Evaluation of hyperbaric oxygen treatment of neuropsychiatric disorders following traumatic brain injury Chinese Medical Journal, 2006, Volume 119, No. 23 SHI Xiao-yan, TANG Zhong-quan, SUN Da, HE Xiao-jun SHI Xiao-yan Neuroscience Care Unit, Second Aff iliated Hospital of Zhejiang University College of Medicine, Hangzhou 310009, China; TANG Zhong-quan Department of Hyperbaric Oxygen, Second Affiliated Hosp ital of Zhejiang University College of Medicine, Hangzhou 310009, China; SUN Da Department of Nuclear Medicine, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou 310009, China; HE Xiao-jun Editorial Board of Chinese Journal of Emergency Medicine, Hangzhou 310009, China Correspondence to: SHI Xiao-yan Neuroscience Care Unit, Second Affiliated Hospital of Zhejiang University College of Medici ne, Hangzhou 310009, China (Tel:86-571- 87783951 Fax:86-571-87783647 Email:xys0571@hotmail ) Psychiatric disorder often occurs after traumatic brain injury (TBI). 1 We noted the clinical effectiveness of hyperbaric oxygen (HBO) in treatment of neuropsychiatric disorders after TBI. Initially, the evaluati on of its effects was only based on the improvement of clinical symptoms and ther e was no any other objective evidence to support the improvement. To study the effects of HBO on cerebral blood flow (CBF) and the usefulness of single photon emission computed tomography (SPECT) images in the diagnosis and assessment of neuropsychiatric disorders after TBI, we compared the results of cerebral SPECT and cerebral c omputed tomography (CT) before and after HBO treatment. METHODS Patients Three hundred and ten patients with neurop sychiatric disorders arising from TBI were included (male 206, female 104, aged 12 to 78 years, mean 45 years). Eighteen patients were younger than 15 years, 20 pa tients were older than 60 years. All the patients had been diagnosed as head trauma based on (1) clear cut head trauma history; (2) headache, dizziness, poor memo ry, epilepsy, hysteria, poor concentration and attention deficit; (3) no history of intracranial space occupying lesion, hypertension or cardiovascular diseases. Among the 310 pati ents, 212 had a disease course of 1 to 6 months, 79 had a course of 6 months to 1 year and 19 had a course longer than 1 year. Two hundred and twenty-five patients had headache, dizziness, poor memory, epilepsy, hysteria and poor concentration. Forty-se ven patients had epilepsy and thirty-eight patients had post traumatic hydrocephalus. 99m Tc-ECD SPECT imaging 99m Tc-ECD brain SPECT was performed under resting condition. Each patient was injected with 740-925 MBq (20-25 mCi) of 99m Tc-ECD. SPECT images were obtained at about 20 minutes to 1 hour after injection using a single head, rotating camera (Elscint APEX 609 RG; Elscint 1 td, Israel) and double head, rotating camera ( Siemens ECAM deut, Germany) equipped with a low ener gy, high resolution collimator. Patients remained supine with eyes open in a softly light room. All patients were cooperative during the study. Data were collected from 60 projections in the 140 keV photopeak (15% window) over 360 degrees in a 64× 64 matrix (Elscint APEX 609 RG) and 128×128 matrix (Siemens ECAM deut) with an acquisition time of 25-30 s/view. The total acquisition time was approximately 30 minutes (Elscint APEX 609 RG) and 15 minutes (Siemens ECAM deut). A zoom factor of 2 was used. Image reconstruction and analysis were performed using the computer system with filter back project (Elscint APEX 609 RG) and iterative back projection (Siemens ECAM deut), reconstruction and attenuation correction. The acquisition data were corrected for nonuniformity. Orthogonal transverse, coronal and sagittal images were generated, followed by orbitomeatal line (OML) reorientation of the reconstructed volume. The final data for visual interpretation consisted of 2-pixe l thick OML level, transverse, coronal and sagittal slices. Images were made between 1 to 3 days before and after treatment. The same instrument was used before and after HBO treatment for examination of each patient and the images were collected and processed under the same conditions. Semiquantitative analysis To accurately evaluate rCBF, 99m Tc-ECD uptake index was calculated for all patients. The uptake index was based on the ratio of 99m Tc-ECD uptake in each of 24 regions of cerebral cortex to the area of cerebellum and four OML level slices (approximately OM, OM + 1.8 cm, OM + 3.6 cm, and OM + 5.4 cm) were selected. In these slices, operator defined (4×4 pixel) regions of interest (ROI ) were drawn on some areas of left/right hemisphere. Using the systems ROI program, the same ROI could be easily moved to other area including cerebellum. The indices were recalculated from counts per pixel of the individual ROI for semiquantitative analysis. 99m Tc-ECD-uptake index The uptake index was (average ROI counts/pixel in the area of cerebral cortex)/(average ROI counts/pixel in the area of cerebellum). 99m Tc-ECD-uptake index
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