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IMAGE INTERPRETATION · BRAIN IMAGING

Focal Perfusion Defect on Brain SPECT

Brain perfusion SPECT, transverse slices showing focal perfusion defect
Brain perfusion SPECT, transverse slices showing focal perfusion defect

Provided clinical image

Question

This series of transverse brain slices demonstrates a focal region of reduced tracer uptake in one cerebral hemisphere consistent with a vascular territory distribution. Which radiopharmaceutical was most likely used to generate these cerebral perfusion images?

  1. ATc-99m HMPAO (Ceretec), which crosses the blood-brain barrier and distributes proportional to regional cerebral blood flow
  2. BTc-99m MDP (medronate), which localizes to hydroxyapatite crystals in areas of active bone remodeling and turnover
  3. CTc-99m MAA (macroaggregated albumin), which lodges in pulmonary capillaries proportional to regional lung blood flow
  4. DTc-99m sestamibi (Cardiolite), which accumulates in mitochondria-rich myocardium proportional to coronary blood flow
Show the answer and explanation

A. Tc-99m HMPAO (Ceretec), which crosses the blood-brain barrier and distributes proportional to regional cerebral blood flow

Tc-99m HMPAO (hexamethylpropyleneamine oxime, Ceretec) is a lipophilic radiopharmaceutical that crosses the intact blood-brain barrier and is trapped intracellularly in proportion to regional cerebral blood flow (rCBF). It is one of two main agents used for brain perfusion SPECT, along with Tc-99m ECD (Neurolite). The focal defect seen here in a vascular territory distribution is characteristic of cerebral infarction — an area of absent or severely reduced perfusion resulting from arterial occlusion.

More brain imaging images

Brain perfusion SPECT, transverse slices showing focal perfusion defectBrain Perfusion SPECT: Injection Environment Brain perfusion SPECT (Tc-99m ECD), transverse slices — normal studyNormal Tc-99m ECD Brain SPECT: Gray vs White Matter Brain perfusion SPECT (Tc-99m ECD), transverse slices — normal studyBrain SPECT: When to Image After ECD Injection DaTSCAN (I-123 ioflupane) SPECT — midbrain axial sliceDaTscan (I-123 Ioflupane): What It Evaluates Tc-99m HMPAO or ECD brain perfusion SPECT — normal distributionNormal Brain Perfusion SPECT with Tc-99m HMPAO Brain perfusion SPECT — transaxial, coronal, sagittal, and temporal slices showing regional cerebral blood flow pattern in dementiaAlzheimer’s Disease on Brain Perfusion SPECT
← Alzheimer’s Disease on FDG PETBrain Perfusion SPECT: Injection Environment →

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