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

Abstract

In the community, there is a need to more objectively evaluate the response of common chronic psychiatric disorders to treatment. Brain single photon emission computed tomography (SPECT) indirectly measures cerebral functional activity by uptake of a radiotracer, which follows regional cerebral blood flow. Brain 3D Thresholded SPECT scans are thresholded three dimensional images derived from brain SPECT data. A retrospective community study of longitudinal (before and after treatment) brain 3D Thresholded SPECT scans of 73 patients with all-cause psychiatric disorders (most frequent diagnostic clusters: attention-deficit hyperactivity disorder, post-mild traumatic brain injury, affective disorders, psychotic disorders, post-viral chronic syndromes), shows these baseline SPECT scans predict improvement (non-worsening to large improvement) in clinical functioning with a sensitivity of 94% (95% confidence interval 86–98%) and a specificity of 67% (95% confidence interval 21–94%). In contrast, contemporaneous analysis by the same radiologist of conventional 2D reading of the same before and after treatment brain SPECT scan data of the same 73 patients, predicted improvement (non-worsening to large improvement) in clinical functioning with a sensitivity of only 26% (95% confidence interval 17–37%) although with a specificity of 100% (95% confidence interval 44–100%). These data suggest 3D Thresholded SPECT scans can provide the clinician with a more objective measure for verifying improvement in psychiatric disorders seen in the community, consistent with prior studies of SPECT as a measure of neurobiological change. Furthermore, these data suggest 3D Thresholded SPECT scans may have clinical application in guiding treatment and potentially improving outcomes.

Single Photon Computed Tomography (SPECT) Findings in Cases with Japanese Adult- Attention-Deficit/Hyperactivity Disorder (ADHD): Special Attention to Cerebellar Posterior Lobe Hypoperfusion on Iodoamphetamine (IMP) SPECT using 3 Dimensional Stereotactic Surface Projection (3D-SSP) Analysis

“…As for methods of statistical analysis, 3D-SSP method is superior than that of SPM in cases with cerebral ischemia, or same level [26,27]. In terms of psychiatric diseases, findings of SPECT are helpful of judgement of treatment effect of various psychiatric diseases including ADHD [28]. Importantly, areas of hypoperfusion in ADHD have been debatable, frontostriatal-cerebellar circuit has pivotal role in adult-ADHD [13].…”