N-isopropyl(I-123)p-iodoamphetamine brain scans with single-photon emission tomography: discordance with transmission computed tomography.

Transmission computed tomography (CT) brain scans were compared with N-isopropyl (I-123)-p-iodoamphetamine (IMP) single-photon emission computed tomography (SPECT) brain scans to determine if there was a correlation between morphology, as seen on CT, and cerebral perfusion changes detected by IMP SPECT. In 12 patients with acute stroke, four showed no discordance between the edema seen on CT and perfusion deficits seen on IMP SPECT; five had positive IMP scans while initial CT scans were negative and follow-up CT scans demonstrated edema in the region of perfusion deficit seen on the IMP scans; and in four patients, the average perfusion deficit was 2.3 times greater than the edema shown on CT at 2 cm above the canthal-meatal line. In nine control patients, there was a 2.3% difference in IMP activity between the right and left hemispheres. The 12 stroke patients showed 30.3% less IMP activity in the abnormal hemisphere compared with the normal side. Three patients, one with temporal lobe seizure, one with hemiballismus, and the third with idiopathic intention tumor, had 54% greater IMP activity on the side of movement or seizure than on the normal side. The discordance between IMP and CT scans was clearly demonstrated in cases in which CT showed no abnormality but IMP provided information on function, reflected in increased or decreased cerebral perfusion.