2.  AUTHOR	Nedd-K, Sfakianakis-G, Ganz-W, Uricchio-B, Vernberg-D, Villanueva-P, Jabir-A-M, Bartlett-J, Keena-J.
INSTITUTION	Department of Neurology, University of Miami School of Medicine, FL 33101.
TITLE	99mTc-HMPAO SPECT of the brain in mild to moderate traumatic brain injury patients: compared with CT--a prospective study.
SOURCE	Brain-Inj 1993 Nov-Dec, VOL: 7 (6), P: 469-79, ISSN: 0269-9052.
ABSTRACT	Single photon emission computed tomography (SPECT) with Technetium-99m hexamethyl propylenamine oxime (Tc-99m-HMPAO) was used in 20 patients with mild to moderate traumatic brain injury (TBI) to evaluate the effects of brain trauma on regional cerebral blood flow (rCBF). SPECT scan was compared with CT scan in 16 patients. SPECT showed intraparenchymal differences in rCBF more often than lesions diagnosed with CT scans (87.5% vs. 37.5%). In five of six patients with lesions in both modalities, the area of involvement was relatively larger on SPECT scans than on CT scans. Contrecoup changes were seen in five patients on SPECT alone, two patients with CT alone and one patient had contrecoup lesions on CT and SPECT. Of the eight patients (50%) with skull fractures, seven (43.7%) had rCBF findings on SPECT scan and five (31.3%) demonstrated decrease in rCBF in brain underlying the fracture. All these patients with fractures had normal brain on CT scans. Conversely, extra-axial lesions and fractures evident on CT did not visualize on SPECT, but SPECT demonstrated associated changes in rCBF. Although there is still lack of clinical and pathological correlation, SPECT appears to be a promising method for a more sensitive evaluation of axial lesions in patients with mild to moderate TBI. Author.

3.  AUTHOR	Jacobs-A, Put-E, Ingels-M, Bossuyt-A.
INSTITUTION	Department of Nuclear Medicine, Virga Jesse Hospital, Hasselt, Belgium.
TITLE	Prospective evaluation of technetium-99m-HMPAO SPECT in mild and moderate traumatic brain injury (see comments).
SOURCE	J-Nucl-Med 1994 Jun, VOL: 35 (6), P: 942-7, ISSN: 0161-5505. CM Comment in: J-Nucl-Med 1994 Jun; 35(6):947-8.
ABSTRACT	We prospectively evaluated the contribution of 99mTc-HMPAO SPECT in patients who have sustained acute, mild or moderate head trauma.
Methods	Forty-two patients formed the first subgroup of moderate trauma (ModTr) and 25 patients formed the second subgroup of mild trauma (MilTr). All 67 patients underwent an initial SPECT (Tinit) within 4 wk after a closed cranial trauma. After a mean interval of 3 mo from the time of Tinit, all patients were clinically re-evaluated; those with an abnormal Tinit underwent a repeat SPECT (Trpt) as well. All SPECT studies were visually graded by agreement of three observers adjudging a score ranging from 0 (no lesions) to 4. RESULTS: For the group as a whole (ModTr + MilTr), the following results could be derived: (1) in 32/33 Tinit negative cases, clinical symptoms had resolved; (2) the positive predictive value of Tinit was only 20/34 (59%); (3) the sensitivity for the repeat SPECT was 19/20 (95%).
Conclusion	Our results show that: (1) SPECT alterations correlate well with the severity of the trauma; (2) a negative initial SPECT study is a reliable predictor of a favorable clinical outcome; (3) in cases with a positive initial SPECT, a follow-up consisting of a combination of SPECT and clinical data is necessary; (4) in patients suffering from postconclusive symptoms, SPECT offers an instrument to objective sequelae. Author.

4.  AUTHOR	Ichise-M, Chung-D-G, Wang-P, Wortzman-G, Gray-B-G, Franks-W.
INSTITUTION	Department of Radiology, Mount Sinai Hospital, Toronto, Ontario Canada.
TITLE	Technetium-99m-HMPAO SPECT, CT and MRI in the evaluation of patients with chronic traumatic brain injury: a correlation with neuropsychological performance (see comments).
SOURCE	J-Nucl-Med 1994 Feb, VOL: 35 (2), P: 217-26, ISSN: 0161-5505. CM Comment in: J-Nucl-Med 1994 Feb; 35(2):227.
ABSTRACT	The purposes of this study were: (1) to compare 99mTc- hexamethylpropyleneamineoxime (HMPAO) SPECT with CT and MRI in chronic traumatic brain injury (TBI) patients and (2) to correlate both functional and structural neuroimaging measurements of brain damage with neuropsychological (NP) performance.
Methods	Twenty-nine patients (minor TBI, n = 15 and major TBI, n = 14) and 17 normal controls (NC) underwent HMPAO SPECT, CT, MRI and NP testing. Imaging data were analyzed both visually and quantitatively.
Results	Nineteen (66%) patients showed 42 abnormalities on SPECT images, whereas 13 (45%) and 10 (34%) patients showed 29 abnormalities on MRI and 24 abnormalities on CT. SPECT detected relatively more abnormalities than CT or MRI in the minor TBI subgroup. The TBI group showed impairment on 11 tests for memory, attention and executive function. Of these, the anterior-posterior ratio (APR) correlated with six tests, whereas the ventricle-to-brain ratio (VBR), a known structural index of a poor NP outcome, correlated with only two tests. CONCLUSION: In evaluating chronic TBI patients, HMPAO SPECT, as a complement to CT or MRI, may play a useful role by demonstrating brain dysfunction in morphologically intact brain regions and providing objective evidence for some of the impaired NP performance. Author.

5.  AUTHOR	Holman-B-L, Zimmerman-R-E, Johnson-K-A, Carvalho-P-A, Schwartz-R-B, Loeffler-J-S, Alexander-E, Pelizzari-C-A, Chen-G-T.
INSTITUTION	Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115.
TITLE	Computer-assisted superimposition of magnetic resonance and high- resolution technetium-99m-HMPAO and thallium-201 SPECT images of the brain.
SOURCE	J-Nucl-Med 1991 Aug, VOL: 32 (8), P: 1478-84, ISSN: 0161-5505.
ABSTRACT	A method for registering three-dimensional CT, MR, and PET data sets that require no special patient immobilization or other precise positioning measures was adapted to high-resolution SPECT and MRI and was applied in 14 subjects (five normal volunteers, four patients with dementia (Alzheimer's disease), two patients with recurrent glioblastoma, and three patients with focal lesions (stroke, arachnoid cyst and head trauma). T2-weighted axial magnetic resonance images and transaxial 99mTc-HMPAO and 201Tl images acquired with an annular gamma camera were merged using an objective registration (translation, rotation and rescaling) program. In the normal subjects and patients with dementia and focal lesions, focal areas of high uptake corresponded to gray matter structures. Focal lesions observed on MRI corresponded to perfusion defects on SPECT. In the patients who had undergone surgical resection of glioblastoma followed by interstitial brachytherapy, increased 201Tl corresponding to recurrent tumor could be localized from the superimposed images. The method was evaluated by measuring the residuals in all subjects and translational errors due to superimposition of deep structures in the 12 subjects with normal thalamic anatomy and 99mTc-HMPAO uptake. This method for superimposing magnetic resonance and high-resolution SPECT images of the brain is a useful technique for correlating regional function with brain anatomy. Author.

6.  AUTHOR	Condon-B-R.
INSTITUTION	Magnetic Resonance Imaging Unit, Southern General Hospital, Glasgow, Scotland, United Kingdom.
TITLE	Multi-modality image combination: five techniques for simultaneous MR-SPECT display.
SOURCE	Comput-Med-Imaging-Graph 1991 Sep-Oct, VOL: 15 (5), P: 311-8, ISSN: 0895-6111.
ABSTRACT	Increasingly, images are being acquired of the same patient using two or more diagnostic imaging modalities. If one such modality is MRI then a data set showing essentially anatomical information is produced. If the second is SPECT using HMPAO then a data set showing cerebral perfusion is also produced. The ability to conjoin such anatomical and functional data is an important goal in radiology. In this technical report five display strategies are investigated as a means of conveying simultaneously to the radiologist all the information from two such data sets. Illustrative examples are given for each display technique. Preliminary observations are made regarding comprehensibility, information loss and efficiency in conveying all the information simultaneously, for all five techniques. Author.

7.  AUTHOR	Prayer-L, Wimberger-D, Oder-W, Kramer-J, Schindler-E, Podreka-I, Imhof-H.
INSTITUTION	Department of Radiology, University of Vienna, Austria.
TITLE	Cranial MR imaging and cerebral 99mTc HM-PAO-SPECT in patients with subacute or chronic severe closed head injury and normal CT examinations.
SOURCE	Acta-Radiol 1993 Nov, VOL: 34 (6), P: 593-9, ISSN: 0284-1851.
ABSTRACT	Eighteen patients in the subacute or chronic state following severe closed head injury with normal cranial CT scans were examined by MR and 99mTc HM-PAO SPECT. Correlations were sought between these 2 imaging modalities and the clinical outcome, as defined by the Glasgow Outcome Scale (GOS) score. Both MR and SPECT revealed cerebral damage in all patients examined but structural and functional alterations did not coincide topographically in 64.9% of lesions. Nevertheless, complementary injury patterns suggesting poor recovery were found; cortical contusions and diffuse axonal injury (MR) in conjunction with cortical and thalamic hypoperfusion (SPECT) were noticed in 8 out of 12 patients with unfavorable outcome (GOS = III and IV). The synthesis of MR and SPECT information clearly enhanced the ability both to accurately assess posttraumatic brain damage and to improve patients' outcome prediction. Author.

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