Research Reports - A new method for evaluation of mild traumatic brain injury with neuropsychological impairment using statistical imaging analysis for Tc-ECD SPECT

Ann Nucl Med. 2012 Dec 20

Uruma G, Hashimoto K, Abo M

OBJECTIVE: The objective of this study was to identify specific brain lesions
with regional perfusion abnormalities possibly associated with neuropsychological
impairments (NPI), as sequela after mild traumatic brain injury (MTBI), using
99mTc-ethylcysteinate dimer single photon emission computed tomography (Tc-99m
ECD SPECT) and its novel analytic software. METHODS: We studied 23 patients with
diffuse axonal injury with NPI group (Impaired-DAI), 26 with MTBI with NPI group
(Impaired-MTBI) and 24 with MTBI without NPI group (Healthy-MTBI). In each
subject, Tc-99m ECD SPECT images were analyzed by easy Z score imaging system
(eZIS) and voxel-based stereotactic extraction estimation (vbSEE). Segmented into
lobule levels, ROIs were set in 140 areas in whole brain, and relative regional
low Tc-99m ECD uptake was computed as "extent" (rate of coordinates with Z score
>2.0 in the ROI). Receiver operating characteristic analysis was performed using
"extent" to discriminate the three groups. RESULTS: The highest area under the
curve (AUC) value for data of Impaired-DAI and Healthy-MTBI groups was obtained
in ROI on the left anterior cingulate gyrus (LtACG), with AUC of 0.93, optimal
"extent" cutoff value of 10.9 %, sensitivity 87.0 %, specificity 83.3 %. The
highest AUC value for data of Impaired-MTBI and Healthy-MTBI groups was also in
the LtACG, with AUC of 0.87, optimal "extent" cutoff value of 9.2 %, sensitivity
73.1 %, specificity 83.3 %. CONCLUSIONS: Using two analytic software packages,
eZIS and vbSEE, we identified specific lesions with low regional Tc-99m ECD
uptake possibly associated with NPIs after MTBI. Especially, this trend was most
marked in the left anterior cingulate gyrus in MTBI patients with NPIs and those
with DAI. The optimal "extent" cutoff value, as a criterion for SPECT
abnormality, might help the diagnosis of NPIs after MTBI.

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