Evaluation of cerebral hemodynamics by ¹²³I-IMP in cerebral AVMs before and after operation by using SPECT

To evaluate cerebral hemodynamics by N-isopropyl-p-[¹²³I]-iodoamphetamine (¹²³I-IMP) preoperative and postoperative (after 1 day, and after 7-10 days) regional cerebral blood flow scan, 6 arteriovenous malformations (AVMs) which performed total removal operations were studied by using a ring type SPECT 'HEADTOME'. We performed the dynamic scan just after the intravenous injection of 222 MBq (6 mCi) of ¹²³I-IMP, then the static scan 20 minutes after the intravenous injection. In preoperative dynamic scans of all cases, only the first frame image showed the increased activity on the nidus probably because of the blood pool. Preoperative static scans of all cases showed the remarkable decreased activity on the nidus, and decreased activity surrounding the nidus probably because of the peripheral steal phenomenon. In postoperative scan of the next day, 4 out of 6 cases showed the transient decreased peripheral steal, particularly 2 out of those 4 cases showed the transient hyperperfusion probably because of the normal perfusion pressure breakthrough (NPPB). And, 2 out of 6 cases showed transient peripheral low perfusion on much larger area than those of the preoperative scans probably because of the focal brain damages and edemas. We conclude that ¹²³I-IMP SPECT on AVM is very usuful to decide the indication of the removal operation, and to estimate the postoperative risk, and to evaluate the preoperative and postoperative cerebral hemodynamic changes in the peripheral area of AVM.