title: Old wine in new bottles: validating the clinical utility of SPECT in predicting cognitive performance in mild traumatic brain injury.
abstract: The neural underpinnings of cognitive dysfunction in mild traumatic brain injury (TBI) are not fully understood. Consequently, patient prognosis using existing clinical imaging is somewhat imprecise. Single photon emission computed tomography (SPECT) is a frequently employed investigation in this population, notwithstanding uncertainty over the clinical utility of the data obtained. In this study, subjects with mild TBI underwent (99m)Tc-ECD SPECT scanning, and were administered a brief battery of cognitive tests and self-report symptom scales of concussion and emotional distress. Testing took place 2 weeks (n=84) and 1 year (n=49) post-injury. Multivariate analysis (i.e., partial least squares analysis) revealed that frontal perfusion in right superior frontal and middle frontal gyri predicted poorer performance on the Stroop test, an index of executive function, both at initial and follow-up testing. Conversely, SPECT scans categorized as normal or abnormal by radiologists did not differentiate cognitively impaired from intact subjects. These results demonstrate the clinical utility of SPECT in mild TBI, but only when data are subjected to blood flow quantification analysis.
authors.affiliation: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5. Electronic address: Kris.romero@utoronto.ca.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Romero
authors.affiliation: Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, Canada M5T 1R8.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Lobaugh
authors.affiliation: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5; L.C. Campbell Cognitive Neurology Research Unit, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5; Heart and Stroke Foundation Centre for Stroke Recovery, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Black
authors.affiliation: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ehrlich
authors.affiliation: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5.
authors.forename: Anthony
authors.initials: A
authors.lastname: Feinstein
mesh_terms: D000328:Adult; D000368:Aged; D001924:Brain Concussion; D001930:Brain Injuries / Q000175:diagnosis*; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis*; D056344:Executive Function; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D057190:Stroop Test; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
keywords: Executive function; Mild TBI; Partial least squares; SPECT; Stroop test