1
|
Ferrand M, Baumann C, Aron O, Vignal JP, Jonas J, Tyvaert L, Colnat-Coulbois S, Koessler L, Maillard L. Intracerebral Correlates of Scalp EEG Ictal Discharges Based on Simultaneous Stereo-EEG Recordings. Neurology 2023; 100:e2045-e2059. [PMID: 36963841 PMCID: PMC10186237 DOI: 10.1212/wnl.0000000000207135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/18/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It remains unknown to what extent ictal scalp EEG can accurately predict the localization of the intracerebral seizure onset in presurgical evaluation of drug-resistant epilepsies. In this study, we aimed to define homogeneous ictal scalp EEG profiles (based on their first ictal abnormality) and assess their localizing value using simultaneously recorded scalp EEG and stereo-EEG. METHODS We retrospectively included consecutive patients with drug-resistant focal epilepsy who had simultaneous stereo-EEG and scalp EEG recordings of at least 1 seizure in the epileptology unit in Nancy, France. We analyzed 1 seizure per patient and used hierarchical cluster analysis to group similar seizure profiles on scalp EEG and then performed a descriptive analysis of their intracerebral correlates. RESULTS We enrolled 129 patients in this study. The hierarchical cluster analysis showed 6 profiles on scalp EEG first modification. None were specific to a single intracerebral localization. The "normal EEG" and "blurred EEG" clusters (early muscle artifacts) comprised only 5 patients each and corresponded to no preferential intracerebral localization. The "temporal discharge" cluster (n = 46) was characterized by theta or delta discharges on ipsilateral anterior temporal scalp electrodes and corresponded to a preferential mesial temporal intracerebral localization. The "posterior discharge" cluster (n = 42) was characterized by posterior ipsilateral or contralateral rhythmic alpha discharges or slow waves on scalp and corresponded to a preferential temporal localization. However, this profile was the statistically most frequent scalp EEG correlate of occipital and parietal seizures. The "diffuse suppression" cluster (n = 9) was characterized by a bilateral and diffuse background activity suppression on scalp and corresponded to mesial, and particularly insulo-opercular, localization. Finally, the "frontal discharge" cluster (n = 22) was characterized by bilateral frontal rhythmic fast activity or preictal spike on scalp and corresponded to preferential ventrodorsal frontal intracerebral localizations. DISCUSSION The hierarchical cluster analysis identified 6 seizure profiles regarding the first abnormality on scalp EEG. None of them were specific of a single intracerebral localization. Nevertheless, the strong relationships between the "temporal," "frontal," "diffuse suppression," and "posterior" profiles and intracerebral discharge localizations may contribute to hierarchize hypotheses derived from ictal scalp EEG analysis regarding intracerebral seizure onset.
Collapse
Affiliation(s)
- Mickaël Ferrand
- From the Department of Neurology (M.F., O.A., J.-P.V., J.J., L.T., L.M.), and University Hospital of Nancy, Lorraine University; Department of Epidemiology and Clinical Evaluation (C.B.), INSERM CIC-EC CIE6, Lorraine University, Vandoeuvre; Neurosciences of Systems and Cognition Project (O.A., J.J., L.T., L.K., L.M.), BioSiS Department (Department Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre; and Department of Neurosurgery (S.C.-C.), University Hospital of Nancy, Lorraine University, Nancy, France
| | - Cédric Baumann
- From the Department of Neurology (M.F., O.A., J.-P.V., J.J., L.T., L.M.), and University Hospital of Nancy, Lorraine University; Department of Epidemiology and Clinical Evaluation (C.B.), INSERM CIC-EC CIE6, Lorraine University, Vandoeuvre; Neurosciences of Systems and Cognition Project (O.A., J.J., L.T., L.K., L.M.), BioSiS Department (Department Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre; and Department of Neurosurgery (S.C.-C.), University Hospital of Nancy, Lorraine University, Nancy, France
| | - Olivier Aron
- From the Department of Neurology (M.F., O.A., J.-P.V., J.J., L.T., L.M.), and University Hospital of Nancy, Lorraine University; Department of Epidemiology and Clinical Evaluation (C.B.), INSERM CIC-EC CIE6, Lorraine University, Vandoeuvre; Neurosciences of Systems and Cognition Project (O.A., J.J., L.T., L.K., L.M.), BioSiS Department (Department Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre; and Department of Neurosurgery (S.C.-C.), University Hospital of Nancy, Lorraine University, Nancy, France
| | - Jean-Pierre Vignal
- From the Department of Neurology (M.F., O.A., J.-P.V., J.J., L.T., L.M.), and University Hospital of Nancy, Lorraine University; Department of Epidemiology and Clinical Evaluation (C.B.), INSERM CIC-EC CIE6, Lorraine University, Vandoeuvre; Neurosciences of Systems and Cognition Project (O.A., J.J., L.T., L.K., L.M.), BioSiS Department (Department Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre; and Department of Neurosurgery (S.C.-C.), University Hospital of Nancy, Lorraine University, Nancy, France
| | - Jacques Jonas
- From the Department of Neurology (M.F., O.A., J.-P.V., J.J., L.T., L.M.), and University Hospital of Nancy, Lorraine University; Department of Epidemiology and Clinical Evaluation (C.B.), INSERM CIC-EC CIE6, Lorraine University, Vandoeuvre; Neurosciences of Systems and Cognition Project (O.A., J.J., L.T., L.K., L.M.), BioSiS Department (Department Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre; and Department of Neurosurgery (S.C.-C.), University Hospital of Nancy, Lorraine University, Nancy, France
| | - Louise Tyvaert
- From the Department of Neurology (M.F., O.A., J.-P.V., J.J., L.T., L.M.), and University Hospital of Nancy, Lorraine University; Department of Epidemiology and Clinical Evaluation (C.B.), INSERM CIC-EC CIE6, Lorraine University, Vandoeuvre; Neurosciences of Systems and Cognition Project (O.A., J.J., L.T., L.K., L.M.), BioSiS Department (Department Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre; and Department of Neurosurgery (S.C.-C.), University Hospital of Nancy, Lorraine University, Nancy, France
| | - Sophie Colnat-Coulbois
- From the Department of Neurology (M.F., O.A., J.-P.V., J.J., L.T., L.M.), and University Hospital of Nancy, Lorraine University; Department of Epidemiology and Clinical Evaluation (C.B.), INSERM CIC-EC CIE6, Lorraine University, Vandoeuvre; Neurosciences of Systems and Cognition Project (O.A., J.J., L.T., L.K., L.M.), BioSiS Department (Department Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre; and Department of Neurosurgery (S.C.-C.), University Hospital of Nancy, Lorraine University, Nancy, France
| | - Laurent Koessler
- From the Department of Neurology (M.F., O.A., J.-P.V., J.J., L.T., L.M.), and University Hospital of Nancy, Lorraine University; Department of Epidemiology and Clinical Evaluation (C.B.), INSERM CIC-EC CIE6, Lorraine University, Vandoeuvre; Neurosciences of Systems and Cognition Project (O.A., J.J., L.T., L.K., L.M.), BioSiS Department (Department Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre; and Department of Neurosurgery (S.C.-C.), University Hospital of Nancy, Lorraine University, Nancy, France
| | - Louis Maillard
- From the Department of Neurology (M.F., O.A., J.-P.V., J.J., L.T., L.M.), and University Hospital of Nancy, Lorraine University; Department of Epidemiology and Clinical Evaluation (C.B.), INSERM CIC-EC CIE6, Lorraine University, Vandoeuvre; Neurosciences of Systems and Cognition Project (O.A., J.J., L.T., L.K., L.M.), BioSiS Department (Department Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Research Center for Automatic Control of Nancy (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre; and Department of Neurosurgery (S.C.-C.), University Hospital of Nancy, Lorraine University, Nancy, France.
| |
Collapse
|
2
|
[Imaging in the presurgical evaluation of epilepsy]. DER NERVENARZT 2021; 93:592-598. [PMID: 34491376 PMCID: PMC9200687 DOI: 10.1007/s00115-021-01180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/19/2022]
Abstract
Während zwei Drittel der PatientInnen mit Epilepsie durch Medikamente anfallsfrei werden, ist die Erkrankung bei 30 % pharmakoresistent. Bei pharmakoresistenter fokaler Epilepsie bietet die Epilepsiechirurgie eine etwa 65 %ige Chance auf Anfallsfreiheit. Vorab muss der Anfallsfokus exakt eingegrenzt werden, wofür bildgebende Methoden unverzichtbar sind. In den letzten Jahren hat sich in der Prächirurgie der Anteil von PatientInnen mit unauffälliger konventioneller Magnetresonanztomographie (MRT) erhöht. Allerdings konnte die Sensitivität der MRT durch spezielle Aufnahmesequenzen und Techniken der Postprozessierung gesteigert werden. Die Quellenlokalisation des Signals von Elektro- und Magnetenzephalographie (EEG und MEG) verortet den Ursprung iktaler und interiktaler epileptischer Aktivität im Gehirn. Nuklearmedizinische Untersuchungen wie die interiktale Positronen-Emissions-Tomographie (PET) und die iktale Einzelphotonen-Emissionscomputertomographie (SPECT) detektieren chronische oder akute anfallsbezogene Veränderungen des Hirnmetabolismus und können auch bei nichtlokalisierendem MRT auf den epileptogenen Fokus hinweisen. Alle Befunde zusammengenommen werden zur Planung eventueller invasiver EEG-Ableitungen und letztlich der chirurgischen Operation eingesetzt. Konkordante Befunde sind mit besseren chirurgischen Ergebnissen assoziiert und zeigen auch im Langzeitverlauf signifikant höhere Anfallsfreiheitsraten.
Collapse
|
3
|
Hou Y, Guo K, Fan X, Shang K, Wang J, Wang Z, Shan Y, Zhao G, Lu J. Crossed cerebellar diaschisis: risk factors and prognostic value in focal cortical dysplasia by 18F-FDG PET/CT. Ann Nucl Med 2021; 35:719-727. [PMID: 33840039 DOI: 10.1007/s12149-021-01613-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Crossed cerebellar diaschisis (CCD) has been widely studied in hemispheric stroke but is less characterized in epilepsy. In this study, we used 18F-FDG PET/CT to investigate the risk factors for CCD and its prognostic value for intractable epilepsy caused by focal cortical dysplasia (FCD). METHODS One hundred medically intractable epilepsy patients pathologically diagnosed with FCD postoperatively were included and classified into two groups: CCD+ and CCD-. PET/CT images were analyzed qualitatively by visual assessment and semi-quantitatively using the absolute asymmetry index (|AI|). Clinical factors, including age, sex, body mass index (BMI), age at seizure onset, epilepsy duration, seizure type, seizure frequency, electroencephalography (EEG) and brain magnetic resonance imaging (MRI), were retrospectively assessed from medical records. Follow-up outcomes were evaluated according to the Engel classification at 3, 6, 12, 24 and 36 months postoperatively. RESULTS Of the 100 patients, 77 (77.0%) were classified as CCD-, and 23 (23.0%) were classified as CCD + . CCD+ patients had a higher number of lobes involved on PET (3.61 ± 2.16 vs 2.26 ± 1.01, P < 0.001) than CCD- patients. CCD- patients showed more negative MRI results than CCD + patients (P = 0.02). At 12 months postoperatively, 70.7% (29/41) of CCD- patients and 30.8% (4/13) of CCD + patients presented a favourable prognosis (P = 0.02). Significant differences in the average |AI| values in the posterior frontal and anterior temporal lobes were found between CCD+ and CCD- patients (P < 0.05). CONCLUSION The number of lobes involved on PET, structural anomalies on MRI, the |AI| values in the posterior frontal and anterior temporal lobes may be predisposing factors for CCD. CCD occurrence may help predict the prognosis of FCD patients at 12 months postoperatively.
Collapse
Affiliation(s)
- Yaqin Hou
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Kun Guo
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiaotong Fan
- Department of Neurosurgery, China INI, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Kun Shang
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Jingjuan Wang
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zhenming Wang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, China INI, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Guoguang Zhao
- Department of Neurosurgery, China INI, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Jie Lu
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
| |
Collapse
|
4
|
Mercante B, Nuvoli S, Sotgiu MA, Manca A, Todesco S, Melis F, Spanu A, Deriu F. SPECT imaging of cerebral blood flow changes induced by acute trigeminal nerve stimulation in drug-resistant epilepsy. A pilot study. Clin Neurophysiol 2021; 132:1274-1282. [PMID: 33867259 DOI: 10.1016/j.clinph.2021.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/17/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the cortical areas targeted by acute transcutaneous trigeminal nerve stimulation (TNS) in patients with drug-resistant epilepsy (DRE) using single photon emission computed tomography (SPECT). METHODS Ten patients with DRE underwent brain SPECT at baseline and immediately after a 20-minute TNS (0.25 ms; 120 Hz; 30 s ON and 30 s OFF) applied bilaterally to the infraorbital nerve. The French Color Standard International Scale was used for qualitative analyses and z-scores were used to calculate the Odds Ratio (OR). RESULTS At baseline global hypoperfusion (mainly in temporo-mesial, temporo-parietal and fronto-temporal and temporo-occipital areas) was detected in all patients. Following TNS, a global increase in cortical tracer uptake and a significant decrease in median hypoperfusion score were observed. A significant effect favoring a general TNS-induced increase in cortical perfusion (OR = 4.96; p = 0.0005) was detected in 70% of cases, with significant effects in the limbic (p = 0.003) and temporal (p = 0.003) lobes. Quantitative analyses of z-scores confirmed significant TNS-induced increases in perfusion in the temporal (+0.59 SDs; p = 0.001), and limbic (+0.43 SDs; p = 0.03) lobes. CONCLUSION Short-term TNS is followed a global increase in cortical perfusion, namely in the temporal and limbic lobes. SIGNIFICANCE The TNS-induced perfusion increase may reflect neurons' activity changes in cortical areas implicated in the epilepsy network.
Collapse
Affiliation(s)
- Beniamina Mercante
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
| | - Maria A Sotgiu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Sara Todesco
- Neurology Unit, «A. Segni» Hospital, ASL n. 1, Sassari, Italy
| | - Francesco Melis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| |
Collapse
|
5
|
Perissinotti A, Niñerola-Baizán A, Rubí S, Carreño M, Marti-Fuster B, Aparicio J, Mayoral M, Donaire A, Sanchez-Izquierdo N, Bargalló N, Rumiá J, Boget T, Pons F, Lomeña F, Ros D, Pavía J, Setoain X. PISCOM: a new procedure for epilepsy combining ictal SPECT and interictal PET. Eur J Nucl Med Mol Imaging 2018; 45:2358-2367. [PMID: 30069576 PMCID: PMC6208811 DOI: 10.1007/s00259-018-4080-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE We present a modified version of the SISCOM procedure that uses interictal PET instead of interictal SPECT for seizure onset zone localization. We called this new nuclear imaging processing technique PISCOM (PET interictal subtracted ictal SPECT coregistered with MRI). METHODS We retrospectively studied 23 patients (age range 4-61 years) with medically refractory epilepsy who had undergone MRI, ictal SPECT, interictal SPECT and interictal FDG PET and who had been seizure-free for at least 2 years after surgical treatment. FDG PET images were reprocessed (rFDG PET) to assimilate SPECT features for image subtraction. Interictal SPECT and rFDG PET were compared using statistical parametric mapping (SPM). PISCOM and SISCOM images were evaluated visually and using an automated volume of interest-based analysis. The results of the two studies were compared with each other and with the known surgical resection site. RESULTS SPM showed no significant differences in cortical activity between SPECT and rFDG PET images. PISCOM and SISCOM showed equivalent results in 17 of 23 patients (74%). The seizure onset zone was successfully identified in 19 patients (83%) by PISCOM and in 17 (74%) by SISCOM: in 15 patients (65%) the two techniques showed concordant successful results. The volume of interest-based analysis showed no significant differences between PISCOM and SISCOM in identifying the extension of the seizure onset zone. However, PISCOM showed a lower amount of indeterminate activity due to propagation, background or artefacts. CONCLUSION Preliminary findings of this initial proof-of-concept study suggest that perfusion and glucose metabolism in the cerebral cortex can be correlated and that PISCOM may be a valid technique for identification of the seizure onset zone. However, further studies are needed to validate these results.
Collapse
Affiliation(s)
- Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Aida Niñerola-Baizán
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Sebastià Rubí
- Nuclear Medicine Department, Hospital Universitari Son Espases, Palma, Spain.,Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
| | - Mar Carreño
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Berta Marti-Fuster
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Javier Aparicio
- Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Maria Mayoral
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | | | | | - Nuria Bargalló
- Department of Radiology, Hospital Clínic, Barcelona, Spain
| | - Jordi Rumiá
- Department of Neurosurgery, Hospital Clínic, Barcelona, Spain
| | - Teresa Boget
- Department of Psychiatry and Psychology, Hospital Clínic, Barcelona, Spain
| | - Francesca Pons
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Francisco Lomeña
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Domènec Ros
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Javier Pavía
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Xavier Setoain
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain. .,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain. .,University of Barcelona, Barcelona, Spain.
| |
Collapse
|
6
|
Verger A, Lagarde S, Maillard L, Bartolomei F, Guedj E. Brain molecular imaging in pharmacoresistant focal epilepsy: Current practice and perspectives. Rev Neurol (Paris) 2018; 174:16-27. [DOI: 10.1016/j.neurol.2017.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
|
7
|
Musters L, Ten Broek M, Kraan GA. Case Report: SPECT/CT as the New Diagnostic Tool for Specific Wrist Pathology. ACTA ACUST UNITED AC 2017; 6. [PMID: 29725555 DOI: 10.4172/2167-7921.1000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Single photon emission computed tomography has been introduced as a promising new diagnostic tool in orthopaedic pathology since the early 90'. Computed tomography, the combined with SPECT, gives insight in the specific sight of wrist pathology. Literature already supports introduction of SPECT/CT in wrist pathology, but clinical application is lagging. Case Report A 40yr old patient reported first in 2004 with persisting pain after a right distal radius fracture. Several diagnostics and operative interventions were performed, all unsuccessful. Because of the persisting pain a SPECT-CT was performed which showed a cyst in the hamate bone, which was successfully enucleated. The patient was finally pain free at recent follow-up. With a QDash-score of 43 and a PRW (H) E-DLV-score of 58/150. Discussion In this case report, SPECT/CT proved a very sensitive diagnostic tool for specific pathology of the wrist. It offered precise localisation and thereby the clinically suspected diagnosis was confirmed and the patient successfully treated.
Collapse
Affiliation(s)
- Linde Musters
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital Delft, The Netherlands
| | - M Ten Broek
- Department of Nuclear Imaging, Reinier de Graaf Hospital, Delft, The Netherlands
| | - G A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital Delft, The Netherlands
| |
Collapse
|
8
|
Hodolic M, Topakian R, Pichler R. (18)F-fluorodeoxyglucose and (18)F-flumazenil positron emission tomography in patients with refractory epilepsy. Radiol Oncol 2016; 50:247-53. [PMID: 27679539 PMCID: PMC5024661 DOI: 10.1515/raon-2016-0032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Epilepsy is a neurological disorder characterized by epileptic seizures as a result of excessive neuronal activity in the brain. Approximately 65 million people worldwide suffer from epilepsy; 20-40% of them are refractory to medication therapy. Early detection of disease is crucial in the management of patients with epilepsy. Correct localization of the ictal onset zone is associated with a better surgical outcome. The modern non-invasive techniques used for structural-functional localization of the seizure focus includes electroencephalography (EEG) monitoring, magnetic resonance imaging (MRI), single photon emission tomography/computed tomography (SPECT/CT) and positron emission tomography/computed tomography (PET/CT). PET/CT can predict surgical outcome in patients with refractory epilepsy. The aim of the article is to review the current role of routinely used tracer 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) as well as non routinely used (18)F-Flumazenil ((18)F-FMZ) tracers PET/CT in patients with refractory epilepsy. CONCLUSIONS Functional information delivered by PET and the morphologic information delivered by CT or MRI are essential in presurgical evaluation of epilepsy. Nowadays (18)F-FDG PET/CT is a routinely performed imaging modality in localization of the ictal onset zone in patients with refractory epilepsy who are unresponsive to medication therapy. Unfortunately, (18)F-FDG is not an ideal PET tracer regarding the management of patients with epilepsy: areas of glucose hypometabolism do not correlate precisely with the proven degree of change within hippocampal sclerosis, as observed by histopathology or MRI. Benzodiazepine-receptor imaging is a promising alternative in nuclear medicine imaging of epileptogenic focus. The use of (11)C-FMZ in clinical practice has been limited by its short half-life and necessitating an on-site cyclotron for production. Therefore, (18)F-FMZ might be established as one of the tracers of choice for patients with refractory epilepsy because of better sensitivity and anatomical resolution.
Collapse
Affiliation(s)
- Marina Hodolic
- Nuclear Medicine Research Department, Iason, Graz, Austria
- Department of Nuclear Medicine, Palacký University Olomouc, Czech Republic
| | - Raffi Topakian
- Department of Neurology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Robert Pichler
- Institute of Nuclear Medicine, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| |
Collapse
|
9
|
Kim S, Mountz JM. SPECT Imaging of Epilepsy: An Overview and Comparison with F-18 FDG PET. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2011; 2011:813028. [PMID: 21785722 PMCID: PMC3139140 DOI: 10.1155/2011/813028] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 05/09/2011] [Indexed: 11/25/2022]
Abstract
Epilepsy surgery is highly effective in treating refractory epilepsy, but requires accurate presurgical localization of the epileptogenic focus. Briefly, localization of the region of seizure onset traditionally dependents on seizure semiology, scalp EEG recordings and correlation with anatomical imaging modalities such as MRI. The introduction of noninvasive functional neuroimaging methods, including single-photon emission computed tomography (SPECT) and positron emission tomography (PET) has dramatically changed the method for presurgical epilepsy evaluation. These imaging modalities have become powerful tools for the investigation of brain function and are an essential part of the evaluation of epileptic patients. Of these methods, SPECT has the practical capacity to image blood flow functional changes that occur during seizures in the routine clinical setting. In this review we present the basic principles of epilepsy SPECT and PET imaging. We discuss the properties of the SPECT tracers to be used for this purpose and imaging acquisition protocols as well as the diagnostic performance of SPECT in addition to SPECT image analysis methods. This is followed by a discussion and comparison to F-18 FDG PET acquisition and imaging analysis methods.
Collapse
Affiliation(s)
- Sunhee Kim
- Division of Nuclear Medicine, Department of Radiology, Children's Hospital of Pittsburgh and The University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - James M. Mountz
- Division of Nuclear Medicine, Department of Radiology, University of Pittsburgh Medical Center, PET Facility, B-932, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| |
Collapse
|
10
|
Uematsu M, Haginoya K, Togashi N, Hino-Fukuyo N, Nakayama T, Kikuchi A, Abe Y, Wakusawa K, Matsumoto Y, Kakisaka Y, Kobayashi T, Hirose M, Yokoyama H, Iinuma K, Iwasaki M, Nakasato N, Kaneta T, Akasaka M, Kamei A, Tsuchiya S. Unique discrepancy between cerebral blood flow and glucose metabolism in hemimegalencephaly. Epilepsy Res 2010; 92:201-8. [DOI: 10.1016/j.eplepsyres.2010.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 09/13/2010] [Accepted: 09/15/2010] [Indexed: 11/27/2022]
|
11
|
Martlé V, Peremans K, Audenaert K, Vermeire S, Bhatti S, Gielen I, Polis I, Van Ham L. Regional brain perfusion in epileptic dogs evaluated by technetium-99m-ethyl cysteinate dimer SPECT. Vet Radiol Ultrasound 2010; 50:655-9. [PMID: 19999353 DOI: 10.1111/j.1740-8261.2009.01600.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
We evaluated the feasibility of interictal single photon emission computed tomography (SPECT) to detect alterations in regional cerebral blood flow and neuronal activity in dogs with idiopathic epilepsy. Twelve dogs with idiopathic epilepsy underwent interictal technetium-99m-ethyl cysteinate dimer SPECT of the brain. Different cortical regions of interest (ROIs), 1 ROI at the cerebellum and 1 ROI at the subcortical area were evaluated by semiquantitative analysis and compared with a control group (18 dogs). Significant hypoperfusion (P = 0.02) was present in the subcortical area of epileptic dogs. This hypoperfusion was not associated with seizure frequency, age at onset of seizures, duration of epilepsy, or time since the last seizure. Interictal SPECT did not reveal cortical or cerebellar perfusion alterations. The subcortical area may play an important role in the pathophysiology of canine idiopathic epilepsy.
Collapse
Affiliation(s)
- Valentine Martlé
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Tc-99m HMPAO-SPECT With CT Attenuation Correction Improves Detection of Epileptogenic Areas. Clin Nucl Med 2009; 34:290-1. [DOI: 10.1097/rlu.0b013e31819e5183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|