Detection of bilateral and symmetrical anomalies in technetium-99m-HMPAO brain SPECT studies

The detection of bilateral and symmetrical regional cerebral blood flow (rCBF) abnormalities requires knowledge of the antero-posterior rCBF distribution in normal subjects of all age groups. These data are very difficult to obtain in children for ethical reasons and in older subjects because of the necessity of recruiting a large number of healthy volunteers from each age group. Therefore, to obtain normal values of antero-posterior rCBF distribution, we have retrospectively selected a group of patients with a low probability of having cerebral lesions, whose 99mTc-HMPAO brain SPECT studies were analyzed semiquantitatively. Cerebellum/mean cerebral cortex index when compared to young adults was higher in the neonatal period, slightly lower between 2 mo and 15 yr, and more or less identical after 15 yr. Cortico/occipital indexes exhibit considerable changes during the first year of life due to important differences in maturation timing of cerebral cortical areas. After 1 yr, all cerebral cortical areas approximately displayed a parallel evolution. A slight increase in fronto/occipital and temporo/occipital indexes was, however, still observed during childhood, while in elderly subjects there was a trend towards a decrease in all cortico/occipital indexes (particularly in prefrontal and motor areas). Changes that occurred after 1 yr were, however, usually smaller than interindividual variation. Despite the large range of "normal" values, the antero-posterior analysis could be useful in various neurologic disorders, because it allows detection of symmetrical rCBF anomalies undiagnosed by the right-left analysis.