[A quantitative approach to the rCBF response to acetazolamide using 99mTc-HMPAO and graphical analysis]

A simple noninvasive method for a quantitative measurement of brain perfusion is presented using intravenous radionuclide angiography with 99mTc-hexamethylpropylene amine oxime (HMPAO). Graphical analysis was employed for the evaluation of the unidirectional influx constant (ku) of the tracer from the blood to the brain and the initial distribution volume (Vn) for the tracer, which is the volume of the exchangeable region plus the plasma space. The ku and Vn values were standardized to provide objective and comparable values, brain perfusion indices (BPI) and corrected Vn (Corr. Vn), between subjects by setting the size ratio of ROI(brain) to ROI(aorta) at 10 and 1, respectively. BPI and Corr. Vn of the whole brain were measured before and 20 min after injection of 1 g acetazolamide. After acetazolamide administration, BPI and Corr. Vn increased in all eight subjects with cerebrovascular diseases and one with a pituitary adenoma, by a mean of x 1.26 and 1.24, respectively. Increase of BPI showed a significant correlation with increase of Corr. Vn. This technique is easy to apply as an adjunct to SPECT and may be helpful in the measurement of brain perfusion changes in the acetazolamide test.