Diagnostic imaging of higher brain dysfunction in patients with adult moyamoya disease using statistical imaging analysis for [123I]iomazenil single photon emission computed tomography.
[123I]iomazenil (IMZ) is a specific radioligand for the central benzodiazepine (BZ) receptor that may be useful as a marker of cortical neuron loss after cerebral ischemia using single photon emission computed tomography (SPECT). This study used statistical imaging analysis for IMZ-SPECT to investigate the relationship between higher brain dysfunction and cortical neuron loss in the medial frontal lobes, to establish a confirmatory diagnosis of higher brain dysfunction in patients with adult moyamoya disease. IMZ-SPECT was estimated by three-dimensional stereotactic surface projections (3D-SSP). Cortical neuron loss was analyzed using the stereotactic extraction estimation (SEE) method (level 3: gyrus level) for 3D-SSP Z-score maps (Z-score >2). Extent of pixels with significant reduction of BZ receptor density within the target gyri (i.e. bilateral medial frontal gyri [MFGs] and anterior cingulate gyri [ACGs]) was calculated. In 6 patients with higher brain dysfunction, significant cortical neuron loss was observed in the bilateral MFGs in 4 patients, unilateral MFG in 1 patient, and bilateral ACGs in 2 patients. In 12 patients without higher brain dysfunction, no significant cortical neuron loss was observed in the bilateral MFGs or ACGs, and mild loss was observed in the bilateral MFGs in 2 patients, unilateral MFG in 4 patients, and unilateral ACG in 2 patients. Long-standing mild hemodynamic ischemia in the anterior circulation of patients with adult moyamoya disease could lead to incomplete brain infarction within the medial frontal lobes. Statistical imaging analysis using 3D-SSP and SEE methods for IMZ-SPECT could demonstrate significant cortical neuron loss in the bilateral frontal medial cortices involving MFG and/or ACG which correlate with higher brain dysfunction in patients with adult moyamoya disease.
Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan. george@med.nmh.or.jp
Jyoji
J
Nakagawara
Toshiaki
T
Osato
Kenji
K
Kamiyama
Kaori
K
Honjo
Hironori
H
Sugio
Kentarou
K
Fumoto
Takeo
T
Murahashi
Hidekazu
H
Takada
Toshiichi
T
Watanabe
Hirohiko
H
Nakamura
D000328:Adult; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D003627:Data Interpretation, Statistical; D005260:Female; D005442:Flumazenil / Q000031:analogs & derivatives*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010865:Pilot Projects; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D007457:Iodine Radioisotopes; D005442:Flumazenil; C063038:iomazenil