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      Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review

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          Abstract

          Purpose

          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.

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          Most cited references126

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          The impact of traumatic brain injuries: A global perspective

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            Traumatic brain injury in the war zone.

            Susan Okie (2005)
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              Major depression following traumatic brain injury.

              Major depression is a frequent psychiatric complication among patients with traumatic brain injury (TBI). To our knowledge, however, the clinical correlates of major depression have not been extensively studied. To determine the clinical, neuropsychological, and structural neuroimaging correlates of major depression occurring after TBI. Prospective, case-controlled, surveillance study conducted during the first year after the traumatic episode occurred. Settings University hospital level I trauma center and a specialized rehabilitation unit. The study group consisted of 91 patients with TBI. In addition, 27 patients with multiple traumas but without evidence of central nervous system injury constituted the control group. The patients' conditions were evaluated at baseline and at 3, 6, and 12 months after the traumatic episode. Psychiatric diagnosis was made using a structured clinical interview and DSM-IV criteria. Neuropsychological testing and quantitative magnetic resonance imaging were performed at the 3-month follow-up visit. Major depressive disorder was observed in 30 (33%) of 91 patients during the first year after sustaining a TBI. Major depressive disorder was significantly more frequent among patients with TBI than among the controls. Patients with TBI who had major depression were more likely to have a personal history of mood and anxiety disorders than patients who did not have major depression. Patients with major depression exhibited comorbid anxiety (76.7%) and aggressive behavior (56.7%). Patients with major depression had significantly greater impairment in executive functions than their nondepressed counterparts. Major depression was also associated with poorer social functioning at the 6-and 12-month follow-up, as well as significantly reduced left prefrontal gray matter volumes, particularly in the ventrolateral and dorsolateral regions. Major depression is a frequent complication of TBI that hinders a patient's recovery. It is associated with executive dysfunction, negative affect, and prominent anxiety symptoms. The neuropathological changes produced by TBI may lead to deactivation of lateral and dorsal prefrontal cortices and increased activation of ventral limbic and paralimbic structures including the amygdala.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                19 March 2014
                : 9
                : 3
                : e91088
                Affiliations
                [1 ]UCLA Medical Center, Los Angeles, California, United States of America
                [2 ]The Synaptic Space, Denver, Colorado, United States of America
                [3 ]University of British Columbia School of Medicine, Vancouver, British Columbia, Canada
                [4 ]PathFinder Brain SPECT, Deerfield, Illinois, United States of America
                [5 ]Sheppard Associates, Toronto, Ontario, Canada
                [6 ]St. Johns Health Center, Santa Monica, California, United States of America
                [7 ]Rossiter-Thornton Associates, Toronto, Ontario, Canada
                [8 ]Private Practice, Toronto, Ontario, Canada
                [9 ]Lions Gate Hospital, Vancouver, British Columbia, Canada
                [10 ]Amen Clinics, Inc., Newport Beach, California, United States of America
                Institute of Automation, Chinese Academy of Sciences, China
                Author notes

                Competing Interests: John Thornton is affiliated to Rossiter-Thornton Associates and Howard Schneider to Sheppard Associates. Muriel van Lierop belongs to a private practice corporation which has no research funding. Dr. Uszler is Medical Director of Drspectscan.com and co-owner of Neuro-Luminance Corp, both of which are clinical service corporations with no research funding. Dr. Pavel is Director of PathFinder Brain SPECT which is a clinical service corporation providing SPECT functional neuroimaging and has no research funding. Dr. Amen is owner of Amen Clinics, which provides SPECT functional neuroimaging and other diagnostic and clinical services. Dr. Henderson is President and owner of Dr. Theodore Henderson, Inc. and The Synaptic Space and co-owner of Neuro-Luminance Corp, which are clinical service or consulting corporations with no research funding. Drs. Raji, Tarzwell, and Cohen have no conflicts of interest or financial disclosures. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: CR RT DP HS MU JT MvL PC DA TH. Performed the experiments: CR RT TH. Analyzed the data: CR TH. Wrote the paper: CR RT DP HS MU JT MvL PC DA TH.

                Article
                PONE-D-13-36068
                10.1371/journal.pone.0091088
                3960124
                24646878
                1e25e0eb-3002-4386-9e5b-cb133d18e642
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 September 2013
                : 10 February 2014
                Page count
                Pages: 10
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Medicine
                Clinical Research Design
                Systematic Reviews
                Mental Health
                Psychiatry
                Neuropsychiatric Disorders
                Neurology
                Head Injury
                Neuroimaging
                Public Health
                Preventive Medicine
                Socioeconomic Aspects of Health
                Radiology
                Nuclear medicine
                SPECT imaging

                Uncategorized
                Uncategorized

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