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The value of Brain SPECT functional Imaging in Clinical Psychiatry

Dan G Pavel M.D. Director, PathFinder Brain SPECT Imaging, Deerfield IL 60015.

Functional Brain SPECT perfusion studies provide important information in the evaluation of many psychiatric conditions with comorbidity. Indeed, the presence of comorbidity is a frequent reason for failed treatments. The comorbidity can be induced by a variety of origins including neurodevelopmental problems, traumatic brain injury, neuroinflammation, non-convulsive epilepsy, neurotoxic exposure, nutritional deficiencies, etc, which all contribute to the altering of blood flow levels in various gray matter structures.

A good quality brain SPECT provides detailed information about location, magnitude, and extent of areas of hyper and/or hypoperfusion(s). Such information will, in turn, contribute to the tailoring of a treatment strategy for a specific patient. In other words, brain SPECT (properly done and interpreted) goes a long way towards avoiding the dreaded “trial-and-error” pathway of treatment, by helping the specialist treat the patient and not the symptom.

The following PDF provides some examples of the usefulness of Brain SPECT functional imaging in clinical Psychiatry practice . It also shows how important functional details, can be easily visualized when using an optimized sequence of displays. In other words the effectiveness of a brain SPECT imaging procedure is greatly enhanced when the image results are presented in a consistent and relevant format.

For viewing the PDF click here

This video corresponds to the same case as shown, on the PDF above, under displays #14 to 14-5

Brain SPECT : improved displays for enhanced results .

Dan G Pavel M.D. Director, PathFinder Brain SPECT Imaging, Deerfield IL 60015

As software capabilities develop, work on quantification techniques is certainly justified. Nonetheless it seems imperative not to lose sight of the need to interpret the individual patient’s images. An improved visualization will go a long way towards improving not only the image interpretation, but also the dialog with referring professionals and with patients. In addition it will go a long way towards further spreading the notion of Brain SPECT as a key functional imaging procedure. To this effect the end result displays should be comprehensivedetailed, precise, consistent and.…user friendly. In other words the end displays should become a most efficient and easy to relate to, communication tool.

There are several ways to look at a brain SPECT: (A) In a static mode (a) using its native image or (b) using its normalized image e.g. after co-registration to a standard atlas / template and, (B) in a dynamic / cinematic mode .

(A) Static mode :

a. Is the basic display of the native images in the form of orthogonal slices ( fig 1 columns 1-3). While this helps in a number of cases there is general agreement that significant improvements can easily be obtained by :

– Using an additional set of slices along the temporal lobes axis (fig 1 column 4) and

– Using thresholded volumetric displays. The most comprehensive way available is an automatic display of 4 standardized thresholds on six views of the brain volume (fig 2 –only 2/4 thresholds and one single view are shown) .

Finally a most significant contribution to the requirements outlined above, is obtained when adding the second type of images .

b. The normalized e.g. template co-registered displays of brain surface and volume. Among their advantages are the ease of discerning features on brain surface projections and volumes This enables a much easier communication between the imaging specialist and the referring physician or patient and family alike . Also the comparison between followup imaging in the same patient or between scans of different patients, is greatly facilitated, given the fact that size / shape will be the same across subjects.

– The original normalization had been to the Talairach atlas as for ex.provided in the Neurostat algorithm (1 ) originally used for statistical analysis . Nonetheless it can also be used for each individual patient’s functional map displayed on eight two dimensional surface projections (fig 3)

– A next step introduced recently (2 ) uses these same Talairach normalized images but for a format of 6 views of volumetric surface display  views (fig 4)

– Recently a more detailed brain template called the MNI brain (Montreal Neurological Institute) has become available and theoretically brain SPECT results can also be co-registered to it .

(B) Dynamic /cinematic mode: there are multiple combinations possible and the ones presently

– The cine-display of two of the volumetric-surface projections in the X & Y axis (fig 4).

– A cine-display of three levels of rotating thresholded volumes in the X & Y axis . This enables a pertinent self explanatory evaluation of location and size of cortical as well as subcortical abnormalities (fig 5).

Two more questions need to be addressed :

1.Which color code ? Indeed brain SPECT being a functional imaging, requires color displays which enable semi-quantitative ways of evaluating differential function but, which color ? We selected 4 out of many color schemes : UBIQ a code with an easy to remember sequence of discrete shades (where the U & I stand for University of Illinois), then the so called “ cool” and “hot iron” (continuously transitioning colors) and, the “Picker 20” code .

2. Is this sequence of intricate methods of visualizations applicable in a routine clinical environment? The answer is “yes” because it can be practically done automatically. Indeed, with currently available a technologist is only required to provide two simple inputs : (a) indicate the file location containing the reconstructed / attenuation corrected, sequence of single slice images and (b) select the color code desired (from a list provided on the screen). Subsequently, in less than one minute a 5 page PDF file is available for distribution whether via screen viewing (including full cinematic displays) and /or via printing.

A final thought : better displays and automation will make it much easier to achieve Brain SPECT standardization as well .

(1) Minoshima, S., Koeppe, R.A., Frey, K.A., & Kuhl, D.E. (1994). Anatomical standardization: linear scaling and nonlinear warping of functional brain images. Journal of Nuclear Medicine, 35(9), 1528-1537.

(2) Good Lion Imaging , Columbia MD ; 1.847.987.5216 and :http://www.smartbrief.com/s/2009/03/access-neurostat-3d-ssp-brain-pet-or-spect-analysis

How We Can Actually See Psychiatric Illness

(based on a press release authored by Dr.Michael Breen at [email protected]; www.DrMichaelBreen.com)

Traditionally symptoms are how patients with mental illness are diagnosed and treated. The problem is that this approach hasn’t worked as well as expected. Success rates in treating most psychiatric illness haven’t changed in decades.

At The Neuroscience Center in many cases we’ve adopted a new approach. We can now see the unique brain images produced by neuropsychiatric illnesses. What we see is usually the combined functional effect of concurrent disorders as for example various combinations among depression, manic depression, anxiety, chronic pain, traumatic brain injury, toxic exposures, epilepsy, developmental diseases and other conditions.

The key to this new approach to mental disorders is a functional brain imaging procedure called Brain SPECT done under the supervision of Dr. Dan Pavel, Director of PathFinder Brain SPECT Imaging, at The Neuroscience Center. Dr. Pavel, a former Professor and former Director of Nuclear Medicine at the University of Illinois, has focused on Brain SPECT for some 25 years. The Brain SPECT shows in dramatic sectional and 3D fashion the blood perfusion (e.g. level of function) to various regions of the brain’s gray matter. While MRI/CT scans show structural changes in the brain, Brain SPECT shows functional changes i.e. the brain’s underlying biology. Dr. Pavel has used this non-invasive technique on thousands of patients. The patient’s unique perfusion patterns, both in terms of hypo and hyper function, are then analyzed and reported by him. This report subsequently helps the Neuropsychiatrist determine an optimized treatment strategy.

The advantages to this approach are many. First each patient becomes truly unique, with a unique set of functional imbalances. Using clusters of symptoms to lump patients into a single group is now known to be of limited value only. Second, Brain SPECT helps deal with the fact that very often neuropsychiatric illness is in fact the effect of several comorbid conditions a reality which needs to be taken into account when the treatment strategy is planned . Finally, by looking at their abnormal Brain SPECTs, patients themselves get the validation that there truly is a biologic substrate to their illness and thus that they are not just a case of “bad attitude” and that relief through treatment is possible.

We don’t use Brain SPECT on all patients, but only in those with complex, multiple coexisting conditions and / or in those which present as treatment refractory e.g after multiple attempts and often years of treatment there is no clear benefit.

Our belief is that ignoring the uniqueness of each patient is a main reason why so many people with neuropsychiatric symptoms are refractory to medications. Indeed similar types of symptoms may correspond to different patterns identified on Brain SPECT, which in turn may show the need for an individualized treatment.

In the future good quality Brain SPECT should be, and hopefully will, become increasingly used for the evaluation and effective treatment of neuropsychiatric disorders.

Welcome to our Blog site !

By now I assume you have checked out the rest of our PathFinder Brain SPECT Imaging web site and you may have already noted this paragraph:


The approach at The Neuroscience Center (TNC) is to integrate the information provided by Brain SPECT in the workup process of refining the differential diagnosis of complex conditions presenting with multiple comorbidities (co-existing conditions) and very often treatment resistance. Examples can be found in combinations of multiple concussions, concurrent or not, with behavioral changes, development illness, substance abuse, learning disability or cognitive impairment and limbic type seizures . Often patients present after having failed treatment attempts for years. Even in these situations experience has shown that among the multiple treatment plans available at TNC, there is one or a combination that ultimately works.


Here I would just like to briefly comment about it because it touches on several key points:


  • PathFinder Brain SPECT Imaging is an integral part of The Neuroscience Center.


  • Brain SPECT is only one (albeit an important one) of the multiple components of the workup undergone by patients with complex Neuropsychiatric conditions.


  • Why is the word “complex” used ? For at least two reasons : 1. Because patients come to us with comorbidity e.g. they are having not one but multiple conditions. 2. Because most of the time they have been treated with multiple medications and other procedures, often for years , but the disorder persists . They are thus considered “treatment resistant”.


  • Once the workup has been completed the Neuropsychiatrist (Steve Best MD) is now able to provide a treatment plan, specific to the functional status of that particular patient.


  • Finally, The Neuroscience Center has the possibility to apply a variety of treatments (one of them unique), which is the reason why one treatment plan or a combination of them will almost always work, as the past experience has shown.


Additional details about TNC can be found at :   www.neuroscience.md