[Acute brain infarction clearly demonstrated by using the three-dimensional stereotactic surface projections (3D-SSP) of 99mTc-HMPAO SPECT].

We report a 66-year-old ambidextrous man who suddenly developed aphasia seven days after coronary artery bypass grafting surgery. CT scan performed 30 minutes after onset failed to depict acute ischemic lesion. MR imaging could not be performed because of intrathoracic wires. An emergent angiogram demonstrated filling defect in the right precentral artery territory. Transaxial images of 99mTc-HMPAO SPECT showed hypoperfusion areas in the right frontal and left temporo-parietal regions. Using the three-dimensional stereotactic surface projections (3D-SSP) of 99mTc-HMPAO SPECT, we could clearly detect a sharply demarcated ischemic area which was later confirmed to be an infracted lesion in the follow-up CT. 3D-SSP, thus, appears to be useful for identifying acute infarction in such cases that MRI is impermissible.