Brain SPECT as an Imaging Biomarker for Evaluating Effects of Novel Treatments in Psychiatry–A Case Series

Abstract

The difficulties of evaluating patients with complex neuropsychiatric conditions and prescribing appropriate treatments are well known. Imaging complements clinical assessments and allows a clinician to narrow the differential diagnosis by facilitating accurate and efficient evaluation. This is particularly relevant to neuropsychiatric conditions that are often diagnosed using a trial-and error process of exclusion. Single Photon Emission Computed Tomography (SPECT) is a functional brain imaging procedure that allows practitioners to measure the functional changes of gray matter structures based on regional cerebral blood flow (rCBF). The accurate diagnosis and treatment selection in psychiatry is challenging due to complex cases and frequent comorbidities. However, such complex neuropsychiatric conditions are increasingly benefitting from new treatment approaches, in addition to established medications. Among these are combination transcranial magnetic stimulation with ketamine infusions (CTK), hyperbaric oxygen therapy (HBOT) and perispinal administration of etanercept (PSE). This article provides readers with six case study examples that demonstrate how brain SPECT imaging can be used, both as a diagnostic tool, and as a potential biomarker for monitoring and evaluating novel treatments for patients with complex neuropsychiatric conditions. Six patients were assessed in our clinic and baseline brain SPECT imagesTourettes and a long history of alcohol were visually compared with SPECT images collected after periods of treatment with CTK or HBOT followed by PSE. This retrospective review demonstrates the clinical utility of these novel treatments and describes how SPECT imaging can complement standard diagnostic assessments. A novel display technique for SPECT images is described and we argue that SPECT imaging can be used for monitoring biomarker for clinical change.

The Legacy of the TTASAAN Report – Premature Conclusions and Forgotten Promises About SPECT Neuroimaging: A Review of Policy and Practice Part II

“…we can see perfusion SPECT neuroimaging can serve as an objective biomarker of response to treatment ( 144 , 145 ), comorbidity ( 30 , 33 , 82 , 84 , 133 ), inherently difficult symptoms to objectify, such as pain ( 147 ), and of diagnostic masqueraders as described herein and elsewhere ( 30 , 33 , 84 , 133 , 148 ).…”

“…b. Recognize the value of SPECT in the monitoring or tracking of changes in brain function as a consequence of treatment (e.g., a biomarker) ( 130 , 144 , 145 ).…”

Longitudinal Single Photon Emission Computed Tomography Neuroimaging as an Indication of Improvement in Psychiatric Disorders in a Community Psychiatric Practice

“…SPECT also demonstrated specific findings in PTSD distinct from a trauma-exposed cohort (12). Perfusion SPECT has also been shown to provide objective evidence of neurophysiological changes in response to specific treatments, such as multi-watt infrared laser therapy for TBI (13), stem cell therapy for Lyme disease (14), and combined ketamine-transcranial magnetic stimulation (15). Studies have suggested SPECT scan data may improve clinical outcome by guiding treatment choices more quickly to successful strategies (4,(16)(17)(18).…”

Stand der Technik in der Radiopharmazie

“…1 Physikalische Eigenschaften von häufig verwendeten Radionukliden für die Einzelphotonen-Emissions-Computertomografie (SPECT) und die Positronen-Emissions-Tomografie (PET). 111 In SPECT 13 N 1 0 m β + (100) 16 O(p,α) 13 N P E T 99 m Tc-Kern enthalten, in dem das koordinativ gesättigte 99 m Technetium(VII) in 99 m TcO -4 auf einen Oxidationszustand reduziert wurde, der für die Herstellung stabiler Komplexe für die Koordinationschemie besser geeignet ist. Am leichtesten zugänglich ist Technetium(V), wie die zahlreichen zugelassenen 99 m Technetium(V)-Radiotracer zeigen, darunter 99 m Tc-Sestamibi, 99 m Tc-Tetrofosmin, 99 m Tc-Teboroxim, 99 m Tc-Bicisat, 99 m Tc-Pentetat, 99 m Tc-Oxidronat (CH5O7P2Tc), bekannt unter den Handelsnamen Cardiolite, Myoview, Cardiotec, Neurolite, Technescan MAG3, Osteoscan HDP [13][14][15][16][17][18].…”

“…111 In SPECT 13 N 1 0 m β + (100) 16 O(p,α) 13 N P E T 99 m Tc-Kern enthalten, in dem das koordinativ gesättigte 99 m Technetium(VII) in 99 m TcO -4 auf einen Oxidationszustand reduziert wurde, der für die Herstellung stabiler Komplexe für die Koordinationschemie besser geeignet ist. Am leichtesten zugänglich ist Technetium(V), wie die zahlreichen zugelassenen 99 m Technetium(V)-Radiotracer zeigen, darunter 99 m Tc-Sestamibi, 99 m Tc-Tetrofosmin, 99 m Tc-Teboroxim, 99 m Tc-Bicisat, 99 m Tc-Pentetat, 99 m Tc-Oxidronat (CH5O7P2Tc), bekannt unter den Handelsnamen Cardiolite, Myoview, Cardiotec, Neurolite, Technescan MAG3, Osteoscan HDP [13][14][15][16][17][18]. Die ersten 3 Komplexe sind als Mittel zur Durchblutung des Herzmuskels zugelassen, während die anderen für die zerebrale Perfusion, die Nierenfunktion bzw.…”