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PET with ¹⁸fluorodeoxyglucose and hexamethylpropylene amine oxime SPECT in late whiplash syndrome

From the Department of Medical Radiology (Drs. Bicik, Schäfer, Blum, Burger, von Schulthess, and Buck), Division of Nuclear Medicine, University of Zurich; the Department of Psychiatry (Dr. Radanov), University of Berne, Inselspital, Berne; the Department of Neurology (Dr. Dvorak), Schulthess Clinic, Spine Unit, Zurich; and the Department of Neurology(Dr. Weber), University of Zurich, Switzerland.

Address correspondence and reprint requests to Dr. Alfred Buck, University Hospital, Department of Medical Radiology, Division of Nuclear Medicine, Ramistr. 100, 8091 Zurich, Switzerland.

Background: Many patients have cognitive abnormalities and psychological problems after whiplash injury to the cervical spine. To our knowledge, neuroradiologic imaging has not depicted brain damage that explains the symptoms. Parietotemporo-occipital perfusion deficits on hexamethylpropylene amine oxime (HMPAO) SPECT studies have been described among patients who have sustained whiplash injury.

Methods: We examined 13 patients with typical late whiplash syndrome (study group) using HMPAO SPECT, ¹⁸fluorodeoxyglucose (FDG) PET, and MRI of the brain and compared the findings with those for 16 control subjects who underwent FDG PET.

Results: In the study group, statistical parametric mapping revealed significantly decreased FDG uptake in the frontopolar and lateral temporal cortex and in the putamen. The frontopolar hypometabolism correlated significantly with scores of the Beck Depression Inventory. However, in individual cases, reliability in the depiction of hypometabolic areas was relatively low. No alterations were found in the parietotemporo-occipital area. In these areas, decreased uptake of HMPAO and FDG correlated with cortical mass.

Conclusion: FDG PET did not allow reliable diagnosis of metabolic disturbances for individual patients. Therefore, we do not recommend FDG PET or HMPAO SPECT as a diagnostic tool in routine examinations of patients with late whiplash syndrome.

Received September 8, 1997. Accepted in final form March 3, 1998.

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