Clinical utility of SPECT neuroimaging in the diagnosis and treatment of traumatic brain injury: a systematic review.
Level 3 - non-randomized controlled study
Systematic review of non-randomized observational (longitudinal and cross-sectional) diagnostic studies
PubMed 24646878 · doi:10.1371/journal.pone.0091088
What was done
A systematic review following PRISMA guidelines evaluated the clinical utility of single photon emission computed tomography (SPECT) in mild, moderate, or severe traumatic brain injury (TBI). Inclusion required cerebral lobar specificity of SPECT findings and direct comparison modalities in the same subjects. From 1,600 identified records, 71 studies (19 longitudinal and 52 cross-sectional) met inclusion criteria; case reports, non-English publications, and studies lacking comparison modalities were excluded.
What was found
Three longitudinal studies evaluated diagnostic predictive value: positive predictive value rose from 59% on initial post-trauma SPECT to 95% at one-year follow-up, a pattern replicated in a larger cohort. Across longitudinal and cross-sectional studies, SPECT detected lesions missed by CT or MRI, particularly in mild TBI in acute and chronic settings. Cross-sectional studies identified abnormalities most frequently in the frontal (94%) and temporal (77%) lobes. SPECT also demonstrated a negative predictive value near 100%.
Why it matters
SPECT may serve as an effective secondary diagnostic tool when patients with closed head injuries experience persistent neurological or psychiatric symptoms despite normal CT or MRI results.
Limits
The review was restricted to English-language publications and included only observational designs (longitudinal and cross-sectional studies). Total participant count across studies, heterogeneity, and formal risk of bias assessments were not reported in the abstract.
Cited by
- context Ninety-four percent of traumatic brain injuries affect the frontal lobes.