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. V(d), images from two SPECT scans, while a single-scan autoradiographic (ARG) technique provided rCBF using a fixed and assumed V(d). 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 mol/min/100 g for the ARG and TLU methods, respectively. Regional V(d) 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 V(d) 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.