Functional Brain Imaging Can Provide Better Diagnosis And Treatment Monitoring In Persons With Traumatic Brain Injury

March 18th 2014

Kaitlyn Brumleu
Amen Clinics
Aja Haydn-Myer


COSTA MESA, Calif., March. 19, 2014 –Traumatic brain injury (TBI) is a devastating problem with serious physical and emotional consequences. Nick Bell, former Oakland Raider running back, suffered for many years with depression, pain, irritability and isolation as the result of repetitive traumatic brain injuries as a football player. Seeking treatment, he received a brain scan as part of his care. Looking at his brain made a significant difference to Bell. He said, “Brain SPECT imaging helped me see the physical damage to my brain in a way which overwhelmingly explained my past behaviors and emotional issues. The SPECT scan motivated me to be aggressive with my treatment, which has made a wonderful difference for both me and my family.” Brain SPECT, which stands for Single Photon Emission Computed Tomography, is a functional brain imaging modality that produces images of blood flow to the brain, showing areas of over or under-activity.

A new paper published by a joint United States and Canadian team in PLOS One suggests SPECT is useful in both identifying and guiding treatment for those with TBI. Using standardized search criteria, the study examined the National Library of Medicine’s largest research databases to identify1600 papers on SPECT and TBI from the world literature over the past 30 years. Of these, 71 studies, involving 2634 patients, were considered of the highest quality and were included in the review. Nineteen studies followed TBI patients over time and 5 looked at the effects of treatment interventions.

The findings of the systematic review include: 1) SPECT is more sensitive compared to standard anatomical CT and MRI in detecting brain abnormalities in TBI; 2) SPECT correlates with psychological and neurological outcomes; 3) SPECT can be used to evaluate treatment interventions. SPECT scans showed abnormalities not seen on MRI and CT in all 10 of the studies that investigated this question (100%).

It was found that a normal SPECT study right after an injury is highly predictive of a good clinical outcome for patients, but an abnormal scan right after an injury was not highly predictive of the ultimate outcome (59%), as the brain has many healing mechanisms. But if the second scan three months later was also abnormal, the scan was highly predictive of poor outcome..

“The bottom line is if a brain SPECT is normal after TBI, patients do well but we need to see at least two abnormal scans over time to see if they do poorly,” says psychiatrist and SPECT expert Daniel Amen, one of the co-authors of the paper. “These important findings can have important implications for diagnosis and brain rehabilitation in persons with TBI.”

TBI is the leading cause of death and disability for people between the ages of 1 and 44 and a significant cause of emotional, thinking and behavioral problems. People who have experienced a TBI have a higher risk of depression, anxiety, suicide, drug and alcohol abuse, job and marital failure, incarceration, homelessness and dementia. Repetitive mild TBI, also known as “repetitive concussion” from contact sports can lead to chronic traumatic encephalopathy (CTE) and increased risk for Alzheimer’s disease. According to the Centers for Disease Control about 1.7 million Americans a year suffer a TBI. The Brain Trauma Foundation reports between 1.6-3.8 million sports-related TBIs occur per year. The U. S. Department of Defense reported over 266,000 soldiers experienced a TBI between 2000 – 2012. TBI costs were $76.5 billion in the year 2000 alone.

Marine Corps Captain (Retired) Patrick Caffrey, inspired by his own experience with SPECT in his treatment for TBI, started his own non-profit foundation called Brain Scans for Warriors. “Too often,” he says, “warriors who served our country are left on their own to find the best help. The brain SPECT scans I had, showed the damage to my brain from being exposed to three blast injuries in Iraq and directed my doctor to prescribe a targeted course of treatment, which made a big difference for me. I want others to know about this important technology.”

According to Dr. Theodore Henderson, a senior author on the study, “Persons with mild traumatic brain injury, which is often referred to as concussion or post-concussion syndrome, may not be properly identified as having credible neurological problems because commonly used anatomical CT or MRI scans in mild brain trauma are abnormal less than 10% of the time. These same patients may have recurring psychiatric symptoms such as depression, attention problems, and impulse control issues. Commonly, they are referred to psychiatrists who generally do not use neuroimaging to diagnose and treat brain disorders. Indeed, many cases of treatment-resistant depression turn out to have undiagnosed traumatic brain injury. Our study shows that SPECT can be useful and a true value-add in guiding diagnosis and treatment of such patients.”

“Ultimately, how would physicians ever know if the TBI was significant unless they ordered a functional imaging study like SPECT?” says Dr. Amen. “Our paper shows that brain SPECT can provide answers that may guide diagnosis and treatment of patients with Traumatic Brain Injury.”

Professor Andrew Newberg, MD from Thomas Jefferson University, not associated with the study, said, “This paper provides high levels of evidence for a tool that has been available for decades. Researchers often want to find new and different ways to make a difference and contribute to science, so they often ignore older technology. Yet, it is time to embrace brain SPECT imaging, especially as it relates to traumatic brain injury. It is one of the best studies available to see the actual function of the brain.”

Raji, Cyrus, Tarzwell, Robert, Pavel, Dan, Schneider, Howard, Uszler, J., Thornton, John, van Lierop, Muriel, Cohen, Philip, Amen, Daniel, Henderson, Theodore. Clinical Utility of SPECT in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review. Accepted for publication PLOS One, February 9, 2014

From 1600 studies identified, 71 articles, 19 longitudinal and 52 cross-sectional studies, met rigorous standardized inclusion criteria. Of these, 100% of longitudinal and 98% of cross sectional studies showed SPECT lesion localization not detected by CT or MRI. Almost 80% of longitudinal and 81% of cross sectional articles showed significant correlation between SPECT and neuropsychological or neurological outcomes. This review highlights the extensive literature base for SPECT in evaluating TBI.