title: Clinical utility of SPECT neuroimaging in the diagnosis and treatment of traumatic brain injury: a systematic review.
abstract: OBJECTIVE
  This systematic review evaluated the clinical utility of single photon emission computed tomography (SPECT) in traumatic brain injury (TBI).
  
  
  METHODS
  After defining a PICO Statement (Population, Intervention, Comparison and Outcome Statement), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were applied to identify 1600 articles. After screening, 374 articles were eligible for review. Inclusion for review was focus on SPECT in the setting of mild, moderate, or severe TBI with cerebral lobar specificity of SPECT findings. Other inclusion criteria were comparison modalities in the same subjects and articles in English. Foreign language articles, SPECT studies that did not include comparison modalities, and case reports were not included for review.
  
  
  RESULTS
  We identified 19 longitudinal and 52 cross-sectional studies meeting inclusion criteria. Three longitudinal studies examined diagnostic predictive value. The first showed positive predictive value increases from initial SPECT scan shortly after trauma to one year follow up scans, from 59% to 95%. Subsequent work replicated these results in a larger cohort. Longitudinal and cross sectional studies demonstrated SPECT lesion localization not detected by CT or MRI. The most commonly abnormal regions revealed by SPECT in cross-sectional studies were frontal (94%) and temporal (77%) lobes. SPECT was found to outperform both CT and MRI in both acute and chronic imaging of TBI, particularly mild TBI. It was also found to have a near 100% negative predictive value.
  
  
  CONCLUSIONS
  This review demonstrates Level IIA evidence (at least one non-randomized controlled trial) for the value of SPECT in TBI. Given its advantages over CT and MRI in the detection of mild TBI in numerous studies of adequate quality, and given its excellent negative predictive value, it may be an important second test in settings where CT or MRI are negative after a closed head injury with post-injury neurological or psychiatric symptoms.
authors.affiliation: UCLA Medical Center, Los Angeles, California, United States of America.
authors.forename: Cyrus A
authors.initials: CA
authors.lastname: Raji
authors.affiliation: University of British Columbia School of Medicine, Vancouver, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Tarzwell
authors.affiliation: PathFinder Brain SPECT, Deerfield, Illinois, United States of America.
authors.forename: Dan
authors.initials: D
authors.lastname: Pavel
authors.affiliation: Sheppard Associates, Toronto, Ontario, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Schneider
authors.affiliation: St. Johns Health Center, Santa Monica, California, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Uszler
authors.affiliation: Rossiter-Thornton Associates, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Thornton
authors.affiliation: Private Practice, Toronto, Ontario, Canada.
authors.forename: Muriel
authors.initials: M
authors.lastname: van Lierop
authors.affiliation: Lions Gate Hospital, Vancouver, British Columbia, Canada.
authors.forename: Phil
authors.initials: P
authors.lastname: Cohen
authors.affiliation: Amen Clinics, Inc., Newport Beach, California, United States of America.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Amen
authors.affiliation: The Synaptic Space, Denver, Colorado, United States of America.
authors.forename: Theodore
authors.initials: T
authors.lastname: Henderson
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*