Tehran University of Medical Sciences
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Davood Beiki

Prospective evaluation of technetium-99m ECD SPET in mild traumatic brain injury for the prediction of sustained neuropsychological sequels


Authors: Mehrazin M, Nezameddini-Kachooei SA, Fallahi B, Derakhshan MK, Beiki D, Ghodsi SM, Assadi M, Pooyafard F, Eftekhari M,
Hell J Nucl Med , Vol.14, No.3, 2011,Page:243-250
Our aim was to evaluate whether single photon emission tomography (SPET) versus computed tomography (CT) in acute phase of mild traumatic brain injury (MTBI) was better for the prediction ofsustained neuropsychological symptoms beyond a typical recovery period.Forty five patients with MTBI were prospectively evaluated with clinical and neuropsychological exams, structural imagingusing CT and perfusion study by 99mTc-ethylene cysteinate dimer (99mTc-ECD) SPET within a week ofthe head trauma. After an interval ranging from 6 to 12 (median: 9) months, all patients were re-evaluated by standard neuropsychological tests for the assessment of sustained personality changes,imbalance and memory deficits. Our resultsshowed that, 25 patients had abnormal brain perfusionon 99mTc-ECD SPET. In 19 cases of total 20 normal 99mTc-ECD SPET studies, no sign of memory deficitand imbalance was observed. Negative predictive value (NPV) for both complications was 95%. NPVof CT for the prediction of memory deficit and imbalance were 77.4% and 90.3%, respectively. Therisk of developing sustained memory deficits and imbalance in patients with positive99mTc-ECD SPETwere 40% and 20%, respectively. A perfusion abnormality on 99mTc-ECD SPET was associated with agreater chance of long-standing memory deficits (odds ratio=13.49, P=0.020) while neither CT nor 99mTc-ECD SPET could independently predict the personality changes in these patients. The patientswith abnormalities on both CT and SPET images faced a significant relative risk of complications, 1.63times, higher than the others. In conclusion, our study indicated that 99mTc-ECD SPET imaging or CTimaging alone, could not predict the occurrence of sustained complications after MTBI. Concurrentuse of both imaging modalities performed shortly a