Comparison of brain perfusion SPECT parameters accuracy for seizure localization in extratemporal lobe epilepsy with dis
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ORIGINAL ARTICLE
Comparison of brain perfusion SPECT parameters accuracy for seizure localization in extratemporal lobe epilepsy with discordant pre-surgical data Supatporn Tepmongkol • Kanokporn Tangtrairattanakul Sukalaya Lerdlum • Tayard Desudchit
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Received: 3 June 2014 / Accepted: 4 September 2014 / Published online: 12 September 2014 Ó The Japanese Society of Nuclear Medicine 2014
Abstract Objective Extratemporal lobe epilepsy is difficult to localize. We aimed to define the best parameter(s) of SPECT for confirmation of seizure origin among the region of maximum cerebral perfusion in ictal phase (MP), maximum change of cerebral perfusion from interictal to ictal phase (MC), and maximum extent of hyperperfusion in ictal phase (ME) of 99mTc ECD brain perfusion SPECT as well as combined SPECT parameters, and combined SPECT and MRI for seizure localization in extratemporal lobe epilepsy. Materials and methods Twenty intractable extratemporal lobe epilepsy patients who had 99mTc-ECD brain SPECT were reviewed. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of single SPECT parameter, combined SPECT parameters, and combined SPECT and MRI parameters for localization of seizure origin were calculated using pathology and surgical outcomes (Engel class I and II) as gold standards. Results Combined SPECT parameters provided more specificity, PPV and accuracy than single SPECT parameters. The best combined SPECT parameters was MP?MC S. Tepmongkol (&) Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama 4 Road, Pathumwan, Bangkok 10330, Thailand e-mail: [email protected] K. Tangtrairattanakul S. Lerdlum Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand T. Desudchit Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
with 80.6 % accuracy, 92.4 % specificity and 43.8 % PPV. Combination of SPECT parameter with MRI (ME?MRI) was the most sensitive (41.7 %), specific (97.5 %), accurate (88.2 %) parameter and had highest PPV (76.9 %) and NPV (89.3 %) for seizure localization. It improved specificity and PPV when compared to MRI alone. Conclusion Combined SPECT parameters improved the specificity and accuracy in seizure localization. The most specific and accurate SPECT combination is MP?MC. The combined SPECT parameter with MRI further improved sensitivity, specificity, accuracy, PPV and NPV. The authors recommend using SPECT combination, MP?MC, when MRI is negative and ME?MRI when there is MRI lesion. Keywords Seizure origin Ictal onset zone Epileptogenic zone 99mTc-ECD Neocortical
Introduction Epilepsy affects approximately 1 % of the general population. Most complex seizures arise from the temporal lobes. About 10–20 % of these patients is refractory to medication and can be rendered seizure free with surgery [1] while only 40–50 % of extratemporal lobe epilepsy (ETE) patients can be treated by surger
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