Fig. 1

Single-photon emission computed tomography imaging results. The color code indicates the level of blood flow, which in turn is proportional to the metabolism level. This enables the detection of hyper or hypo functioning areas: from lowest levels (blue hues) to highest levels (white and black surrounded by white). The black and white display is a volumetric rendition at a standardized threshold level for both studies. Upper row: a baseline single-photon emission computed tomography image revealed extensive left hemispheric underperfusion, and multiple localized underperfusions in the right hemisphere. Bilateral involvement of parts of the dorsolateral prefrontal cortex, and extensive underperfusion in the temporal lobes (more on the left) and to a lesser extent in the orbitofrontal areas. Lower row: a follow-up single-photon emission computed tomography image after 5 months showed similar overall appearance but with increased perfusion in multiple small localized areas namely in parts of the anterior aspect of the prefrontal cortex (including in the ventromesial aspect), right superior parietal, right lateral occipital, superior aspect of the left frontoparietal area, posterior cingulate/precuneus and apico-mesial right temporal. In addition, significant increase was seen in the striatum bilaterally. HBOT hyperbaric oxygen therapy, PSE perispinal etanercept