Radiology Section - Single Photon Emission Computed Tomography (SPECT) for the Diagnosis of ADHD, Dementias and Other Psychiatric Conditions

IMPORTANT REMINDER

Regence Medical Policies are developed to provide guidance for members and providers regarding coverage in accordance with contract terms. Benefit determinations are based in all cases on the applicable contract language. To the extent there may be any conflict between the Medical Policy and contract language, the contract language takes precedence.

PLEASE NOTE: Contracts exclude from coverage, among other things, services or procedures that are considered investigational or cosmetic. Providers may bill members for services or procedures that are considered investigational or cosmetic. Providers are encouraged to inform members before rendering such services that the members are likely to be financially responsible for the cost of these services.

DESCRIPTION

Single photon emission computed tomography (SPECT) is a nuclear imaging technique that is used to visualize functional information about body organs, including the brain. Brain imaging requires the use of radiopharmaceuticals that cross the blood-brain barrier. The radioactive isotope decay results in emission of gamma rays that are detected by a gamma camera which allows reconstruction of cross-sectional slices.

POLICY/CRITERIA

Single photon emission computed tomography (SPECT) is considered investigational for evaluation of ADHD, dementias, and all other psychiatric conditions.

POSITION STATEMENT

The evidence is not sufficient to permit conclusions about the benefits of SPECT imaging in the diagnosis and treatment of ADHD, dementias and all other psychiatric conditions.

• There are no well-designed, prospective randomized clinical trials which demonstrate how SPECT may be used in the clinical setting to either diagnose or direct treatment of ADHD, dementias, or other psychiatric conditions.
• There are no evidence-based clinical practice guidelines which recommend SPECT to diagnose or manage treatment of any psychiatric condition.

Effectiveness

No randomized controlled trials comparing SPECT to standard methods of evaluating ADHD, dementias or other psychiatric conditions have been published to date.

A significant number of published studies focused on investigating differences in regional cerebral perfusion in response to drug therapy and on serotonin and dopamine receptor and transporter activity. (1-3, 7, 8) These studies are preliminary and have not added to the body of knowledge with respect to the following:

• Demonstration of technical feasibility, including assessment of reproducibility and precision
• An understanding of normal and abnormal values. There are no reports on sensitivity and specificity, or positive and negative predictive values compared to standard diagnostic methods.
• An understanding of the clinical utility of SPECT and how it may be used to benefit diagnosis and management of ADHD, dementias or other psychiatric conditions
• A reproducible, valid method of differentiating psychiatric disorders with overlapping and/or similar symptoms (e.g., ADHD and bipolar disorder)

The American Psychiatric Association and the American Academy of Neurology clinical practice guidelines state that there is no evidence to support clinical use of neuroimaging in the diagnosis and management of psychiatric conditions. (4-6)

Safety

The risks associated with SPECT imaging include exposure to low-dose radiation. Special consideration should be given to this risk in pediatric patients because of their increased sensitivity to radiation. (5) SPECT imaging is not recommended for pregnant women. Other risks include possible allergic reaction to the radiopharmaceuticals. If the radiopharmaceuticals are injected intravenously, patients may experience a local reaction at the injection site (e.g. bleeding, pain, bruising, or swelling) or in rare instances infection.

REFERENCES

1. McGough JJ. Diagnostic controversies in adult attention deficit hyperactivity disorder. Am J Psychiatry 2004;161(11):1948-56
2. Voeller KK. Attention-deficit hyperactivity disorder (ADHD). J Child Neurol 2004;19(10):798-814
3. Vles JS, Feron FJ, Hendriksen JG, et.al. Methylphenidate down-regulates the dopamine receptor and transporter system in children with attention deficit hyperkinetic disorder (ADHD). Neuropediatrics 2003;34:77-80
4. Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: Diagnosis of dementia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56;1143-1153.  Available online at: www.neurology.org/cgi/reprint/56/9/1143.pdf  (Verified 08/12/2009)
5. American Psychiatric Association Council on Children, Adolescents and Their Families. Brain Imaging and Child and Adolescent Psychiatry\With Special Emphasis On Single Photon Emission Computed Tomography (SPECT). http://www.psych.org/Departments/EDU/Library/APAOfficial DocumentsandRelated/ResourceDocuments/200501.aspx (Verified 08/12/2009)
6. American Academy of Child and Adolescent Psychiatry. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. J. Am. Acad. Child Adolesc. Psychiatry, 2007;46(7):894Y921. Available online at: http://www.aacap.org/galleries/PracticeParameters/JAACAP_ADHD_2007. pdf (Verified 08/12/2009)
7. Nobili F, Frisoni GB, Portet F at al. Brain SPECT in subtypes of mild cognitive impairment. Findings from the DESCRIPA multicenter study. J Neurol. 2008 Sep;255(9):1344-53. Epub 2008 Aug 1
8. Ruhé HG, Booij J, v Weert HC at a. Evidence why paroxetine dose escalation is not effective in major depressive disorder: a randomized controlled trial with assessment of serotonin transporter occupancy. Neuropsychopharmacology. 2009 Mar;34(4):999-1010. Epub 2008 Oct 1.

Cross References

None

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