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Yasuda S, Katakura Y, Kubo Y, Dobashi K, Kimura K, Fujiwara S, Chida K, Akamatsu Y, Kobayashi M, Yoshida K, Terasaki K, Ogasawara K. Recovery of cortical neurotransmitter receptor function and its impact on cognitive improvement after indirect revascularization surgery alone for adult patients with ischemic moyamoya disease: 123I-iomazenil single-photon emission computed tomography study. World Neurosurg 2022; 164:e1135-e1142. [PMID: 35660480 DOI: 10.1016/j.wneu.2022.05.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Brain 123I-iomazenil single-photon emission computed tomography (SPECT) can assess the distribution of the binding potential of central benzodiazepine receptors in the cerebral cortex. This binding potential may reflect neuronal function in viable tissues. The present prospective study using brain 123I-iomazenil SPECT aimed to determine whether improvements in cognitive function after indirect revascularization surgery alone are associated with postoperative recovery in neurotransmitter receptor function in the affected cerebral hemisphere among adult patients with moyamoya disease (MMD) accompanied by ischemic presentation due to misery perfusion. METHODS Twenty-two patients who underwent indirect revascularization surgery alone also underwent brain SPECT scanning at 180 minutes after 123I-iomazenil administration and neuropsychological testing before and at 6 months after surgery. The affected-to-contralateral cerebral hemispheric asymmetry of tracer uptake before and after surgery was then calculated. RESULTS The asymmetry of tracer uptake was significantly increased after surgery (p < 0.0001). A significant difference between the pre- and postoperative asymmetry of tracer uptake was seen in patients with improved cognition compared with those with unchanged cognition (p = 0.0001). The area under the receiver operating characteristic curve was 0.99 for the difference between the pre- and postoperative asymmetry of tracer uptake to assess the ability to discriminate patients with improved cognition from those with unchanged cognition. CONCLUSIONS Improvements in cognitive function after indirect revascularization surgery alone are associated with postoperative recovery in the binding potential of central benzodiazepine receptors in the affected cerebral hemisphere in adult patients with MMD accompanied by ischemic presentation due to misery perfusion.
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Affiliation(s)
- Sara Yasuda
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Yasukazu Katakura
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kazumasa Dobashi
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kazuto Kimura
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kohei Chida
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Yosuke Akamatsu
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kazunori Terasaki
- Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba, Japan.
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Sato S, Fujiwara S, Miyoshi K, Chida K, Kobayashi M, Kubo Y, Yoshida K, Terasaki K, Ogasawara K. Improvement in gait function after carotid endarterectomy is associated with postoperative recovery in perfusion and neurotransmitter receptor function in the motor-related cerebral cortex: a 123I-iomazenil SPECT study. Nucl Med Commun 2020; 41:1161-1168. [PMID: 32815897 DOI: 10.1097/mnm.0000000000001275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Carotid endarterectomy (CEA) often restores cerebral perfusion and neurotransmitter receptor function, which is seen on early and late images, respectively, on brain I-iomazenil single-photon emission computed tomography (SPECT). The reliability of gait-related parameters obtained using a triaxial accelerometer, a portable device for gait assessment, has been confirmed with test-retest measurements. The purpose of the present prospective cohort study was to determine whether improvement in gait function after CEA is associated with postoperative recovery in perfusion and neurotransmitter receptor function in the motor-related cerebral cortex. METHODS Gait testing using a triaxial accelerometer was performed preoperatively and 6 months postoperatively in 64 patients undergoing CEA for ipsilateral internal carotid artery stenosis (≥70%). I-iomazenil SPECT was also performed with scanning within 30 min (early images) and at 180 min (late images) after tracer administration before and after surgery. SPECT data were analyzed using a three-dimensional stereotactic surface projection, and motor (Brodmann 4) and premotor (Brodmann 6) cortexes in each hemisphere were combined and defined as the motor-related cortex. RESULTS Based on preoperative and postoperative gait testing, seven patients (11%) showed postoperative improved gait. Logistic regression analysis revealed that postoperative increase in I-iomazenil uptake in the motor-related cortex ipsilateral to surgery on early [95% confidence interval (CI), 4.32-365.21; P = 0.0477) or late (95% CI, 9.45-1572.57; P = 0.0173) images was an independent predictor of postoperative improved gait. CONCLUSIONS Improvement in gait function after CEA is associated with postoperative recovery in perfusion and neurotransmitter receptor function in the motor-related cerebral cortex.
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Affiliation(s)
- Shinpei Sato
- Department of Neurosurgery.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | | | | | | | - Masakazu Kobayashi
- Department of Neurosurgery.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | | | | | | | - Kuniaki Ogasawara
- Department of Neurosurgery.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
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Kubo Y, Koji T, Murakami T, Yoshida K, Matsumoto Y, Ogasawara K. Long-Term Outcomes of Cerebral Blood Flow and Neurotransmitter Receptor Function on Iodine-123-Iomazenil Single-Photon Emission Computed Tomography and Cognitive Assessments After Parent Artery Occlusion Combined with Cerebral Revascularization for Internal Carotid Artery Aneurysms. World Neurosurg 2020; 143:e199-e205. [PMID: 32810631 DOI: 10.1016/j.wneu.2020.07.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Many studies of external-internal carotid artery (EC-IC) bypass as cerebral revascularization for unclippable internal carotid artery (ICA) aneurysms have reported surgical outcomes, including bypass patency and aneurysm resolution. However, no previous studies have assessed the long-term outcomes of cerebral blood flow (CBF), brain neural density, and cognition. The purpose of the present study was to evaluate the long-term outcomes of CBF and neurotransmitter receptor function using early and late images of iodine-123 (123I)-iomazenil (IMZ) single-photon emission computed tomography (SPECT) and the cognitive function of patients who had undergone EC-IC bypass for symptomatic aneurysms in the cavernous portion of the ICA. METHODS We performed a prospective observational study of 11 patients who had undergone superficial temporal artery-middle cerebral artery bypass or bypass using a saphenous vein graft for symptomatic aneurysms in the cavernous portion of the ICA. One patient experienced extensive infarction and, therefore, did not undergo postoperative testing. 123I-IMZ SPECT was performed with scanning at 23 minutes (early) and 180 minutes (late) after tracer administration before and after surgery. The preoperative and follow-up neuropsychological test scores from 6 patients were also analyzed. RESULTS None of 10 patients who had undergone EC-IC bypass showed reductions in CBF and brain neural density. In addition, the neuropsychological test scores had not changed significantly from preoperatively to postoperatively. CONCLUSION Using early and late 123I-IMZ SPECT, the present study has demonstrated that patients undergoing uncomplicated cerebral revascularization for unclippable ICA aneurysms will not experience reductions in CBF or neurotransmitter receptor function, and their cognitive function was not impaired.
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Affiliation(s)
- Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
| | - Takahiro Koji
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | | | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | | | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
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Crossed Cerebellar Tracer Uptake on Acute-Stage 123I-Iomazenil SPECT Imaging Predicts 3-Month Functional Outcome in Patients With Nonfatal Hypertensive Putaminal or Thalamic Hemorrhage. Clin Nucl Med 2018. [PMID: 29538036 DOI: 10.1097/rlu.0000000000002068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Whereas SPECT images obtained 180 minutes after administration of I-iomazenil (IMZ) (late images) are proportional to the distribution of central benzodiazepine receptor-binding potential, SPECT images obtained within 30 minutes after I-IMZ administration (early images) correlate with regional brain perfusion. The aim of the present study was to determine whether crossed cerebellar tracer uptake on acute-stage I-IMZ SPECT imaging predicts 3-month functional outcome in patients with nonfatal hypertensive putaminal or thalamic hemorrhage. METHODS Forty-six patients underwent early and late SPECT imaging with I-IMZ within 7 days after the onset of hemorrhage. A region of interest was automatically placed in the bilateral cerebellar hemispheres using a 3-dimensional stereotaxic region-of-interest template, and the ratio of the value in the cerebellar hemisphere contralateral to the affected side to that in the ipsilateral cerebellar hemisphere (ARcbl) was calculated in each patient. Each patient's physical function was measured using the modified Rankin scale (mRS) score 3 months after onset. RESULTS The ARcbl on early (ρ = -0.511, P = 0.0003) and late (ρ = -0.714, P < 0.0001) images correlated with the mRS 3 months after the onset of hemorrhage. Multivariate analysis showed that only a low ARcbl in late images was significantly associated with a poor functional outcome (mRS score ≥3 at 3 months after onset) (95% confidence interval, 0.001-0.003; P = 0.0212). CONCLUSIONS Crossed cerebellar tracer uptake on acute-stage I-IMZ SPECT imaging predicts 3-month functional outcome in patients with nonfatal hypertensive putaminal or thalamic hemorrhage.
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Murakami T, Kashimura H, Endo H, Kuroda H, Ogasawara K. Chronological Changes in Brain Blood Flow and Central Benzodiazepine Receptor Binding Potential in a Patient with Symptomatic Epilepsy after Surgery for Aneurysmal Subarachnoid Hemorrhage: 123I-Iomazenil Single-Photon Emission Computed Tomography Studies. Case Rep Neurol 2017. [DOI: 10.1159/000480228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Early <sup>123</sup>I-iomazenil single-photon emission computed tomography (SPECT) images are correlated with blood flow in the brain, and late images are correlated with cortical benzodiazepine receptor binding potential. Reduced metabolism in the contralateral cerebral hemisphere is indicated by crossed cerebellar hypoperfusion (CCH). We present the case of a 63-year-old man who developed symptomatic epilepsy 13 days after surgery for an aneurysmal subarachnoid hemorrhage. Early images on <sup>123</sup>I-iomazenil SPECT 2 days after seizure onset revealed CCH and hyperperfusion in the affected cerebral hemisphere where benzodiazepine receptor binding potential was reduced in late images on <sup>123</sup>I-iomazenil SPECT. These abnormal findings resolved on repeated <sup>123</sup>I-iomazenil SPECT 1 month after seizure onset. The case we present here is consistent with the idea that the central benzodiazepine receptor system in the human brain undergoes changes that are related to seizures due to epilepsy.
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Nagamitsu S, Yamashita Y, Tanigawa H, Chiba H, Kaida H, Ishibashi M, Kakuma T, Croarkin PE, Matsuishi T. Upregulated GABA Inhibitory Function in ADHD Children with Child Behavior Checklist-Dysregulation Profile: 123I-Iomazenil SPECT Study. Front Psychiatry 2015; 6:84. [PMID: 26082729 PMCID: PMC4451796 DOI: 10.3389/fpsyt.2015.00084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/18/2015] [Indexed: 11/23/2022] Open
Abstract
The child behavior checklist-dysregulation profile (CBCL-DP) refers to a pattern of elevated scores on the attention problems, aggression, and anxiety/depression subscales of the child behavior checklist. The aim of the present study was to investigate the potential role of GABA inhibitory neurons in children with attention deficit/hyperactivity disorder (ADHD) and dysregulation assessed with a dimensional measure. Brain single photon emission computed tomography (SPECT) was performed in 35 children with ADHD using 123I-iomazenil, which binds with high affinity to benzodiazepine receptors. Iomazenil binding activities were assessed with respect to the presence or absence of a threshold CBCL-DP (a score ≥210 for the sum of the three subscales: Attention Problems, Aggression, and Anxiety/Depression). We then attempted to identify which CBCL-DP subscale explained the most variance with respect to SPECT data, using "age," "sex," and "history of maltreatment" as covariates. Significantly higher iomazenil binding activity was seen in the posterior cingulate cortex (PCC) of ADHD children with a significant CBCL-DP. The Anxiety/Depression subscale on the CBCL had significant effects on higher iomazenil binding activity in the left superior frontal, middle frontal, and temporal regions, as well as in the PCC. The present brain SPECT findings suggest that GABAergic inhibitory neurons may play an important role in the neurobiology of the CBCL-DP, in children with ADHD.
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Affiliation(s)
- Shinichiro Nagamitsu
- Department of Pediatrics and Child Health, Kurume University School of Medicine , Fukuoka , Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine , Fukuoka , Japan
| | - Hitoshi Tanigawa
- Department of Radiology, Kurume University School of Medicine , Fukuoka , Japan
| | - Hiromi Chiba
- Department of Psychiatry, Kurume University School of Medicine , Fukuoka , Japan
| | - Hayato Kaida
- Department of Radiology, Kurume University School of Medicine , Fukuoka , Japan
| | - Masatoshi Ishibashi
- Department of Radiology, Kurume University School of Medicine , Fukuoka , Japan
| | - Tatsuyuki Kakuma
- Biostatistics Center, Kurume University School of Medicine , Fukuoka , Japan
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester , MN , USA
| | - Toyojiro Matsuishi
- Department of Pediatrics and Child Health, Kurume University School of Medicine , Fukuoka , Japan
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Combination of preoperative cerebral blood flow and 123I-iomazenil SPECT imaging predicts postoperative cognitive improvement in patients undergoing uncomplicated endarterectomy for unilateral carotid stenosis. Clin Nucl Med 2012; 37:128-33. [PMID: 22228333 DOI: 10.1097/rlu.0b013e31823e9a9a] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the present study was to determine whether preoperative cerebral blood flow (CBF) or cortical central benzodiazepine receptor binding potential as measured by brain perfusion or (123)I-iomazenil (IMZ) single-photon emission computed tomography (SPECT) imaging, respectively, can predict cognitive improvement after uncomplicated carotid endarterectomy (CEA). METHODS Neuropsychological testing was performed preoperatively and after 1 month postoperatively in 140 patients who underwent CEA for unilateral internal carotid artery (ICA) stenosis (≥ 70%). Brain perfusion SPECT using N-isopropyl-p-[(123)I]-iodoamphetamine and IMZ SPECT was also performed before surgery. SPECT data were analyzed using a 3-dimensional stereotaxic region-of-interest template. RESULTS Fourteen patients (10%) showed improved cognitive function postoperatively. Logistic regression analysis demonstrated that, among the variables tested, low relative CBF in the cerebral hemisphere ipsilateral to surgery was significantly associated with postoperative cognitive improvement (95% confidence interval: 0.623-0.868; P = 0.0003). The combination of reduced relative CBF and moderately reduced relative uptake of IMZ identified development of postoperative cognitive improvement with 100.0% sensitivity, 84.9% specificity, a positive predictive value of 42.4%, and a negative predictive value of 100%. Further, in a subgroup of patients with reduced relative CBF and moderately reduced relative uptake of IMZ, the difference between these 2 values was significantly greater in patients with postoperative cognitive improvement than in those without (P < 0.0001). CONCLUSIONS The combination of preoperative CBF and cortical central benzodiazepine receptor binding potential as determined by SPECT can predict cognitive improvement after CEA.
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Postoperative resolution of 123I-iomazenil uptake and metabolic rate of oxygen in the cerebral cortex accompanied by postoperative improvement of cognition in a patient undergoing extracranial-intracranial arterial bypass surgery for internal carotid artery occlusion: a case report. Clin Nucl Med 2011; 36:361-2. [PMID: 21467853 DOI: 10.1097/rlu.0b013e31820aa17b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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