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Studies Using SPECT and Structural Imaging

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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.

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