Nuclear Medicine Imaging of Head and Face Injuries

  • K. P. KoopmansEmail author


Head injuries, which form approximately 10 % of all sports-related trauma in high school sports activities, can have devastating effects on the individual and society.

Nuclear medicine has thus far not been playing an important role in trauma to the bony structures of the head, but this might change due to the higher resolution and sensitivity of 18F-NaF PET for ossal pathology. Especially in the follow-up, 18F-NaF may become more important, but research is warranted.

Concussion is mainly a clinical diagnosis, and imaging techniques do not play an important role. However, new techniques in both cerebral blood flow measurements with SPECT and cerebral metabolism with PET are emerging. These techniques not only give a better insight in the underlying pathological mechanisms of concussion but can also aid in the diagnosis and follow-up of patients suspected of concussion. Actually, the position of nuclear medicine techniques in the diagnosis of concussion has not been determined, so more research is warranted.


Fracture Healing Bone Scintigraphy Regional Blood Flow Mild Traumatic Brain Injury Bone Bruise 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abdel-Dayem HM, Abu-Judeh H, Kumar M, Atay S, Naddaf S, El-Zeftawy H et al (1998) SPECT brain perfusion abnormalities in mild or moderate traumatic brain injury. Clin Nucl Med 23:309–317CrossRefPubMedGoogle Scholar
  2. Abu-Judeh HH, Singh M, Masdeu JC, Abdel-Dayem HM (1998) Discordance between FDG uptake and technetium-99m-HMPAO brain perfusion in acute traumatic brain injury. J Nucl Med 39:1357–1359PubMedGoogle Scholar
  3. Adirim TA, Cheng TL (2003) Overview of injuries in the young athlete. Sports Med 33:75–81CrossRefPubMedGoogle Scholar
  4. Amen DG, Newberg A, Thatcher R, Jin Y, Wu J, Keator D et al (2011a) Impact of playing American professional football on long-term brain function. J Neuropsychiatry Clin Neurosci 23:98–106CrossRefPubMedGoogle Scholar
  5. Amen DG, Wu JC, Taylor D, Willeumier K (2011b) Reversing brain damage in former NFL players: implications for traumatic brain injury and substance abuse rehabilitation. J Psychoactive Drugs 43:1–5CrossRefPubMedGoogle Scholar
  6. Audenaert K, Jansen HM, Otte A, Peremans K, Vervaet M, Crombez R et al (2003) Imaging of mild traumatic brain injury using 57Co and 99mTc HMPAO SPECT as compared to other diagnostic procedures. Med Sci Monit 9:MT112–MT117PubMedGoogle Scholar
  7. Bensch FV, Koivikko MP, Koskinen SK (2011) MDCT findings in sports and recreational accidents. Acta Radiol 52:1107–1112CrossRefPubMedGoogle Scholar
  8. Bigler ED, Maxwell WL (2012) Neuropathology of mild traumatic brain injury: relationship to neuroimaging findings. Brain Imaging Behav 6:108–136CrossRefPubMedGoogle Scholar
  9. Bishop JA, Palanca AA, Bellino MJ, Lowenberg DW (2012) Assessment of compromised fracture healing. J Am Acad Orthop Surg 20:273–282CrossRefPubMedGoogle Scholar
  10. Broglio SP, Eckner JT, Martini D, Sosnoff JJ, Kutcher JS, Randolph C (2011) Cumulative head impact burden in high school football. J Neurotrauma 28:2069–2078PubMedCentralCrossRefPubMedGoogle Scholar
  11. Catafau AM (2001) Brain SPECT in clinical practice. Part I: perfusion. J Nucl Med 42:259–271PubMedGoogle Scholar
  12. Darrow CJ, Collins CL, Yard EE, Comstock RD (2009) Epidemiology of severe injuries among United States high school athletes: 2005–2007. Am J Sports Med 37:1798–1805CrossRefPubMedGoogle Scholar
  13. Drubach LA, Sapp MV, Laffin S, Kleinman PK (2008) Fluorine-18NaF PET imaging of child abuse. Pediatr Radiol 38:776–779CrossRefPubMedGoogle Scholar
  14. Drubach LA, Johnston PR, Newton AW, Perez-Rossello JM, Grant FD, Kleinman PK (2010) Skeletal trauma in child abuse: detection with 18F-NaF PET. Radiology 255:173–181CrossRefPubMedGoogle Scholar
  15. Even-Sapir E, Arbel R, Lerman H, Flusser G, Livshitz G, Halperin N (2002) Bone injury associated with anterior cruciate ligament and meniscal tears: assessment with bone single photon emission computed tomography. Invest Radiol 37:521–527CrossRefPubMedGoogle Scholar
  16. Even-Sapir E, Mishani E, Flusser G, Metser U (2007) 18F-Fluoride positron emission tomography and positron emission tomography/computed tomography. Semin Nucl Med 37:462–469CrossRefPubMedGoogle Scholar
  17. Folkersma H, Boellaard R, Yaqub M, Kloet RW, Windhorst AD, Lammertsma AA et al (2011) Widespread and prolonged increase in (R)-(11)C-PK11195 binding after traumatic brain injury. J Nucl Med 52:1235–1239CrossRefPubMedGoogle Scholar
  18. Gowda NK, Agrawal D, Bal C, Chandrashekar N, Tripati M, Bandopadhyaya GP et al (2006) Technetium Tc-99m ethyl cysteinate dimer brain single-photon emission CT in mild traumatic brain injury: a prospective study. AJNR Am J Neuroradiol 27:447–451PubMedGoogle Scholar
  19. Grant FD, Fahey FH, Packard AB, Davis RT, Alavi A, Treves ST (2008) Skeletal PET with 18F-fluoride: applying new technology to an old tracer. J Nucl Med 49:68–78CrossRefPubMedGoogle Scholar
  20. Gross H, Kling A, Henry G, Herndon C, Lavretsky H (1996) Local cerebral glucose metabolism in patients with long-term behavioral and cognitive deficits following mild traumatic brain injury. J Neuropsychiatry Clin Neurosci 8:324–334CrossRefPubMedGoogle Scholar
  21. Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA et al (2013) American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 47:15–26CrossRefPubMedGoogle Scholar
  22. Hashimoto K, Abo M (2009) Abnormal regional benzodiazepine receptor uptake in the prefrontal cortex in patients with mild traumatic brain injury. J Rehabil Med 41:661–665CrossRefPubMedGoogle Scholar
  23. Hsu WK, Feeley BT, Krenek L, Stout DB, Chatziioannou AF, Lieberman JR (2007) The use of 18F-fluoride and 18F-FDG PET scans to assess fracture healing in a rat femur model. Eur J Nucl Med Mol Imaging 34:1291–1301PubMedCentralCrossRefPubMedGoogle Scholar
  24. Humayun MS, Presty SK, Lafrance ND, Holcomb HH, Loats H, Long DM et al (1989) Local cerebral glucose abnormalities in mild closed head injured patients with cognitive impairments. Nucl Med Commun 10:335–344CrossRefPubMedGoogle Scholar
  25. Iverson GL, Gaetz M, Lovell MR, Collins MW (2004) Cumulative effects of concussion in amateur athletes. Brain Inj 18:433–443CrossRefPubMedGoogle Scholar
  26. Jacobs A, Put E, Ingels M, Put T, Bossuyt A (1996) One-year follow-up of technetium-99m-HMPAO SPECT in mild head injury. J Nucl Med 37:1605–1609PubMedGoogle Scholar
  27. Kaur J, Chopra R (2010) Three dimensional CT reconstruction for the evaluation and surgical planning of mid face fractures: a 100 case study. J Maxillofac Oral Surg 9:323–328PubMedCentralCrossRefPubMedGoogle Scholar
  28. Kraus JF (1991) Epidemiologic features of injuries to the central nervous system. In: Anderson DW (ed) Neuroepidemiology: a tribute to Bruce Schoenberg. CRC Press, Boca Raton, pp 333–353Google Scholar
  29. Langlois JA, Rutland-Brown W, Wald MM (2006) The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 21:375–378CrossRefPubMedGoogle Scholar
  30. Leonard JP, Nowotnik DP, Neirinckx RD (1986) Technetium-99m-d, 1-HM-PAO: a new radiopharmaceutical for imaging regional brain perfusion using SPECT – a comparison with iodine-123 HIPDM. J Nucl Med 27:1819–1823PubMedGoogle Scholar
  31. Lin AP, Liao HJ, Merugumala SK, Prabhu SP, Meehan WP 3rd, Ross BD (2012) Metabolic imaging of mild traumatic brain injury. Brain Imaging Behav 6:208–223CrossRefPubMedGoogle Scholar
  32. Marshall CM (2012) Sports-related concussion: a narrative review of the literature. J Can Chiropr Assoc 56:299–310PubMedCentralPubMedGoogle Scholar
  33. McCrory P, Meeuwisse W, Aubry M, Cantu B, Dvorak J, Echemendia RJ et al (2013) Consensus statement on concussion in sport – the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Clin J Sport Med 23:89–117CrossRefPubMedGoogle Scholar
  34. Peskind ER, Petrie EC, Cross DJ, Pagulayan K, McCraw K, Hoff D et al (2011) Cerebrocerebellar hypometabolism associated with repetitive blast exposure mild traumatic brain injury in 12 Iraq war Veterans with persistent post-concussive symptoms. Neuroimage 54(Suppl 1):S76–S82PubMedCentralCrossRefPubMedGoogle Scholar
  35. Proctor MR, Cantu RC (2000) Head and neck injuries in young athletes. Clin Sports Med 19:693–715CrossRefPubMedGoogle Scholar
  36. Provenzano FA, Jordan B, Tikofsky RS, Saxena C, Van Heertum RL, Ichise M (2010) F-18 FDG PET imaging of chronic traumatic brain injury in boxers: a statistical parametric analysis. Nucl Med Commun 31:952–957CrossRefPubMedGoogle Scholar
  37. Rangger C, Kathrein A, Freund MC, Klestil T, Kreczy A (1998) Bone bruise of the knee: histology and cryosections in 5 cases. Acta Orthop Scand 69:291–294CrossRefPubMedGoogle Scholar
  38. Rechel JA, Collins CL, Comstock RD (2011) Epidemiology of injuries requiring surgery among high school athletes in the United States, 2005 to 2010. J Trauma 71:982–989CrossRefPubMedGoogle Scholar
  39. Ruff RM, Crouch JA, Troster AI, Marshall LF, Buchsbaum MS, Lottenberg S et al (1994) Selected cases of poor outcome following a minor brain trauma: comparing neuropsychological and positron emission tomography assessment. Brain Inj 8:297–308CrossRefPubMedGoogle Scholar
  40. Small GW, Kepe V, Siddarth P, Ercoli LM, Merrill DA, Donoghue N et al (2013) PET scanning of brain tau in retired national football league players: preliminary findings. Am J Geriatr Psychiatry 21:138–144CrossRefPubMedGoogle Scholar
  41. Soudry G, Mannting F (1995) Hot calcaneus on three-phase bone scan due to bone bruise. Clin Nucl Med 20:832–834CrossRefPubMedGoogle Scholar
  42. Su JK, Ramirez JF (2012) Management of the athlete with concussion. Perm J 16:54–56PubMedCentralCrossRefPubMedGoogle Scholar
  43. Top H, Aygit C, Sarikaya A, Karaman D, Firat MF (2004) Evaluation of maxillary sinus after treatment of midfacial fractures. J Oral Maxillofac Surg 62:1229–1236CrossRefPubMedGoogle Scholar
  44. Ucar BY, Necmioglu S, Bulut M, Azboy I, Demirtas A, Gumus H (2012) Determining bone bruises of the knee with magnetic resonance imaging. Open Orthop J 6:464–467PubMedCentralCrossRefPubMedGoogle Scholar
  45. Virji-Babul N, Borich MR, Makan N, Moore T, Frew K, Emery CA et al (2013) Diffusion tensor imaging of sports-related concussion in adolescents. Pediatr Neurol 48:24–29CrossRefPubMedGoogle Scholar
  46. Zemper ED (2010) Catastrophic injuries among young athletes. Br J Sports Med 44:13–20CrossRefPubMedGoogle Scholar
  47. Zukotynski K, Grant FD, Curtis C, Micheli L, Treves ST (2010) Skeletal scintigraphy in pediatric sports medicine. AJR Am J Roentgenol 195:1212–1219CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Radiology and Nuclear MedicineMartini Hospital GroningenGroningenThe Netherlands

Personalised recommendations