When the brain works right, people tend to work right. When the brain is troubled, people tend to struggle to be their best selves. If we agree that mental disorders and difficult behaviors may be related to functional problems in the brain, then a logical next step is to consider physically evaluating the brain when faced with people who struggle with complex problems or are unresponsive to our best diagnostic and treatment efforts. If this is true, then why are psychiatrists the only physicians who rarely look at the organ they treat?
It is time to change. Amen Clinics has provided education and insight on the clinical use of brain imaging in psychiatry. Over the past 30 years Amen Clinics has built the world’s largest database of brain scans related to emotional, learning and behavioral problems.
The study we do is called brain SPECT imaging. SPECT stands for Single Photon Emission Computed Tomography. It is a nuclear medicine procedure widely used to study heart, liver, thyroid, bone and brain problems. Brain SPECT imaging is a proven, reliable measure of cerebral blood flow. Because brain activity is directly related to blood flow, SPECT effectively shows us the patterns of activity in the brain. SPECT allows physicians to look deep inside the brain to observe three things: areas of the brain that work well, areas of the brain that work too hard and areas of the brain that do not work hard enough.
The procedure guidelines of the Society of Nuclear Medicine list the evaluation of suspected brain trauma, evaluation of patients with suspected dementia, presurgical location of seizures, and the detection and evaluation of cerebral vascular disease as common indications for brain SPECT. The guidelines also say that many additional indications appear promising. At Amen Clinics, because of our experience, we have added the indications of evaluating violence, substance abuse, the subtypes of ADD, anxiety and depression, and complex or resistant psychiatric problems for brain SPECT.
A SPECT scan is similar to an MRI study in that both can show 3D images and “slices” of the brain. However, whereas MRI shows the physical anatomy or structure of the brain, SPECT shows how the brain works. PET, another nuclear imaging technique, is very similar to SPECT but is a more costly imagining technique. Both SPECT and PET scans show areas of the brain that are healthy, overactive, or underactive. MRI does not give any information on function. A newer version of MRI, functional MRI or “fMRI” is also capable of showing brain activity and is used extensively in scientific research on brain function. fMRI shows instantaneous neural activity to see how the brain responds to a specific stimulus. With SPECT we see brain activity averaged over a few minutes so it is better at showing the brain doing everyday activities such concentrating, meditating, reading, etc. For both fMRI and PET, the images actually occur when a patient lies in the camera, which can be uncomfortable, noisy, and anxiety provoking. For SPECT, the image occurs when a patient is in the injection room, making the procedure more reliable and easier to do.
Although a SPECT scan is simple from the patient’s perspective, it takes considerable skill and experience to dependably generate accurate brain SPECT images suitable for psychiatric applications. Equally important is the need for total consistency in imaging techniques among patients so that results are quantifiable, repeatable, and consistent.
At Amen Clinics our experience with more than 140,000 brain SPECT scans over 30 years guides us in being the best in the world for brain SPECT imaging.
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