Single Photon Emission Computed Tomography of Neonatal Periventricular Leukomalacia

We describe herein single photon emission computed tomography (SPECT) with 99mTc HM-PAO of a patient with neonatal cystic periventricular leukomalacia (PVL). The patient, who was a low birth weight infant of 27 weeks gestation weighing 1,290 g, had suffered from respiratory distress syndrome. Following surfactant replacement therapy, mechanical ventilation were carried out six days after birth. Serial cranial ultrasonography (US) showed periventricular high-echoic lesions followed by cyst formation at three weeks of age. Although cystic PVL was markedly observed on both cranial US and MRI, a SPECT study initially revealed no abnormal distribution of rCBF. A chronological SPECT study at nine months of age revealed decreased rCBF of 10% in the left hemisphere as compared to the contralateral side. At the time decreased rCBF was observed on SPECT, periventricular cyst formation tended to disappear on simultaneous MRI. It is known that PVL is an infarction which affects all the cellular elements of the white matter and may lead to abnormal myelination. SPECT studies may also useful to clarify the cerebral function in neonatal PVL