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Ictal SPECT in neocortical epilepsies: clinical usefulness and factors affecting the pattern of hyperperfusion

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Authors
Lee, Sang Kun; Lee, Seo-Young; Yun, Chang-Ho; Lee, Ho-Young; Lee, Jae-Sung; Lee, Dong-Soo
Issue Date
2006-08-10
Publisher
Springer Verlag
Citation
Neuroradiology. 2006 Sep;48(9):678-84. Epub 2006 Aug 5.
Keywords
AdolescentAdultCerebral CortexChildElectroencephalographyEpilepsy/diagnosis/physiopathology/*radionuclide imagingFemaleFrontal Lobe/radionuclide imagingHumansMaleMiddle AgedNeocortex/*radionuclide imagingOccipital Lobe/radionuclide imagingParietal Lobe/radionuclide imagingSensitivity and SpecificitySubtraction TechniqueTemporal Lobe/radionuclide imaging*Tomography, Emission-Computed, Single-Photon
Abstract
INTRODUCTION: The aims of this analysis were to: (1) determine the value of ictal SPECT in the localization of neocortical epileptogenic foci, (2) evaluate the relationships between the results of ictal SPECT and other potential affecting factors, and (3) compare traditional visual analysis and the subtraction method. METHODS: We retrospectively analyzed 81 consecutive patients with neocortical epilepsy who underwent epilepsy surgery and achieved a favourable surgical outcome, including 36 patients with normal MRI. Side-by-side visual analysis and subtraction images were classified as correctly localizing,correctly lateralizing, or non-localizing/non-lateralizing images according to the resected lobe. RESULTS: Side-by-side visual analysis and subtraction SPECT correctly localized the epileptogenic lobe in 58.9% and 63.0% of patients, respectively. The two methods were complementary and the diagnostic sensitivity of ictal SPECT using the two methods was 79.0%. Ictal SPECT using the visual method correctly localized the epileptogenic lobe more frequently in patients with a localizing pattern of ictal scalp EEG at the time of radioligand injection. When using subtraction images, an injection delay of less than 20 s after seizure onset was significantly correlated with correct localization. The subtraction method was superior to the visual method for localizing frontal lobe epilepsy (FLE) and parietal lobe epilepsy (PLE), and in patients with non-localizing/non-lateralizing EEG at onset. CONCLUSIONS: Ictal SPECT analyses using visual and subtraction methods are useful and complementary for the localization of the epileptogenic foci of neocortical epilepsy. Early radioligand injection and ictal EEG patterns are related to ictal SPECT localization. The subtraction method may be more useful in some epileptic syndromes.
ISSN
0028-3940 (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16896909

http://hdl.handle.net/10371/15572
DOI
https://doi.org/10.1007/s00234-006-0106-z
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Neurology (신경과학교실)Journal Papers (저널논문_신경과학교실)
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