Nakagawara Jyoji, Osato Toshiaki, Kamiyama Kenji, Honjo Kaori, Sugio Hironori, Fumoto Kentarou, Murahashi Takeo, Takada Hidekazu, Watanabe Toshiichi, Nakamura Hirohiko
Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan.
Neurol Med Chir (Tokyo). 2012;52(5):318-26. doi: 10.2176/nmc.52.318.
[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.
[123I]碘美托咪定（IMZ）是一种针对中枢苯二氮䓬（BZ）受体的特异性放射性配体，使用单光子发射计算机断层扫描（SPECT）时，它可能作为脑缺血后皮质神经元丢失的标志物。本研究采用IMZ-SPECT的统计成像分析，来研究高级脑功能障碍与内侧额叶皮质神经元丢失之间的关系，以确诊成人烟雾病患者的高级脑功能障碍。IMZ-SPECT通过三维立体定向表面投影（3D-SSP）进行评估。使用立体定向提取估计（SEE）方法（第3级：脑回水平）对3D-SSP Z分数图（Z分数>2）分析皮质神经元丢失情况。计算目标脑回（即双侧内侧额叶脑回[MFGs]和前扣带回[ACGs]）内BZ受体密度显著降低的像素范围。在6例高级脑功能障碍患者中，4例双侧MFGs、1例单侧MFG和2例双侧ACGs观察到显著的皮质神经元丢失。在12例无高级脑功能障碍的患者中，双侧MFGs或ACGs未观察到显著的皮质神经元丢失，2例双侧MFGs、4例单侧MFG和2例单侧ACG观察到轻度丢失。成人烟雾病患者前循环长期存在轻度血流动力学缺血可能导致内侧额叶不完全性脑梗死。使用3D-SSP和SEE方法对IMZ-SPECT进行统计成像分析，可以证明双侧额叶内侧皮质（包括MFG和/或ACG）存在显著的皮质神经元丢失，这与成人烟雾病患者的高级脑功能障碍相关。
