Functional neuroimaging, including SPECT, is more notable for its absence than presence in the clinical MTBI literature: The selection of excerpts at the top of this review indicates the relative consistency of issues in TBI management over most of the past decade. No breakthrough therapies or diagnostic tests have changed the approach to management of TBI during that period by incorporation into standard clinical practice. Precision of diagnosis and prediction in the majority mildly injured patients clearly needs improvement and remains an area of active research. However, research has been and generally remains focused on CT; potential alternate functional imaging approaches are at the stage passed through at the beginning of most new imaging technology diffusion to the extant that only research at the technical efficacy stage is available as guidance for a new screening program. To qualify as components of an effective screening program, both functional imaging (SPECT and others) and TBI itself fail to meet the essential criteria discussed above.
Clearly, this level of research is inadequate to the potential use in screening of expensive tests involving injected contrast agents and whose diagnostic performance and clinical impact remain undefined.
Table 1’s high level summary of the contents of the literature documents the absence of research compelling enough to guide design of functional imaging-based TBI screening programs for populations of soldiers pre-and post-deployment.
Finally, the single available systematic review of functional imaging in MTBI (Davalos, 2007) does focus on SPECT but provides no support for, and no mention of, use of this imaging in screening.