In comparison with PET neuroimaging, brain perfusion imaging with single photon emission computed tomography (SPECT) generally has suboptimal spatial resolution and detection sensitivity (Davison and O’Brien, Int J Geriatr Psychiatry 29:551–561, 2014). However, the clinical utility of brain perfusion SPECT has increased due to more widespread availability and lower costs compared to those of PET. Furthermore, dual-session brain perfusion SPECT studies with and without challenge of Diamox (acetazolamide), a cerebrovascular dilating agent, can evaluate cerebrovascular reserve (CVR) (Gupta et al., Stroke 43:2884–2891, 2012). This unique functional neuroimaging protocol not only helps differentiate cerebrovascular diseases from neurodegenerative dementias but also plays an important role in risk evaluation and stratification for cerebral ischemic events in selected patients. In conjunction with clinical presentation and other neuroimaging (CT, MRI, or PET) findings, altered perfusion patterns on brain SPECT can be interpretated with a certain level of confidence, as presented in this chapter, for at least the following neurological conditions: normal aging, mild cognitive impairment (MCI), Alzheimer’s disease (AD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), vascular dementia (VD), and posterior cortical atrophy (PCA).
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