Brain SPECT studies

Brain SPECT studies were initially used in the late 1960s and early to mid-1970s. CT and the more sophisticated MRI anatomical studies replaced SPECT studies in the late 1970s and 1980s. At the time, the resolution (im­age clarity) of those studies was superior to SPECT for seeing tumors, cysts, and blood clots. Yet, despite their clarity, CT scans and MRIs could offer im­ages of only a static brain and its anatomy; they gave no information about the activity of 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 are problems of brain function.

Two technological advancements have once again encouraged the use of SPECT studies. The early SPECT cameras were called single-headed.

They used only one imaging device and took as long as one lour to rotate around a person's brain. People had trouble holding still for that long, the images were fuzzy and hard to read (earning nuclear medicine the nickname "unclear medicine"), and they did not give much information about the activity levels of the deep brain structures. Then multi-headed Cameras were developed with special filters that imaged the brain faster with enhanced resolution. Advancements in computer technology allowed for Improved data acquisition. The brain SPECT studies of today, with their markedly improved resolution, can see deeper into the inner workings of the brain with far greater clarity.

We typically do two scans when we evaluate a patient's brain. We do a baseline scan during which the patient is asked to let his mind wander, and 0 concentration scan during which we challenge the brain with a comput­erized test that measures attention span and impulse control. We have found it most helpful to have both scans to see how the brain activates with or without concentration and to have a baseline scan for comparison.

We look for three things when we evaluate a SPECT study: areas of the brain that work well, areas of the brain that work too hard, and areas of the brain that do not work hard enough.
The images in this book represent two kinds of three-dimensional (3D) images of the brain. The first is a 3D surface image, which captures the top 45 percent of brain activity. It shows blood flow of the brain s cortical, or outside, surface. These images are helpful for visualizing areas of healthy blood flow and activity as well as seeing areas with diminished perfusion and activity. They are helpful in looking at strokes, brain trauma, and the effects from drug abuse. A healthy 3D surface scan shows good, full, symmetrical activity across the brain's cortical surface.

The second type of SPECT images we look at are 3D active brain images comparing average brain activity to the hottest 15 percent of activity. These images are helpful in visualizing overactive brain areas, as seen in active seizures, and many types of anxiety and depression, among other irregular­ities. A healthy 3D active scan shows increased activity, seen by the light color in the active scans below, in the back of the brain, the cerebellum, and visual, or occipital, cortex, and average activity everywhere else.

It is important to note that everyone's brain looks different. Brains are like faces and there is variation among them. From an aesthetic standpoint, on scans some brains are beautiful, while others are a bit misshapen and symmetrical activity. A healthy brain has all of its major parts intact and they work together in a relatively harmonious fashion. While there are normal age variations, the brain scans of children and teenagers reveal more activity than the brain scans of adults; even an elderly brain, if properly cared for during life, looks full, symmetrical, and healthy.



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