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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:447-451, February 2006
© 2006 American Society of Neuroradiology

BRAIN

Technetium Tc-99m Ethyl Cysteinate Dimer Brain Single-Photon Emission CT in Mild Traumatic Brain Injury: A Prospective Study

N.K. Gowda^b, D. Agrawal^a, C. Bal^b, N. Chandrashekar^b, M. Tripati^b, G.P. Bandopadhyaya^b, A. Malhotra^b and A.K. Mahapatra^a

^a Department of Neurosurgery, Neurosciences Center
^b Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Address correspondence to Dr Naveen Krishne Gowda, Senior Resident, or Chandrashekar Bal, MD, DNB, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India 110029

PURPOSE: To explore the role of single-photon emission CT (SPECT) in initial diagnostic evaluation of patients with mild traumatic brain injury (MTBI) and to identify subgroups in which it may serve as a useful diagnostic tool.

MATERIALS AND METHODS: Patients with MTBI seen during a 14-month period were prospectively included in this study. All patients had a CT of head within 12 hours of injury and SPECT by using technetium Tc99m ethyl cysteinate dimer (Tc99m-ECD) within 72 hours of injury. Both SPECT and CT findings were compared with clinical features such as posttraumatic amnesia (PTA), postconcussion syndrome (PCS), and loss of consciousness (LOC).

RESULTS: Ninety-two patients with MTBI underwent SPECT in the study period. There were 28 children and 64 adults, with male-to-female ratio of 4.5 to 1. CT findings were abnormal in 31 (34%) and SPECT in 58 (63%). The most common abnormality was hypoperfusion in the frontal lobe(s) in adults and the temporal lobe in children. A significantly higher number of perfusion abnormalities were seen in patients with PTA (P = .03), LOC (P = .02), and PCS (P = .01) than in patients without these symptoms. Compared to CT, SPECT had a much higher sensitivity for detecting an organic basis in these subgroup, of patients (P < .05).

CONCLUSION: Tc99m-ECD SPECT can be used as a complementary technique to CT in initial evaluation of patients with MTBI. It is particularly useful in patients having PCS, LOC, or PTA with normal CT scan.

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