One-year follow-up of technetium-99m-HMPAO SPECT in mild head injury.
We evaluated the predictive capacity of 99mTc-HMPAO SPECT for clinical outcome during a follow-up period of 12 mo after mild head injury.


METHODS
We prospectively evaluated 136 patients with mild head injury who underwent initial SPECT imaging (SPECTO) within 4 wk after the trauma. Re-evaluations were made 2.9-3.3 mo (T3mo), 5.7-6.3 mo (T6mo) and 11.9-12.6 mo (T12mo) postinjury. All patients with an abnormal SPECT underwent a repeat study at the subsequent time of evaluation. Patients with a previously normal SPECT scan did not undergo a repeat study. Clinical reassessments (CLIN) were performed as long as the earlier study had been positive or until patients were completely asymptomatic.


RESULTS
During all follow-up evaluations, SPECT had a high sensitivity and negative predictive value, increasing from 91% and 89%, respectively, at T3mo to 100% at T6mo and at T12mo. Clinical normalization occurred earlier than scintigraphic normalization. However, at 12 mo postinjury, we observed considerable improvement in the specificity and positive predictive value of SPECT (85% and 83%, respectively). The persistent lesions on the SPECT scan were related to their severity and to localization in the frontal cortex.


CONCLUSIONS
A normal 99mTc-HMPAO SPECT scan is a reliable tool in the exclusion of clinical sequelae of mild head injury. At 12 mo postinjury, a positive SPECT study is also a reliable predictor for clinical outcome.
Jacobs
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A
Department of Nuclear Medicine, Virga Jesse Hospital, Hasselt, Belgium.
Put
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E
Ingels
M
M
Put
T
T
Bossuyt
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010091:Oximes; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime