECT, an annular single crvsial brain camera for high efficiency SPECT. IEEE Trans Nucl Sei 1988; NS-35: 654-8.
• 27 Gibbs JM, Wise RJS, Leenders KL, Jones T. Evaluation of cerebral perfusion reserve in patients with carotidartery occlusion. Lancet 1984; i: 310-4.
• 28 Günther W, Moser E, Mueller FSpahn. et al. Pathologic cerebral blood flow during motor function in schizophrenic and endogenous depressed patients. Biol Psychiatry 1986; 21: 889-99.
• 29 Heiss WD. Flow thresholds of functional and morphological damage of brain tissue. Stroke 1983; 14: 329-31.
• 30 Herold S, Brown MM, Frackowiak RSJ. et al. Assessment of cerebral haemodynamic reserve: correlation between PET parameters and CO₂ reactivity measured by intravenous 133-Xenon injection technique. J Neurol Neurosurg Psychiatry 1988; 51: 1045-50.
• 31 Higashi Y, Yamaoga N, Ohi J. et al. Development of the Shimadzu single photon emission tomograph for head, SET-031. Shimadzu Rev 1985; 42: 59-66.
• 32 Holman BL, Carvalho PA, Zimmerman RE. et al. Brain perfusion SPECT using an annular single crystal camera: initial clinical experience. J Nucl Med 1990; 31: 1456-61.
• 33 Holman BL, Hill TC, Lee RGL. et al. Brain imaging with radiolabeled amines. In: Nuclear Medicine Annual 1983. New York: Raven; 1983
• 34 Innis RB, Al-Tikriti MS, Zoghbi SS. et al. SPECT imaging of the benzodiazepine receptor: Feasibility of in vivo potency measurements from stepwise displacement curves. J Nucl Med 1991; 32: 1754-61.
• 35 Jarritt PH, Ell PJ. Gamma camera emission tomography: Quality control & clinical applications. London: Current Medical Literature Ltd; 1984
• 36 Jordan K. Möglichkeiten und Grenzen der SPECT-Technik. Nuklearmedizincr 1985; 08: 207-13.
• 37 Kety SS, Schmidt CF. The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and carboxidc consumption of normal young man. J Clin Invest 1948; 27: 484-92.
• 38 Keyes Jr JW. Tips for high quality SPECT. Computer and Instrumentation Council Newsletters 1990; 07: 1-3.
• 39 Keyeux A, Laterre Ch, Beckers CH. Resting and hypcrkapnic rCBF in patients with unilateral occlusivc disease of the internal carotid artery. J Nucl Med 1988; 29: 311-9.
• 40 Knapp WH, Kummer R, Kübler W. Imaging of cerebral blood flow-to-volumc distribution using SPECT. J Nucl Med 1986; 27: 465-70.
• 41 Kuhl DE. Imaging of local brain function with ECT. Radiology 1984; 150: 625-31.
• 42 Kuhl DE, Barrio JR, Huang SC. et al. Quantifying local cerebral blood flow by N-isopropyl-p-(I-123) iodoamphctaminc (IMP) tomography. J Nucl Med 1982; 23: 196-203.
• 43 Kuhl DE, Edwards RQ, Ricci AR. et al. The Mark IV system for radionuclide computed tomography of the brain. Radiology 1976; 121: 405-13.
• 44 Kung HF, Alavi A, Chang W. et al. In vivo SPECT imaging of CNS D-2 dopamine reccptors: Initial studies with Iodine-123-IBZM in humans. J Nucl Med 1990; 31: 573-9.
• 45 Kung HF, Pan S, Kung MP. et al. In vitro and in vivo evaluation of (123I) IBZM: A potential CNS D-2 dopamine receptor imaging agent. J Nucl Med 1989; 30: 88-92.
• 46 Kung HF, Tramposch KM, Blau M. A new brain perfusion imaging agent: (I-123)-HIPDM: N,N,N’-trimethyl-N’-(2-hydroxy-3-methyl-5-iodobenzyl)-1,3-propanediamine. J Nucl Med 1983; 24: 66-72.
• 47 Larsson SA. Gamma camera emission tomography. Acta Radiol. 1980 Suppl. 363.
• 48 Lassen NA. Regional cerebral blood flow measurements in stroke: the necessity of a tomographic approach. J Cerebr Blood Flow Metab 1981; 01: 141-2.
• 49 Lassen NA, Hendriksen L, Holm S. et al. Cerebral blood flow tomography: Xenon-133 compared with isopropyl amphetamine-iodine-123. J Nucl Med 1983; 24: 17-21.
• 50 Leinsinger G, Schmiedek P, Keisig T. et al. 133-Xe-DPECT: Bedeutung der zerebrovaskulären Reservekapazität für Diagnostik und Therapie der chronischen zerebralen Ischämie. Nucl-Med 1988; 27: 127-34.
• 51 Levine RL, Sunderland JJ, Lagreze HL. et al. Cerebral perfusion reserve indexes determined by fluoromethane PET. Stroke 1988; 19: 19-27.
• 52 Lottes G. Verfahren zur iterativen Rekonstruktion bei der longitudinalen SPECT am Beispiel eines Multidetektor-Scanners. Doctoral Thesis, Medical University Hannover; Federal Republic of Germany: 1982
• 53 Mazière B, Mazière M. Where have we got with neuroreceptor mapping of the human brain?. Eur J Nucl Med 1990; 16: 817-35.
• 54 Olsen TS, Larsen B, Herning M, Skriver EB, Lassen NA. Blood flow and vascular reactivity in collaterally perfused brain tissue. Evidence of an ischemic penumbra in patients with acute stroke. Stroke 1983; 14: 332-7.
• 55 Podreka I, Baumgarner C, Suess E. et al. Quantification of regional cerebral blood flow with 1MP-SPECT. Stroke 1989; 20: 183-191.
• 56 Podreka I, Goldenberg G, Baumgartner C. HMPAO brain uptake in young normal subjects: gender differences and hemispheric asymmetries. J Cereb Blood Flow Metab 1989; (Suppl. 01) 202.
• 57 Powers WJ, Raichle ME. PET and its application to the study of cerebrovascular disease in man. Stroke 1985; 16: 361-76.
• 58 Reich T, Rusinek H. Cerebral cortical and white matter reactivity to carbon oxide. Stroke 1989; 20: 452-7.
• 59 Ringelstein EB, Sievers C, Ecker S, Schneider PA, Otis SM. Noninvasive assessment of CO₂-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusion. Stroke 1988; 19: 963-9.
• 60 Risberg J, Ali ZA, Wilson EM. RCBF by 133-Xenon inhalation. Stroke 1975; 06: 142-8.
• 61 Roncari G, Ziegler WH, Guentert TW. Pharmacokinetics of the new benzodiazepine antagonist Ro 15-1788 in man following intravenous and oral administration. Br J Clin Pharmacol 1986; 22: 421-8.
• 62 Sakai F, Nakazawa K, Tazaki Y. et al. Regional cerebral blood volume and hematocrit measured in normal human volunteers by SPECT. J Cerebr Blood Flow Metab 1985; 05: 207-13.
• 63 Sakai F, Tazaki Y. Regional cerebral blood flow, volume, and hematocrit measured by SPECT. In: Cerebral ischemia and hemorheology. Hartmann A, Kuschinsky W. eds. Berlin - Heidelberg - New York: Springer; 1987: 211-6.
• 64 Schlake HP, Böttger IG, Grotemeyer KH. et al. Single photon emission computed tomography with Technetium-99m hexamethyl propylenamino oxime in the pain interval of migraine and cluster headache. Eur Neurol 1990; 30: 153-6.
• 65 Schmidlin P. Zerlegung der Aufnahmen der symmetrischen Positronen-Kamera in einzelne Bildebenen mit Hilfe eines mathematischen Verfahrens. 9th Ann Meet; Soc Nucl Med - Europe - Antwerpen, Belgium: 1971
• 66 Schmid-Schönbein H, Driessen G, Gallasch H. Hemorheology and cerebral infarction: on the role of pathological blood thixotrophy in the pathogenesis of an therapy for states of acute cerebral hypoperfusion. In: Cerebral ischemia and hemorheology. Hartmann A, Kuschinsky W. eds. Berlin - Heidelberg - New York: Springer; 1987: 27-50.
• 67 Schmidt U, Knapp WH, Busse O. et al. Veränderung der zerebralen Aufnahme von Tc-99m-HMPAO in Abhängigkeit vom arteriellen C02-Spiegel. Nucl-Med 1988; 27: 27.
• 68 Schober O, Galaske RG, Heyer R. Determination of brain death with ¹²³I-IMP and ^99mTc-HMPAO. Neurosurg Rev 1987; 10: 19-22.
• 69 Schubiger PA, Hasler PH, Beer-Wohlfahrt H. et al. Evaluation of a multicentre study with Iomazenil - a benzodiazepine receptor ligand. Nucl Med Commun 1991; 12: 569-82.
• 70 Sorenson JA, Phelps ME. Physics in nuclear medicine. Second edition. New York: Grune and Stratton; 1987
• 71 Tatsch K, Schwarz J, Oertel WH, Kirsch CM. SPECT imaging of dopamine D2 receptors with ¹²³I-IBZM: initial experience in controls and patients with Parkinson’s syndrome and Wilson’s disease. Nucl Med Commun 1991; 12: 699-707.
• 72 Todd-Pokropek A, Clarke G, Marsh R, Gillardi MC, Fazio F. The need for scatter and attenuation correction. In: Radioaktive Isotope in Klinik und Forschung. Höfer R, Bergmann H. eds. 1984
• 73 Toyama H, Takeshita G, Takeuchi A. et al. Cerebral hemodynamics in patients with chronic obstructive carotid disease by rCBF, rCBV, and rCBV/rCBF ratio using SPECT. J Nucl Med 1990; 31: 55-60.
• 74 Tsui BMW, Gullberg GT, Edgerton ER. et al. Design and clinical utility of a fan beam collimator for SPECT imaging of the head. J Nucl Med 1986; 27: 810-9.
• 75 Vallabhajosula S, Zimmerman RE, Picard M. et al. Technetium-99m ECD: a new brain imaging agent: in vivo kinetics and biodistribution studies in normal human subjects. J Nucl Med 1989; 30: 599-604.
• 76 Verhoeff NPLG. Pharmacological implications for neuroreceptor imaging. Eur J Nucl Med 1991; 18: 482-502.
• 77 Verhoeff NPLG, Brücke T, Podreka I. et al. Dynamic SPECT in two healthy volunteers to determine the optimal time for in vivo D2 dopamine receptor imaging with ^l23I-IBZM using the rotating gamma camera. Nucl Med Commun 1991; 12: 687-97.
• 78 Verhoeff NPLG, Costa DC, Ell PJ. et al. Dopamine D2-receptor imaging with dynamic 1-123 IBZM SPECT in patients with schizophrenia or HIV encephalopathy. In: The state of the art of nuclear medicine in Europe. Schmidt HAE, Van der Schoot JB. eds. Stuttgart - New York: Schattauer; 1991: 207-12.
• 79 Verhoeff NPLG, Van Royen EA, Ell PJ. et al. Benzodiazepine receptor density in human brain measured in vivo with 123-1- Iomazenil SPECT. Nuclear Medicine. In: The state of the art of nuclear medicine in Europe. Schmidt HAE, Van der Schoot JB. eds. Stuttgart - New York: Schattauer; 1991: 203-6.
• 80 Verhoeff NPLG, Van Royen EA, Horn J. et al. Whole body distribution of 1-123 Iodo-benzamide in 6 healthy human volunteers. J Nucl Med 1991; 32: 1018.
• 81 Verhoeff NPLG, Van Royen EA, Overweg J. et al. ¹²³I Iomazenil whole body distribution in human volunteers. Eur J Nucl Med 1990; 16: 461.
• 82 Vostrup S, Brun B, Lassen NA. Evaluation of cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke 1986; 17: 1291-8.
• 83 Vyth A, Fennema PJ, Van der Schoot JB. Tl-201 diethyldithiocarbamate. A possible radiopharmaceutical for brain imaging. Pharm Weekbl (Sei edit) 1983; 05: 213-6.
• 84 Walovitch RC, Makuch J, Knapik G. et al. Brain retention of ^99mTc ECD is related to in vivo metabolism. J Nucl Med 1988; 29: 747.
• 85 Wise RJS, Bernardi S, Frackowiak RSJ, Legg NJ, Jones T. Serial observations on the pathophysiology of acute stroke. Brain 1983; 106: 197-222.
• 86 Young AB, Frey KA, Agranoff BW. Receptor assays: In vitro and in vivo. In: Positron emission tomography and autoradiography. Phelps ME, Mazziotta JC, Schelbert HR. eds. New York: Raven; 1986: 74.