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J Neurol Neurosurg Psychiatry 1997;63:368-372 doi:10.1136/jnnp.63.3.368
  • Short report

PET and SPECT in whiplash syndrome: a new approach to a forgotten brain?

  1. A Ottea,d,
  2. T M Ettlinb,
  3. E U Nitzschea,
  4. K Wachterb,
  5. S Hoegerlea,
  6. G H Simona,
  7. L Fierzc,
  8. E Mosera,
  9. J Mueller-Brandd
  1. aDepartment of Nuclear Medicine, University Hospital, Freiburg, Germany, bRehabilitation Clinic, Rheinfelden, Switzerland, cErlachstrasse 18, Bern, Switzerland, dInstitute of Nuclear Medicine, University Hospital, Basel, Switzerland
  1. Dr Andreas Otte, Division of Nuclear Medicine, Department of Radiological Science, University Hospital, School of Medicine, Petersgraben 4 CH-4031 Basel, Switzerland.
  • Received 5 November 1996
  • Revised 4 March 1997
  • Accepted 17 March 1997

Abstract

Whiplash associated disorders are a medicolegally controversial condition becoming increasingly worrisome in the western world. This study was designed to evaluate perfusion and glucose metabolism in whiplash brain. Using Tc-99m-bicisate (ECD) single photon emission computed tomography (SPECT) and F-18-fluorodeoxyglucose (FDG) PET, six clinically and neuropsychologically controlled patients (patient group) with whiplash syndrome and 12 normal controls (control group) were investigated. Standardised elliptical regions of interest (ROIs) were determined in three adjacent transaxial slices in the frontal, parietal, temporal, and parieto-occipital cortex, cerebellum, brain stem, basal ganglia, and thalamus. For PET, the glucose metabolic index (GMI; =ROI uptake/global uptake at the level of the basal ganglia) and, for SPECT, the perfusion index (PI; =ROI/global) were calculated. In the patient group there was significant hypometabolism and hypoperfusion in the parieto-occipital regions (on the right (R) and left (L) side) compared with the control group: PET data: GMI parieto-occipital R: control 1.066 (0.081) (mean (SD)), patient 0.946 (0.065); P=0.0092, Mann Whitney. GMI parieto-occipital L: control 1.034 (0.051), patient 0.922 (0.073); p=0.0067. SPECT data: PI parieto-occipital R: control 1.262 (0.066), patient 1.102 (0.063); P=0.0039. PI parieto-occipital L: control 1.226 (0.095), patient 1.098 (0.075); P=0.0273. In some patients there was hypometabolism (>2 SD of control) in regions other than the parieto-occipital region. It is hypothesised that parieto-occipital hypometabolism may be caused by activation of nociceptive afferent nerves from the upper cervical spine.

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