Clinical comparison of 99mTc exametazime and 123I Ioflupane SPECT in patients with chronic mild traumatic brain injury.
BACKGROUND
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.


RESULTS
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.


CONCLUSIONS
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.
Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
Andrew B
AB
Newberg
Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
Mijail
M
Serruya
Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
Andrew
A
Gepty
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
Charles
C
Intenzo
Magee Rehabilitation Hospital, Philadelphia, Pennsylvania, United States of America.
Todd
T
Lewis
Amen Clinics, Inc., Newport Beach, California, United States of America.
Daniel
D
Amen
Institute for Neurodegenerative Disorders, New Haven, Connecticut, United States of America ; Yale University School of Medicine, New Haven, Connecticut, United States of America.
David S
DS
Russell
Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
Nancy
N
Wintering
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000293:injuries / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009662:Nortropanes; D011485:Protein Binding; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000098:blood supply / Q000293:injuries / Q000378:metabolism / Q000503:physiopathology*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D050483:Dopamine Plasma Membrane Transport Proteins; D009662:Nortropanes; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; C519528:ioflupane