Medical Procedures
SPECT Scans
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A SPECT scan (single photon emission computed tomography) is a nuclear medicine study that measures blood flow and activity levels in the brain. Because the SPECT scan provides information about how the brain works, it is an excellent diagnostic tool for identifying behavioral and cognitive problems in persons with brain injury.
In the 1970’s and 80’s, the use of SPECT studies was nearly eliminated due to the development of the Standard MRI and CAT scan with their superior resolution for delineating tumors, cysts and blood clots. Yet despite their clarity, MRI and CAT scans could offer only images of a static brain and its anatomy; they gave little or no information on the activity in a working brain. In the last decade, it has become increasingly recognized that many neurological and psychiatric disorders are not disorders of the brain’s anatomy, but problems in how it functions. And now, thanks to new multiheaded cameras and the advancement of computer technology, SPECT images of today can see into the deeper areas of the brain with far greater clarity and show what CAT scans and MRIs cannot—how the brain actually functions.
There are other sophisticated brain studies besides the SPECT that measure brain function: the functional MRI (fMRI), the PET scan and the quantitative EEG. However, the SPECT scan has several advantages. First, the largest amount of data available to date on how the brain works has been documented using SPECT scans. Second, the process is simple and the results immediate. Radioactive isotopes are bound to a substance that is readily taken up by the cells in the brain. A small amount, injected by IV, locks into the brain in just one minute. The whole procedure including the scan takes only about fifteen minutes. Also the person being scanned does not have to lay immobile “in camera” throughout a SPECT procedure. This allows the scan to take photographs of the person’s brain in a variety of states (e.g. at rest or after performing tasks that will stimulate certain parts of the brain, etc). SPECT scans, which cost around $1000 per scan are also less expensive than fMRI or PET scans and are usually covered by insurance when brain injury is present. Due to cost, ease of use and availability, the SPECT scan is often the diagnostic tool of choice for securing images of brain function.
When evaluating the scan, physicians are usually alerted that something is wrong in one of three ways: they see too much activity in a certain area; they see to little activity in a certain area; or they see asymmetrical areas of activity that ought to be symmetrical.
Using this information along with a detailed clinical history, it is possible to pin-point trouble spots affecting a person’s biological, psychological and social makeup so that appropriate intervention can be recommended. In brain injury where cognitive issues may be complex, the scan can help differentiate between two problems with similar symptoms. Multiple problems, once identified, can be addressed in the context of an over-all plan.
One benefit of using a SPECT scan in brain injury is that helps persons with brain injury and their families know what they are dealing with. Seeing areas of deficit in black and white encourages compassion and a valuable reality check about problems that are unlikely to be “fixed.” Yet when the scan reveals abnormalities that have the potential to improve, that information offers hope. A game plan based on the results of the scan can help in discerning what “next step” is possible. The findings may also provide the support needed to secure additional services through insurance that such a step would require.
When looking for a person, clinic or facility to provide a SPECT scan, some things to consider are:
- How much experience do they have with SPECT scans? Someone who does ten or twenty scans a year is not going to be as astute in picking up abnormalities as someone who does hundreds.
- Do they administer a clinical history using professional (preferably masters-level) personnel? Because the clinical history information is used in conjunction with the scan to determine diagnosis, competent evaluators are critical .
- Is there an end product? The value of the SPECT cannot be fully realized by just documenting the underlying physiology of the person’s brain function. A plan that looks at biological, psychological and social solutions to address the problems is the other half of the equation. Using an integrated approach, a qualified doctor should be able to identify problem areas (such as in executive function and impulse control) and recommend appropriate medications and therapies known to be effective in changing abnormalities or deficits in brain activity.
- Who interprets the results, determines the diagnosis and develops the plan? The physician or assistants? The benefit of the plan to the person and the family will directly relate to the experience and qualification of the person/s directly involved in the process. Can the doctor or clinic refer the person to neurologists, neuropsychologists and therapists who understand this integrated approach and are willing to work with the plan?
The good news for persons with brain injury is that technology is available to help with better diagnosis and better diagnosis makes possible more appropriate and effective treatment.
Daniel Amen is a board certified child and adult psychiatrist, brain imaging specialist, and the CEO of Amen Clinics, Inc. in Newport Beach and Fairfield, California and the new clinic in Tacoma, Washington. Dr. Amen has pioneered the use of brain imaging in clinical psychiatric practice and is a nationally recognized expert on the relationship between the brain and behavior. His clinics have the world’s largest database of functional brain scans for neuropsychiatry. He has won writing and research awards from the American Psychiatric Association, the US Army and the Baltimore-DC Institute for Psychoanalysis.
The Brain Place is a website giving in-depth information on SPECT scan technology including abstracts, brain maps detailing location/function, case studies, and history.
Dr. Amen's book, Change Your Brain, Change Your Life, is a layman’s guide to understanding the brain, how it works, and how to change it. The text includes medication helpful in addressing specific symptoms.