123 I-iomazenil (IMZ)-SPECT is used as a tool to detect the viability of neuronal cells. We investigated the distribution of IMZ in the brain of patients suffering from moyamoya disease, comparing it with the images of MRI and the distribution of 123 I-N-isopropyl-4-iodoamphetamin hydrochloride (IMP)-SPECT. In the present study, we investigated 5 patients (4 females and 1 male, aged 30 to 61) who received our modified surgery according to our strategy (EC-IC bypass surgery and/or EMS, EDAS) in

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... ur institution from July 2008 to November 2009. The initial symptoms were ischemic events in 4 patients, and bleeding in 1 patient. 123 I-IMZ-SPECT was started 170 minutes after an injection of 123 I-IMZ. The distribution of IMZ or IMP was analyzed by iSSP5 and NEUROFLEXER to obtain Z scores. The revascularization procedures were performed at the sites where cerebral blood flow (CBF) was significantly reduced and poor response to Diamox treatment was seen preoperatively. The uptake of 123 I-IMZ-SPECT was lower on the symptomatic side than on the asymptomatic side. Only in the region where 123 I-IMZ uptake had been preserved preoperatively, the surgery induced a successful restoration of CBF postoperatively. These results strongly suggest that 123 I-IMZ-SPECT is useful for evaluation of preoperative neuronal viability of the patients with moyamoya disease as well as preoperative prediction of surgical efficacy.