Brain perfusion imaging using 99mTc-Ethyl cysteinate dimer with acetazolamide challenge reveals “steal phenomenon” in suspected stroke: A case report

Chronic cerebral ischaemia (CCI) is a potentially life-threatening condition caused by carotid artery occlusion, hypotension and other causes. Moyamoya Syndrome (MMS) is an example of CCI, in which there is progressive narrowing of the branches of the internal carotid artery. Conventionally, magnetic resonance angiography (MRA) or digital subtraction angiogram (DSA) are utilised to visualise the vascular abnormalities. However, nuclear medicine imaging can help to give more functional information that can improve the management and surgical outcome of patients. There is a need to highlight the role of single-photon emission computed tomography/computed tomography (SPECT/CT) imaging using 99mTc-Ethyl Cysteinate Dimer (99mTc-ECD) with Acetazolamide (ACZ) challenge to diagnose MMS and decide on further surgical or medical intervention. We illustrate a case of a young woman who benefited from this imaging for the management of her condition.