Functional Neuroimaging Distinguishes Posttraumatic Stress Disorder from Traumatic Brain Injury in Focused and Large Community Datasets

• Published in: PloS one Vol. 10; no. 7; p. e0129659
• Main Authors: Amen, Daniel G., Raji, Cyrus A., Willeumier, Kristen, Taylor, Derek, Tarzwell, Robert, Newberg, Andrew, Henderson, Theodore A.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.07.2015; Public Library of Science (PLoS)
• Subjects: Accuracy; Adult; Basal ganglia; Biomarkers; Brain; Brain injuries; Brain Injuries - diagnosis; Cingulum; Communities; Comorbidity; Computed tomography; Cortex (temporal); Databases, Factual; Demographics; Demography; Diagnosis, Differential; Diagnostic systems; Female; Functional Neuroimaging - methods; Ganglia; Head injuries; Humans; Image Interpretation, Computer-Assisted; Image Processing, Computer-Assisted; Lobes; Male; Medical imaging; Middle Aged; Military Personnel; Neuroimaging; Neurology; Perfusion; Photon emission; Post traumatic stress disorder; Posttraumatic stress disorder; Prefrontal cortex; Psychotropic drugs; Regression analysis; Regression models; Reproducibility of Results; Retrospective Studies; ROC Curve; Sensitivity; Sensitivity analysis; Severity of Illness Index; Single photon emission computed tomography; Stress Disorders, Post-Traumatic - diagnosis; Symptomology; Temporal lobe; Thalamus; Tomography, Emission-Computed, Single-Photon - methods; Traumatic brain injury; Variance analysis; Veterans; Visual cortex; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0129659

Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are highly heterogeneous and often present with overlapping symptomology, providing challenges in reliable classification and treatment. Single photon emission computed tomography (SPECT) may be advantageous in the diagnostic separation of these disorders when comorbid or clinically indistinct. Subjects were selected from a multisite database, where rest and on-task SPECT scans were obtained on a large group of neuropsychiatric patients. Two groups were analyzed: Group 1 with TBI (n=104), PTSD (n=104) or both (n=73) closely matched for demographics and comorbidity, compared to each other and healthy controls (N=116); Group 2 with TBI (n=7,505), PTSD (n=1,077) or both (n=1,017) compared to n=11,147 without either. ROIs and visual readings (VRs) were analyzed using a binary logistic regression model with predicted probabilities inputted into a Receiver Operating Characteristic analysis to identify sensitivity, specificity, and accuracy. One-way ANOVA identified the most diagnostically significant regions of increased perfusion in PTSD compared to TBI. Analysis included a 10-fold cross validation of the protocol in the larger community sample (Group 2). For Group 1, baseline and on-task ROIs and VRs showed a high level of accuracy in differentiating PTSD, TBI and PTSD+TBI conditions. This carefully matched group separated with 100% sensitivity, specificity and accuracy for the ROI analysis and at 89% or above for VRs. Group 2 had lower sensitivity, specificity and accuracy, but still in a clinically relevant range. Compared to subjects with TBI, PTSD showed increases in the limbic regions, cingulum, basal ganglia, insula, thalamus, prefrontal cortex and temporal lobes. This study demonstrates the ability to separate PTSD and TBI from healthy controls, from each other, and detect their co-occurrence, even in highly comorbid samples, using SPECT. This modality may offer a clinical option for aiding diagnosis and treatment of these conditions.