Technetium Tc-99m ethyl cysteinate dimer brain single-photon emission CT in mild traumatic brain injury: a prospective study.
OBJECTIVE
To explore the role of single-photon emission CT (SPECT) in initial diagnostic evaluation of patients with mild traumatic brain injury (MTBI) and to identify subgroups in which it may serve as a useful diagnostic tool.


METHODS
Patients with MTBI seen during a 14-month period were prospectively included in this study. All patients had a CT of head within 12 hours of injury and SPECT by using technetium Tc99m ethyl cysteinate dimer (Tc99m-ECD) within 72 hours of injury. Both SPECT and CT findings were compared with clinical features such as posttraumatic amnesia (PTA), postconcussion syndrome (PCS), and loss of consciousness (LOC).


RESULTS
Ninety-two patients with MTBI underwent SPECT in the study period. There were 28 children and 64 adults, with male-to-female ratio of 4.5 to 1. CT findings were abnormal in 31 (34%) and SPECT in 58 (63%). The most common abnormality was hypoperfusion in the frontal lobe(s) in adults and the temporal lobe in children. A significantly higher number of perfusion abnormalities were seen in patients with PTA (P = .03), LOC (P = .02), and PCS (P = .01) than in patients without these symptoms. Compared to CT, SPECT had a much higher sensitivity for detecting an organic basis in these subgroup, of patients (P < .05).


CONCLUSIONS
Tc99m-ECD SPECT can be used as a complementary technique to CT in initial evaluation of patients with MTBI. It is particularly useful in patients having PCS, LOC, or PTA with normal CT scan.
Gowda
N K
NK
Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi.
Agrawal
D
D
Bal
C
C
Chandrashekar
N
N
Tripati
M
M
Bandopadhyaya
G P
GP
Malhotra
A
A
Mahapatra
A K
AK
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D001924:Brain Concussion / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003545:Cysteine / Q000031:analogs & derivatives*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D038223:Post-Concussion Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
D015609:Organotechnetium Compounds; C059659:technetium Tc 99m bicisate; D003545:Cysteine