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Forensic Applications of Cerebral Single Photon Emission Computed Tomography in Mild Traumatic Brain Injury

Dr. Wortzel is Instructor-Fellow, Veterans Integrated Service Network 19 Mental Illness Research, Education, and Clinical Care (VISN 19 MIRECC), Denver Veteran's Affairs Medical Center, and the Neurobehavioral Disorders Program, Department of Psychiatry, University of Colorado School of Medicine, Denver, CO. Dr. Filley is Professor and Dr. Anderson is Associate Professor, Departments of Neurology and Psychiatry, University of Colorado School of Medicine and Denver VA, Denver, CO. Dr. Oster is Instructor-Fellow, Neurobehavioral Disorders Program, and Department of Neurology and Neurobehavioral Disorders Program, Department of Psychiatry, University of Colorado School of Medicine, Denver, CO. Dr. Arciniegas is Director of the Neurobehavioral Disorders Program and Associate Professor of Psychiatry and Neurology, University of Colorado School of Medicine, Denver, CO. Address correspondence to: Hal S. Wortzel, MD, Department of Psychiatry, CPH Room 2508, 4200 East 9th Avenue, C268-25, Denver, CO 80262. E-mail: hal.wortzel{at}uchsc.edu

Traumatic brain injury (TBI) is a substantial source of mortality and morbidity world wide. Although most such injuries are relatively mild, accurate diagnosis and prognostication after mild TBI are challenging. These problems are complicated further when considered in medicolegal contexts, particularly civil litigation. Cerebral single photon emission computed tomography (SPECT) may contribute to the evaluation and treatment of persons with mild TBI. Cerebral SPECT is relatively sensitive to the metabolic changes produced by TBI. However, such changes are not specific to this condition, and their presence on cerebral SPECT imaging does not confirm a diagnosis of mild TBI. Conversely, the absence of abnormalities on cerebral SPECT imaging does not exclude a diagnosis of mild TBI, although such findings may be of prognostic value. The literature does not demonstrate consistent relationships between SPECT images and neuropsychological testing or neuropsychiatric symptoms. Using the rules of evidence shaped by Daubert v. Merrell Dow Pharmaceuticals, Inc., and its progeny to analyze the suitability of SPECT for forensic purposes, we suggest that expert testimony regarding SPECT findings should be admissible only as evidence to support clinical history, neuropsychological test results, and structural brain imaging findings and not as stand-alone diagnostic data.

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				R. P. Granacher Jr Commentary: Applications of Functional Neuroimaging to Civil Litigation of Mild Traumatic Brain Injury J Am Acad Psychiatry Law, September 1, 2008; 36(3): 323 - 328. [Abstract] [Full Text] [PDF]