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One-Year Follow-up of Technetium-99m-HMPAO SPECT in Mild Head Injury

Department of Nuclear Medicine, Virgo Jesse Hospital, Hasselt, Belgium
Department of Neurosurgery, St.-Franciskus Hospital, Heusden-Zolder, Belgium
Department of Nuclear Medicine, University Hospital, Free University of Brussels (VUB), Jette, Belgium

Correspondence: For correspondence or reprints contact: Axel Jacobs, MD Nuclear Medicine Department, Virga Jesse Hospital, Stadsomvaart 11, B-3500 Hasselt, Belgium.

ABSTRACT

We evaluated the predictive capacity of ^99mTc-HMPAO SPECT for clinical outcome during a follow-up period of 12 mo after mild head injury. Methods: We prospectively evaluated 136 patients with mild head injury who underwent initial SPECT imaging (SPECTO) within 4 wk after the trauma. Re-evaluations were made 2.9–3.3 mo (T3mo), 5.7–6.3 mo (T6mo) and 11.9–12.6 mo (T12mo) postinjury. All patients with an abnormal SPECT underwent a repeat study at the subsequent time of evaluation. Patients with a previously normal SPECT scan did not undergo a repeat study. Clinical reassessments (CLIN) were performed as long as the earlier study had been positive or until patients were completely asymptomatic. Results: During all follow-up evaluations, SPECT had a high sensitivity and negative predictive value, increasing from 91% and 89%, respectively, at T3mo to 100% at T6mo and at T12mo. Clinical normalization occurred earlier than scintigraphic normalization. However, at 12 mo postinjury, we observed considerable improvement in the specificity and positive predictive value of SPECT (85% and 83%, respectively). The persistent lesions on the SPECT scan were related to their severity and to localization in the frontal cortex. Conclusion: A normal ^99mTc-HMPAO SPECT scan is a reliable tool in the exclusion of clinical sequelae of mild head injury. At 12 mo postinjury, a positive SPECT study is also a reliable predictor for clinical outcome.

Key Words: regional cerebral blood flow • SPECT • mild head injury • technetium-99m-HMPAO

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