Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review

BackgroundThe most common assessment modalities to determine the level of injury following a traumatic brain injury (TBI) includes computerized tomography (CT) scans and/or magnetic resonance imaging (MRI). Evidence is mixed as to whether single photon emission computed tomography (SPECT) is specific and accurate in identifying TBI. ObjectivesThis study systematically assessed recent evidence of the clinical utility of SPECT in the diagnosis of TBI and examined the diagnostic accuracy of SPECT in TBI and its performance in comparison to other imaging modalities (e.g., CT and MRI). MethodsPubMed, MEDLINE, and Embase databases were systematically searched for published articles from December 2012 to July 2022. Randomized controlled trials (RCTs) and observational studies published in English that used SPECT to evaluate patients with all severity of TBIs were eligible for inclusion. Titles and abstracts were screened, and 111 selected full-text articles were independently screened based on predefined inclusion/exclusion criteria (guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PRISMA) and assessed for quality using the Newcastle-Ottawa Scale. ResultsFourteen eligible studies, all observational, reporting location of lesions on brain SPECT were included, reporting data from 21632 participants of which 20,746 participants were from one study; the remaining 886 participants were from the remaining13 studies. The heterogeneity of the data precludes a meta-analysis. There was no consensus among experts from the thirteen smaller studies; however, the largest study indicated that the specificity of visual readings was 54%. In particular, abnormalities and brain perfusions may lead to false positives. Quantitative analysis theoretically increases the reliability of findings for brain SPECT, but error rates are unknown and not published. ConclusionThere is a lack of evidence to support the clinical utility of brain SPECT for the diagnosis and treatment of TBI.