Improved Outcomes Using Brain SPECT-Guided Treatment Versus Treatment-as-Usual in Community Psychiatric Outpatients: A Retrospective Case-Control Study

Thornton, John F.; Schneider, Howard; McLean, Mary Kay; Lierop, Muriel J. van; Tarzwell, Robert

doi:10.1176/appi.neuropsych.12100238

Cited by 7 publications

(9 citation statements)

References 12 publications

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“…With stimulant treatment, perfusion increased in the prefrontal cortex ( 338 , 343 ) corresponding with clinical improvement of ADHD symptoms. Clinical experience has heavily supported these findings ( 109 , 302 , 349 ).…”

Section: Assessment Of the State Of The Art—spect In Brain Disordersmentioning

confidence: 95%

The Legacy of the TTASAAN Report—Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I

2022

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Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970's. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was originally approved in 1988, but was unstable. As a result, the quality of SPECT images varied greatly based on technique until 1993, when a method of stabilizing HMPAO was developed. In addition, most SPECT perfusion studies pre-1996 were performed on single-head gamma cameras. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. Although the TTASAAN report was published in January 1996, it was approved for publication in October 1994. Consequently, the reported brain SPECT studies relied upon to derive the conclusions of the TTASAAN report largely pre-date the introduction of stabilized HMPAO. While only 12% of the studies on traumatic brain injury (TBI) in the TTASAAN report utilized stable tracers and multi-head cameras, 69 subsequent studies with more than 23,000 subjects describe the utility of perfusion SPECT scans in the evaluation of TBI. Similarly, dementia SPECT imaging has improved. Modern SPECT utilizing multi-headed gamma cameras and quantitative analysis has a sensitivity of 86% and a specificity of 89% for the diagnosis of mild to moderate Alzheimer's disease—comparable to fluorodeoxyglucose positron emission tomography. Advances also have occurred in seizure neuroimaging. Lastly, developments in SPECT imaging of neurotoxicity and neuropsychiatric disorders have been striking. At the 25-year anniversary of the publication of the TTASAAN report, it is time to re-examine the utility of perfusion SPECT brain imaging. Herein, we review studies cited by the TTASAAN report vs. current brain SPECT imaging research literature for the major indications addressed in the report, as well as for emerging indications. In Part II, we elaborate technical aspects of SPECT neuroimaging and discuss scan interpretation for the clinician.

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Section: Assessment Of the State Of The Art—spect In Brain Disordersmentioning

confidence: 95%

The Legacy of the TTASAAN Report—Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I

2022

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“…Similar results were obtained in a smaller study by a different group (36). A group of 28 patients who underwent SPECT functional neuroimaging at baseline and received treatment guided by the results of the SPECT scans were compared to a matched group of 28 controls who received treatment guided only by clinical acumen.…”

Section: Well-established Diagnostic Roles For Spect and Petmentioning

confidence: 52%

“…In contrast, some patients with depression have markedly decreased dorsal frontal cortex and medial frontal cortex activity and perfusion. These patients are less likely to respond to SSRI medications, but may respond better to noradrenergic antidepressants (29,36). Treatment-resistant depression may show markedly increased activity and perfusion in the subgenual cingulate (30).…”

Section: Brain Function and Psychiatry In Historymentioning

confidence: 99%

Functional Neuroimaging in Psychiatry—Aiding in Diagnosis and Guiding Treatment. What the American Psychiatric Association Does Not Know

et al. 2020

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“…The diagnosis for BD needed to be within the past 5 years along with a YMRS score (Young, Biggs, Ziegler, & Meyer, 1978) with at least 20 points. Patients receiving medication to treat BD or electroconvulsive therapy during the 6 months prior to the evaluation were excluded, to avoid confounders in baseline brain perfusion (Miller, Rezai, Alliger, & Andreasen, 1997; Thornton, Schneider, McLean, van Lierop, & Tarzwell, 2014).…”

Section: Methodsmentioning

confidence: 99%

Brain perfusion during manic episode and at 6‐month follow‐up period in bipolar disorder patients: Correlation with cognitive functions

et al. 2020

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Improved Outcomes Using Brain SPECT-Guided Treatment Versus Treatment-as-Usual in Community Psychiatric Outpatients: A Retrospective Case-Control Study

Cited by 7 publications

References 12 publications

The Legacy of the TTASAAN Report—Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I

The Legacy of the TTASAAN Report—Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I

Functional Neuroimaging in Psychiatry—Aiding in Diagnosis and Guiding Treatment. What the American Psychiatric Association Does Not Know

Brain perfusion during manic episode and at 6‐month follow‐up period in bipolar disorder patients: Correlation with cognitive functions

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