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Single-Photon Emission Computed Tomography (SPECT)

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Figure 6–1. Procedure for obtaining a single-photon emission computed tomography (SPECT) scan.The same scanner is used for imaging many body systems, including brain, heart, bone, and lung. Details of the procedure differ. Before brain imaging, the patient receives an intravenous injection of the radioactive tracer while lying in a darkened room. After a short period in the darkened room to allow the tracer to distribute through the brain, the patient is ready to be scanned. The tracer distribution is stable for several hours, thus allowing a considerable time window for scanning to occur. After the patient is positioned on the scanner table, the gamma camera heads are moved in as close to the patient's head as possible. Illustrated is a multidetector system (IREX, Philips Medical Systems, Andover, MA), with three cameras (arrows). The cameras rotate around the patient's head during the imaging examination, and data are collected from multiple positions. The data are transmitted to a computer that produces tomographic images in the desired plane(s) of section.Source. Picture courtesy of Philips Medical Systems, Andover, MA.

Figure 6–2. SPECT imaging then and now.Axial single-photon emission computed tomography (SPECT) images of normal brain acquired in 1982, early 1990s, and 2009. Note the significant improvement in resolution since the 1980s.Source. SPECT image (1982) reprinted from Hill TC, Holman, BL, Lovett RD, et al.: "Initial Experience With SPECT (Single Photon Computerized Tomography) of the Brain Using N-isopropyl I-123p-iodoamphetamine: Concise Communication." Journal of Nuclear Medicine 23:193, 1982. Used with permission of the Society of Nuclear Medicine.

Figure 6–3. Serial axial SPECT images of a normal adult brain.Reference numbers for brain slice order are shown next to each slice. SPECT = single-photon emission computed tomography.

Figure 6–4. Current SPECT imaging capabilities.Three-dimensional reconstruction of single-photon emission computed tomography (SPECT) results obtained 2 months post traumatic brain injury (A). Areas of normal blood flow are red. Note the absence of flow in the right anterior temporal and frontal lobes (foreground), resulting in visualization of the left temporal and frontal lobes from the medial side. Seeing blood flow deficits in three dimensions improves appreciation of the extent of lesions. Merging blood flow data with anatomical imaging also improves identification of areas of abnormality. Sectional SPECT images overlaid on T1-weighted magnetic resonance axial (B) and coronal (C) images.Source. Pictures courtesy of Philips Medical Systems, Andover, MA.

Figure 6–5. Early subacute presentation of traumatic brain injury on SPECT.A 61-year-old man had a motor vehicle collision with a tree. This resulted in severe trauma with loss of consciousness requiring neurosurgical interventions. After several weeks of hospitalization, the patient was released. Within a few days, the patient'€™s family brought him to a psychiatric emergency service with agitation, incoherence, cognitive impairment, and psychosis. Two different sectional levels in the brain are illustrated with companion axial CT, T2-weighted MR, FLAIR MR, and SPECT. Note that the injury is more apparent on the FLAIR images than on the T2- weighted MR and CT images. The true extent of the injury, however, can be appreciated only on the SPECT images.CT = computed tomography; FLAIR = fluid-attenuated inversion recovery; MR = magnetic resonance; SPECT = single-photon emission computed tomography.

Figure 6–6. Late subacute presentation of traumatic brain injury.A 24-year-old man had a motor vehicle accident with no loss of consciousness 10 years after a mild head injury. Shortly thereafter, the patient presented with severe cognitive deficits, depression, agitation, aggression, and psychosis. Symptoms were sufficiently severe to require prolonged psychiatric hospitalization. MR examination during this time was normal. Numerous perfusion abnormalities were evident on SPECT scans acquired 2 years later (a single sagittal and three coronal sections are illustrated). The most pronounced abnormality was moderately reduced perfusion in the left parietal lobe near the posterior Sylvian fissure and in both temporal lobes. Mildly reduced perfusion was noted in the occipital lobes (left greater than right) and basal ganglia (particularly near the caudate heads). Some of these abnormalities are visible on both the sagittal and coronal images (arrows). MR = magnetic resonance; SPECT = single-photon emission computed tomography.

Figure 6–7. Chronic presentation of traumatic brain injury.A 52-year-old man had a high-impact closed-head injury 30 years before scanning. He presented with a 30-year history of emotional incontinence and depression. The patient also reported a loss of singing ability after the accident. Two different sectional levels in the brain are illustrated with companion axial T2-weighted MR and SPECT. There are minimal white matter changes in the parietal region apparent on the MR image. Mildly decreased perfusion is evident in the medial frontal lobes (left greater than right, arrowhead). Moderately decreased perfusion is evident in the right anterior temporal lobe adjacent to the Sylvian fissure (arrow). MR = magnetic resonance; SPECT = single-photon emission computed tomography.
Table Reference Number
Table 6–2. Commonly used U.S. Food and Drug Administration–approved tracers for SPECT

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