Clinical Comparison of 99mTc Exametazime and 123I Ioflupane SPECT in Patients with Chronic Mild Traumatic Brain Injury

• Published in: PloS one Vol. 9; no. 1; p. e87009
• Main Authors: Newberg, Andrew B., Serruya, Mijail, Gepty, Andrew, Intenzo, Charles, Lewis, Todd, Amen, Daniel, Russell, David S., Wintering, Nancy
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 2014; Public Library of Science (PLoS)
• Subjects: Abnormalities; Adolescent; Adult; Aged; Binding; Biology; Blood; Blood flow; Brain; Brain Injuries - diagnosis; Brain Injuries - metabolism; Brain Injuries - physiopathology; Cerebral blood flow; Computed tomography; Cortex; Dopamine; Dopamine Plasma Membrane Transport Proteins - metabolism; Dopamine transporter; Emission analysis; Female; Frontal lobe; Frontal Lobe - blood supply; Frontal Lobe - injuries; Frontal Lobe - metabolism; Frontal Lobe - physiopathology; Head injuries; Headache; Headaches; Humans; Integrative medicine; Male; Medical imaging; Medicine; Mental disorders; Mental health; Middle Aged; Migraine; Neostriatum; NMR; Nortropanes; Nuclear magnetic resonance; Pain; Parietal lobe; Patients; Perfusion; Photon emission; Physiology; Protein Binding; Psychiatry; Radiopharmaceuticals; Researchers; Single photon emission computed tomography; Studies; Technetium isotopes; Technetium Tc 99m Exametazime; Temporal lobe; Temporal Lobe - blood supply; Temporal Lobe - injuries; Temporal Lobe - metabolism; Temporal Lobe - physiopathology; Tomography, Emission-Computed, Single-Photon - methods; Traumatic brain injury; United States > US; Connecticut; Pennsylvania
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0087009

This study evaluated the clinical interpretations of single photon emission computed tomography (SPECT) using a cerebral blood flow and a dopamine transporter tracer in patients with chronic mild traumatic brain injury (TBI). The goal was to determine how these two different scan might be used and compared to each other in this patient population. Twenty-five patients with persistent symptoms after a mild TBI underwent SPECT with both (99m)Tc exametazime to measure cerebral blood flow (CBF) and (123)I ioflupane to measure dopamine transporter (DAT) binding. The scans were interpreted by two expert readers blinded to any case information and were assessed for abnormal findings in comparison to 10 controls for each type of scan. Qualitative CBF scores for each cortical and subcortical region along with DAT binding scores for the striatum were compared to each other across subjects and to controls. In addition, symptoms were compared to brain scan findings. TBI patients had an average of 6 brain regions with abnormal perfusion compared to controls who had an average of 2 abnormal regions (p<0.001). Patient with headaches had lower CBF in the right frontal lobe, and higher CBF in the left parietal lobe compared to patients without headaches. Lower CBF in the right temporal lobe correlated with poorer reported physical health. Higher DAT binding was associated with more depressive symptoms and overall poorer reported mental health. There was no clear association between CBF and DAT binding in these patients. Overall, both scans detected abnormalities in brain function, but appear to reflect different types of physiological processes associated with chronic mild TBI symptoms. Both types of scans might have distinct uses in the evaluation of chronic TBI patients depending on the clinical scenario.