Procedure Guideline for Brain Perfusion SPECT Using 99mTc Radiopharmaceuticals 3.0

Jack E. Juni; Alan D. Waxman; Michael D. Devous; Ronald S. Tikofsky; Masanori Ichise; Ronald L. Van Heertum; Robert F. Carretta; Charles C. Chen

doi:10.2967/jnmt.109.067850

I. PURPOSE

The purpose of this guideline is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of brain perfusion SPECT studies using ^99mTc radiopharmaceuticals.

II. BACKGROUND INFORMATION AND DEFINITIONS

SPECT of the brain is a technique for obtaining tomographic images of the 3-dimensional distribution of a radiopharmaceutical, which reflects regional cerebral perfusion.

III. PROCEDURE

A. Patient Preparation

Before arrival, patients should be instructed to avoid, if possible, caffeine, alcohol, or other drugs known to affect cerebral blood flow.
Before injection:
1. The most important aspect of patient preparation is to evaluate the patient for ability to cooperate.
2. A consistent environment must be maintained at the time of injection and uptake:
  1. Place the patient in a quiet, dimly lit room.
  2. Instruct the patient to keep eyes and ears open.
  3. Ensure that the patient is seated or reclining comfortably.
  4. Place intravenous access at least 10 min before injection to permit accommodation.
  5. Instruct the patient not to speak or read.
  6. Have no interaction with the patient before, during, or for 5 min after injection.

B. Information Pertinent to Performing the Procedure

Relevant patient data suggested for optimal interpretation of scans includes patient history (including any past drug use or trauma), neurologic examination, psychiatric examination, mental status examination (e.g., Folstein mini-mental examination or other neuropsychologic tests), recent morphologic imaging studies (e.g., CT, MRI), and current medications and when last taken.

C. Precautions

Demented patients must be closely monitored at all times.
Patients with neurologic deficits may require special care and monitoring.
If sedation is required, it should be given after injection of the radiopharmaceutical, when possible.

D. Radiopharmaceutical

Radiopharmaceutical types:
1. Unstabilized ^99mTc-exametazime (HMPAO)
2. Stabilized ^99mTc-HMPAO
3. ^99mTc-bicisate (ethyl cystine dimer [ECD])
  Dosimetry for these radiopharmaceuticals is presented in Tables 1 and 2.
Radiopharmaceutical preparation:
1. Use fresh generator eluate (<2 h old) for optimal results with ^99mTc-HMPAO.
2. Do not use pertechnetate obtained from a generator that has not been …