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Traub-Weidinger T, Arbizu J, Barthel H, Boellaard R, Borgwardt L, Brendel M, Cecchin D, Chassoux F, Fraioli F, Garibotto V, Guedj E, Hammers A, Law I, Morbelli S, Tolboom N, Van Weehaeghe D, Verger A, Van Paesschen W, von Oertzen TJ, Zucchetta P, Semah F. EANM practice guidelines for an appropriate use of PET and SPECT for patients with epilepsy. Eur J Nucl Med Mol Imaging 2024; 51:1891-1908. [PMID: 38393374 PMCID: PMC11139752 DOI: 10.1007/s00259-024-06656-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Epilepsy is one of the most frequent neurological conditions with an estimated prevalence of more than 50 million people worldwide and an annual incidence of two million. Although pharmacotherapy with anti-seizure medication (ASM) is the treatment of choice, ~30% of patients with epilepsy do not respond to ASM and become drug resistant. Focal epilepsy is the most frequent form of epilepsy. In patients with drug-resistant focal epilepsy, epilepsy surgery is a treatment option depending on the localisation of the seizure focus for seizure relief or seizure freedom with consecutive improvement in quality of life. Beside examinations such as scalp video/electroencephalography (EEG) telemetry, structural, and functional magnetic resonance imaging (MRI), which are primary standard tools for the diagnostic work-up and therapy management of epilepsy patients, molecular neuroimaging using different radiopharmaceuticals with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) influences and impacts on therapy decisions. To date, there are no literature-based praxis recommendations for the use of Nuclear Medicine (NM) imaging procedures in epilepsy. The aims of these guidelines are to assist in understanding the role and challenges of radiotracer imaging for epilepsy; to provide practical information for performing different molecular imaging procedures for epilepsy; and to provide an algorithm for selecting the most appropriate imaging procedures in specific clinical situations based on current literature. These guidelines are written and authorized by the European Association of Nuclear Medicine (EANM) to promote optimal epilepsy imaging, especially in the presurgical setting in children, adolescents, and adults with focal epilepsy. They will assist NM healthcare professionals and also specialists such as Neurologists, Neurophysiologists, Neurosurgeons, Psychiatrists, Psychologists, and others involved in epilepsy management in the detection and interpretation of epileptic seizure onset zone (SOZ) for further treatment decision. The information provided should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals and imaging modalities.
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Affiliation(s)
- Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Javier Arbizu
- Department of Nuclear Medicine, University of Navarra Clinic, Pamplona, Spain
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University Medical Centre, Leipzig, Germany
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Lise Borgwardt
- Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen, Blegdamsvej 9, DK-2100, RigshospitaletCopenhagen, Denmark
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig Maximilian-University of Munich, Munich, Germany
- DZNE-German Center for Neurodegenerative Diseases, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, University-Hospital of Padova, Padova, Italy
| | - Francine Chassoux
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, 91401, Orsay, France
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
- NIMTLab, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | - Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London & Guy's and St Thomas' PET Centre, King's College London, London, UK
| | - Ian Law
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Silvia Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy, Université de Lorraine, IADI, INSERM U1254, Nancy, France
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, KU Leuven and Department of Neurology, University Hospitals, Leuven, Belgium
| | - Tim J von Oertzen
- Depts of Neurology 1&2, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine-DIMED, University-Hospital of Padova, Padova, Italy
| | - Franck Semah
- Nuclear Medicine Department, University Hospital, Inserm, CHU Lille, U1172-LilNCog-Lille, F-59000, Lille, France.
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Czarnetzki C, Spinelli L, Huppertz HJ, Schaller K, Momjian S, Lobrinus J, Vargas MI, Garibotto V, Vulliemoz S, Seeck M. Yield of non-invasive imaging in MRI-negative focal epilepsy. J Neurol 2024; 271:995-1003. [PMID: 37907727 PMCID: PMC10827933 DOI: 10.1007/s00415-023-11987-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The absence of MRI-lesion reduces considerably the probability of having an excellent outcome (International League Against Epilepsies [ILAE] class I-II) after epilepsy surgery. Surgical success in magnetic-resonance imaging (MRI)-negative cases relies therefore mainly on non-invasive techniques such as positron-emission tomography (PET), subtraction ictal/inter-ictal single-photon-emission-computed-tomography co-registered to MRI (SISCOM), electric source imaging (ESI) and morphometric MRI analysis (MAP). We were interested in identifying the optimal imaging technique or combination to achieve post-operative class I-II in patients with MRI-negative focal epilepsy. METHODS We identified 168 epileptic patients without MRI lesion. Thirty-three (19.6%) were diagnosed with unifocal epilepsy, underwent surgical resection and follow-up ⩾ 2 years. Sensitivity, specificity, predictive values, and diagnostic odds ratio (OR) were calculated for each technique individually and in combination (after co-registration). RESULTS 23/33 (70%) were free of disabling seizures (75.0% with temporal and 61.5% extratemporal lobe epilepsy). None of the individual modalities presented an OR > 1.5, except ESI if only patients with interictal epileptiform discharges (IEDs) were considered (OR 3.2). On a dual combination, SISCOM with ESI presented the highest outcome (OR = 6). MAP contributed to detecting indistinguishable focal cortical dysplasia in particular in extratemporal epilepsies with a sensitivity of 75%. Concordance of PET, ESI on interictal epileptic discharges, and SISCOM was associated with the highest chance for post-operative seizure control (OR = 11). CONCLUSION If MRI is negative, the chances to benefit from epilepsy surgery are almost as high as in lesional epilepsy, provided that multiple established non-invasive imaging tools are rigorously applied and co-registered together.
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Affiliation(s)
- Christian Czarnetzki
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Laurent Spinelli
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | | | - Karl Schaller
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Shahan Momjian
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Johannes Lobrinus
- Department of Clinical Pathology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Maria-Isabel Vargas
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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Prener M, Drejer V, Ziebell M, Jensen P, Madsen CG, Olsen S, Thomsen G, Pinborg LH, Paulson OB. Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. II: Methodological considerations on hyper- and hypoperfusion. Epilepsia Open 2023; 8:1503-1511. [PMID: 37750050 PMCID: PMC10690685 DOI: 10.1002/epi4.12833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Single-photon emission computed tomography (SPECT) with the tracer 99m Tc-HMPAO is a method to visualize the cerebral hyperperfusion during an epileptic seizure and thus localize the epileptogenic zone and seizure propagation. Subtraction of interictal from Ictal SPECT Co-registered to MRI (SISCOM) visualizes areas with relative increases in cerebral blood flow. The purpose of this retrospective study is to explore the added value of visualizing areas of hypoperfusion as well as hyperperfusion, so-called reversed SISCOM. METHODS Fifty-six patients operated for epilepsy who had been investigated with SISCOM were included in the analysis. The patients were divided into two groups based on seizure duration after tracer injection, above or below 30 s. The preoperative SISCOM description was compared to the area of resection and given a concordance score. The 56 SISCOM were recalculated visualizing also areas of hypoperfusion and again compared to the site of resection using the same scale of concordance. The reversed SISCOM were categorized into three subgroups: "Altered Conclusion," "Confirmed Conclusion," and "Adds Nothing." If an area of hyperperfusion had an area of hypoperfusion in close proximity, it was re-interpreted as noise, thus possibly altering the conclusion. If the areas of hypoperfusion were in the opposite hemisphere it was interpreted as confirming factor. Further the concordance scores from conventional SISCOM and reversed SISCOM was compared to surgical outcome to explore the difference in sensitivity, positive predictive value (PPV), and odds ratio. RESULTS In approximately half of the cases reversed SISCOM added additional value, meaning either altered the conclusion or confirmed the conclusion. The sensitivity, PPV, and odds ratio was also better in the subgroup of long, >30 s seizure duration after injection, and got worse in the group with short, <30 s seizure duration after injection. SIGNIFICANCE Adding reversed SISCOM performed better than conventional SISCOM at predicting good surgical outcome.
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Affiliation(s)
- Martin Prener
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Veronica Drejer
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Morten Ziebell
- Department of NeurosurgeryRigshospitaletCopenhagenDenmark
| | - Per Jensen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Camilla Gøbel Madsen
- Department of Radiology, Centre for Functional and Diagnostic imaging and ResearchCopenhagen University Hospital Amager and HvidovreHvidovreDenmark
| | - Svitlana Olsen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Gerda Thomsen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Lars H. Pinborg
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
- Epilepsy Clinic, Department of Neurology, Rigshospitalet, Copenhagen, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Olaf B. Paulson
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Rogeau A, Lilburn DML, Kaplar Z, Anderson C, Scott CJ, Chowdhury FA, Fraioli F, Bomanji JB. Identifying and troubleshooting the pitfalls of ictal/interictal brain perfusion SPECT studies. Nucl Med Commun 2023; 44:1053-1058. [PMID: 37661779 DOI: 10.1097/mnm.0000000000001755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Epilepsy is a prevalent condition, and surgical intervention can benefit patients with refractory seizures. Single photon emission computed tomography (SPECT) using 99mTc-HMPAO or 99mTc-ECD provides assessment of regional cerebral blood flow and is the primary non-invasive approach for imaging brain perfusion in ictal and interictal states. Ictal/interictal SPECT is valuable in localising epileptogenic foci, particularly when MRI and electroencephalography are negative. However, to obtain accurate images reflecting brain perfusion in both states, meticulous preparation of the patient, timely radiotracer injection and close coordination between neurology and nuclear medicine teams are essential. Tracers also have inherent limitations, and patients may present with coexisting brain pathologies for which coregistration of SPECT images with MRI is recommended to improve diagnostic accuracy. Inconclusive SPECT findings may require repeating the exam or considering additional investigations. A comprehensive approach, considering various factors, is crucial for accurate interpretation of SPECT studies in presurgical epilepsy evaluations. This article provides a summary of the organisation and key challenges involved in conducting ictal/interictal SPECT studies, covering the entire process from a patient's hospital arrival to the integration of results within their presurgical pathway and using our experience of 182 patients over 10 years.
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Affiliation(s)
- Antoine Rogeau
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Nuclear Medicine, Lille University Hospitals, Lille, France
| | - David M L Lilburn
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Imaging, School of Medicine, University College London
| | - Zoltan Kaplar
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Cameron Anderson
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Catherine J Scott
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fahmida A Chowdhury
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Imaging, School of Medicine, University College London
| | - Jamshed B Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
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5
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Prener M, Drejer V, Ziebell M, Jensen P, Madsen CG, Olsen S, Thomsen G, Pinborg LH, Paulson OB. Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. I: Predictive value and methodological considerations. Epilepsia Open 2023; 8:1064-1074. [PMID: 37464953 PMCID: PMC10472396 DOI: 10.1002/epi4.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE This retrospective study investigates the predictive value of ictal subtraction single-photon emission computed tomography (SPECT) co-registered to magnetic resonance imaging (MRI) (SISCOM) for successful epilepsy surgery. METHODS 57 patients examined with SISCOM as a part of epilepsy surgery evaluation were divided into two groups based on seizure duration after tracer injection (group 1: Seizure duration above or equal to 30 s, group 2: Seizure duration under 30 s). SISCOM was compared to the surgical site and categorized as good or poor concordance. Subsequently, Odds ratios (ORs) and positive predictive values (PPVs) were calculated for each group for good surgical outcome, freedom from disabling seizures. RESULTS The PPVs and ORs for good surgical outcome was 74.1% and 5.71 for group 1 and 40% and 0.22 for group 2. SISCOM had a similar positive predictive value regardless of whether the focus was in the same or neighboring lobe, but same hemisphere as the resection. CONCLUSION In conclusion, the implementation of a precise definition for a well-executed ictal SPECT scan with respect to seizure duration after injection enhances the positive predictive value (PPV) and odds ratio (OR) for successful surgical outcome, surpassing previous findings, whether the focus in resected lobe or the neighboring.
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Affiliation(s)
- Martin Prener
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Veronica Drejer
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Morten Ziebell
- Department of NeurosurgeryRigshospitaletCopenhagenDenmark
| | - Per Jensen
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Camilla Gøbel Madsen
- Department of Radiology, Centre for Functional and Diagnostic imaging and ResearchCopenhagen University Hospital Amager and HvidovreHvidovreDenmark
| | - Svitlana Olsen
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Gerda Thomsen
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Lars H. Pinborg
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
- Department of Neurology, Epilepsy ClinicRigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Olaf B. Paulson
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Sukprakun C, Tepmongkol S. Nuclear imaging for localization and surgical outcome prediction in epilepsy: A review of latest discoveries and future perspectives. Front Neurol 2022; 13:1083775. [PMID: 36588897 PMCID: PMC9800996 DOI: 10.3389/fneur.2022.1083775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Background Epilepsy is one of the most common neurological disorders. Approximately, one-third of patients with epilepsy have seizures refractory to antiepileptic drugs and further require surgical removal of the epileptogenic region. In the last decade, there have been many recent developments in radiopharmaceuticals, novel image analysis techniques, and new software for an epileptogenic zone (EZ) localization. Objectives Recently, we provided the latest discoveries, current challenges, and future perspectives in the field of positron emission tomography (PET) and single-photon emission computed tomography (SPECT) in epilepsy. Methods We searched for relevant articles published in MEDLINE and CENTRAL from July 2012 to July 2022. A systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted using the keywords "Epilepsy" and "PET or SPECT." We included both prospective and retrospective studies. Studies with preclinical subjects or not focusing on EZ localization or surgical outcome prediction using recently developed PET radiopharmaceuticals, novel image analysis techniques, and new software were excluded from the review. The remaining 162 articles were reviewed. Results We first present recent findings and developments in PET radiopharmaceuticals. Second, we present novel image analysis techniques and new software in the last decade for EZ localization. Finally, we summarize the overall findings and discuss future perspectives in the field of PET and SPECT in epilepsy. Conclusion Combining new radiopharmaceutical development, new indications, new techniques, and software improves EZ localization and provides a better understanding of epilepsy. These have proven not to only predict prognosis but also to improve the outcome of epilepsy surgery.
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Affiliation(s)
- Chanan Sukprakun
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supatporn Tepmongkol
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,Chulalongkorn University Biomedical Imaging Group (CUBIG), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,*Correspondence: Supatporn Tepmongkol ✉
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Říha P, Doležalová I, Mareček R, Lamoš M, Bartoňová M, Kojan M, Mikl M, Gajdoš M, Vojtíšek L, Bartoň M, Strýček O, Pail M, Brázdil M, Rektor I. Multimodal combination of neuroimaging methods for localizing the epileptogenic zone in MR-negative epilepsy. Sci Rep 2022; 12:15158. [PMID: 36071087 PMCID: PMC9452535 DOI: 10.1038/s41598-022-19121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
The objective was to determine the optimal combination of multimodal imaging methods (IMs) for localizing the epileptogenic zone (EZ) in patients with MR-negative drug-resistant epilepsy. Data from 25 patients with MR-negative focal epilepsy (age 30 ± 10 years, 16M/9F) who underwent surgical resection of the EZ and from 110 healthy controls (age 31 ± 9 years; 56M/54F) were used to evaluate IMs based on 3T MRI, FDG-PET, HD-EEG, and SPECT. Patients with successful outcomes and/or positive histological findings were evaluated. From 38 IMs calculated per patient, 13 methods were selected by evaluating the mutual similarity of the methods and the accuracy of the EZ localization. The best results in postsurgical patients for EZ localization were found for ictal/ interictal SPECT (SISCOM), FDG-PET, arterial spin labeling (ASL), functional regional homogeneity (ReHo), gray matter volume (GMV), cortical thickness, HD electrical source imaging (ESI-HD), amplitude of low-frequency fluctuation (ALFF), diffusion tensor imaging, and kurtosis imaging. Combining IMs provides the method with the most accurate EZ identification in MR-negative epilepsy. The PET, SISCOM, and selected MRI-post-processing techniques are useful for EZ localization for surgical tailoring.
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Affiliation(s)
- Pavel Říha
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Irena Doležalová
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Radek Mareček
- Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Martin Lamoš
- Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Michaela Bartoňová
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Martin Kojan
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Michal Mikl
- Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Martin Gajdoš
- Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Lubomír Vojtíšek
- Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Marek Bartoň
- Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Ondřej Strýček
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Pail
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Milan Brázdil
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Ivan Rektor
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic. .,Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
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8
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Pavel DG, Henderson TA, DeBruin S, Cohen PF. The Legacy of the TTASAAN Report - Premature Conclusions and Forgotten Promises About SPECT Neuroimaging: A Review of Policy and Practice Part II. Front Neurol 2022; 13:851609. [PMID: 35655621 PMCID: PMC9152128 DOI: 10.3389/fneur.2022.851609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970s. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was not stabilized until 1993 and most early SPECT scans were performed on single-head gamma cameras. These early scans were of inferior quality. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. This two-part series explores the policies and procedures related to perfusion SPECT functional neuroimaging. In Part I, the comparison between the quality of the SPECT scans and the depth of the data for key neurological and psychiatric indications at the time of the TTASAAN report vs. the intervening 25 years were presented. In Part II, the technical aspects of perfusion SPECT neuroimaging and image processing will be explored. The role of color scales will be reviewed and the process of interpreting a SPECT scan will be presented. Interpretation of a functional brain scans requires not only anatomical knowledge, but also technical understanding on correctly performing a scan, regardless of the scanning modality. Awareness of technical limitations allows the clinician to properly interpret a functional brain scan. With this foundation, four scenarios in which perfusion SPECT neuroimaging, together with other imaging modalities and testing, lead to a narrowing of the differential diagnoses and better treatment. Lastly, recommendations for the revision of current policies and practices are made.
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Affiliation(s)
- Dan G Pavel
- PathFinder Brain SPECT, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States.,Neuro-Laser Foundation, Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Baltimore, MD, United States
| | - Philip F Cohen
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Nuclear Medicine, Lions Gate Hospital, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Pavel DG, Henderson TA, DeBruin S. The Legacy of the TTASAAN Report-Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I. Front Neurol 2022; 12:749579. [PMID: 35450131 PMCID: PMC9017602 DOI: 10.3389/fneur.2021.749579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970's. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was originally approved in 1988, but was unstable. As a result, the quality of SPECT images varied greatly based on technique until 1993, when a method of stabilizing HMPAO was developed. In addition, most SPECT perfusion studies pre-1996 were performed on single-head gamma cameras. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. Although the TTASAAN report was published in January 1996, it was approved for publication in October 1994. Consequently, the reported brain SPECT studies relied upon to derive the conclusions of the TTASAAN report largely pre-date the introduction of stabilized HMPAO. While only 12% of the studies on traumatic brain injury (TBI) in the TTASAAN report utilized stable tracers and multi-head cameras, 69 subsequent studies with more than 23,000 subjects describe the utility of perfusion SPECT scans in the evaluation of TBI. Similarly, dementia SPECT imaging has improved. Modern SPECT utilizing multi-headed gamma cameras and quantitative analysis has a sensitivity of 86% and a specificity of 89% for the diagnosis of mild to moderate Alzheimer's disease-comparable to fluorodeoxyglucose positron emission tomography. Advances also have occurred in seizure neuroimaging. Lastly, developments in SPECT imaging of neurotoxicity and neuropsychiatric disorders have been striking. At the 25-year anniversary of the publication of the TTASAAN report, it is time to re-examine the utility of perfusion SPECT brain imaging. Herein, we review studies cited by the TTASAAN report vs. current brain SPECT imaging research literature for the major indications addressed in the report, as well as for emerging indications. In Part II, we elaborate technical aspects of SPECT neuroimaging and discuss scan interpretation for the clinician.
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Affiliation(s)
- Dan G Pavel
- Pathfinder Brain SPECT Imaging, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Columbia, SC, United States
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10
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Presurgical evaluation of drug-resistant paediatric focal epilepsy with PISCOM compared to SISCOM and FDG-PET. Seizure 2022; 97:43-49. [DOI: 10.1016/j.seizure.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
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11
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A Novel method of seizure onset zone localization by serial Tc-99 m ECD brain perfusion SPECT clearance patterns. Brain Imaging Behav 2022; 16:1646-1656. [PMID: 35199278 DOI: 10.1007/s11682-022-00640-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/02/2022]
Abstract
In this prospective study, we postulate that there is a difference between clearance of [99mTc]Tc- ethyl cysteinate dimer (ECD) in the seizure onset zone (SOZ) and other brain areas and thus SOZ localization by clearance patterns might become a potential novel method for SOZ localization in epilepsy. The parametric images of brain ECD clearance were generated by linear regression model analysis from serial brain SPECT scans from 30 to 240 min after ECD injection (7-times point) in 7 patients with drug-resistant epilepsy and 3 normal volunteers. Clearance patterns of the SOZ confirmed by good surgical outcome or consensus with other investigations were analyzed quantitatively and semi-quantitatively by visual grading (slower or faster washout than contralateral brain regions). The average [99mTc]Tc-ECD clearance rates of SOZs were + 1.08% ± 2.57%/hr (wash in), -7.02% ± 2.56%/hr (washout), and -5.37% ± 1.71%/hr (washout) in ictal, aura and interictal states, respectively. Paired t-tests between the SOZ and contralateral regions showed statistically significant difference (p = 0.039 in interictal state). Clearance patterns that can define the SOZs were 1) wash in and slow washout on ictal slope, 2) fast washout on aura slope and interictal slope with 100% (6/6), 100% (2/2) and 75% (6/8) localization using ictal, aura, and interictal slope maps, respectively. Our study provided the evidence that clearance pattern methods are potential additive diagnostic tools for SOZ localization when routine one-time point SPECT are unable to define the SOZ.
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12
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Bal CS, Tripathi M, Khan D. Gamma camera imaging in epilepsy. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Bandopadhyay R, Singh T, Ghoneim MM, Alshehri S, Angelopoulou E, Paudel YN, Piperi C, Ahmad J, Alhakamy NA, Alfaleh MA, Mishra A. Recent Developments in Diagnosis of Epilepsy: Scope of MicroRNA and Technological Advancements. BIOLOGY 2021; 10:1097. [PMID: 34827090 PMCID: PMC8615191 DOI: 10.3390/biology10111097] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 12/18/2022]
Abstract
Epilepsy is one of the most common neurological disorders, characterized by recurrent seizures, resulting from abnormally synchronized episodic neuronal discharges. Around 70 million people worldwide are suffering from epilepsy. The available antiepileptic medications are capable of controlling seizures in around 60-70% of patients, while the rest remain refractory. Poor seizure control is often associated with neuro-psychiatric comorbidities, mainly including memory impairment, depression, psychosis, neurodegeneration, motor impairment, neuroendocrine dysfunction, etc., resulting in poor prognosis. Effective treatment relies on early and correct detection of epileptic foci. Although there are currently a few well-established diagnostic techniques for epilepsy, they lack accuracy and cannot be applied to patients who are unsupportive or harbor metallic implants. Since a single test result from one of these techniques does not provide complete information about the epileptic foci, it is necessary to develop novel diagnostic tools. Herein, we provide a comprehensive overview of the current diagnostic tools of epilepsy, including electroencephalography (EEG) as well as structural and functional neuroimaging. We further discuss recent trends and advances in the diagnosis of epilepsy that will enable more effective diagnosis and clinical management of patients.
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Affiliation(s)
- Ritam Bandopadhyay
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, Punjab, India;
| | - Tanveer Singh
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA;
| | - Mohammed M. Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah 13713, Saudi Arabia;
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Efthalia Angelopoulou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.A.); (C.P.)
| | - Yam Nath Paudel
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia;
| | - Christina Piperi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.A.); (C.P.)
| | - Javed Ahmad
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 11001, Saudi Arabia;
| | - Nabil A. Alhakamy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (N.A.A.); (M.A.A.)
| | - Mohamed A. Alfaleh
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (N.A.A.); (M.A.A.)
- Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Awanish Mishra
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, Punjab, India;
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)—Guwahati, Changsari, Guwahati 781101, Assam, India
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14
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Englot DJ, Lagrange AH. Of Blobs and Buzzes: Does SISCOM Imaging Actually Help SEEG Planning? Epilepsy Curr 2021; 22:22-24. [PMID: 35233191 PMCID: PMC8832343 DOI: 10.1177/15357597211025408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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MNI SISCOM: an Open-Source Tool for Computing Subtraction Ictal Single-Photon Emission CT Coregistered to MRI. J Digit Imaging 2021; 34:357-361. [PMID: 33604806 DOI: 10.1007/s10278-021-00422-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022] Open
Abstract
Subtraction ictal single-photon emission computed tomography (SPECT) coregistered to MRI (SISCOM) is a well-established technique for quantitative analysis of ictal vs interictal SPECT images that can contribute to the identification of the seizure onset zone in patients with drug-resistant epilepsy. However, there is presently a lack of user-friendly free and open-source software to compute SISCOM results from raw SPECT and MRI images. We aimed to develop a simple graphical desktop application for computing SISCOM. MNI SISCOM is a new free and open-source software application for computing SISCOM and producing practical MRI/SPECT/SISCOM image panels for review and reporting. The graphical interface allows any user to quickly and easily obtain SISCOM images with minimal user interaction. Additionally, MNI SISCOM provides command line and Python interfaces for users who would like to integrate these features into their own scripts and pipelines. MNI SISCOM is freely available for download from: https://github.com/jeremymoreau/mnisiscom .
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16
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Kaur K, Garg A, Tripathi M, Chandra SP, Singh G, Viswanathan V, Bharti K, Singh V, Ramanujam B, Bal CS, Sharma MC, Pandey R, Vibha D, Singh RK, Mandal PK, Tripathi M. Comparative contribution of magnetoencephalography (MEG) and single-photon emission computed tomography (SPECT) in pre-operative localization for epilepsy surgery: A prospective blinded study. Seizure 2021; 86:181-188. [PMID: 33647809 DOI: 10.1016/j.seizure.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The aim of this study was to compare the diagnostic value and accuracy of ictal SPECT and inter-ictal magnetoencephalography (MEG) in localizing the site for surgery in persons with drug resistant epilepsy. METHOD This was a prospective observational study. Patients expected to undergo epilepsy surgery were enrolled consecutively and the localization results from different imaging modalities were discussed in an epilepsy surgery meet. Odds ratio of good outcome (Engel I) were calculated in patients who underwent surgery in concordance with MEG and SPECT findings. Post-surgical seizure freedom lasting at least 36 months or more was considered the gold standard for determining the diagnostic output of SPECT and MEG. RESULTS MEG and SPECT were performed in 101 and 57 patients respectively. In 45 patients SPECT could not be done due to delay in injection or technical factors. The accuracy of MEG and SPECT in localizing the epileptogenic zone was found to be 74.26 % and 78.57 % respectively. The diagnostic odds ratio for Engel I surgical outcome was reported as 2.43 and 5.0 for MEG and SPECT respectively. The diagnostic odds ratio for MEG in whom SPECT was non-informative was found to be 6.57 [95 % CI 1.1, 39.24], although it was not significantly associated with good surgical outcome. MEG was useful in indicating sites for SEEG implantation. CONCLUSION SPECT was found to be non-informative for most patients, but reported better diagnostic output than MEG. MEG may be a useful alternative for patients in whom SPECT cannot be done or was non-localizing.
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Affiliation(s)
- Kirandeep Kaur
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India; MEG Facility, National Brain Research Institute, Manesar, India
| | - Ajay Garg
- Dept of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Dept of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Dept of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Singh
- MEG Facility, National Brain Research Institute, Manesar, India
| | | | - Kamal Bharti
- MEG Facility, National Brain Research Institute, Manesar, India
| | - Vivek Singh
- MEG Facility, National Brain Research Institute, Manesar, India
| | - Bhargavi Ramanujam
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandra Sekhar Bal
- Dept of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Dept of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Pandey
- Dept of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manjari Tripathi
- Dept of Neurology, All India Institute of Medical Sciences, New Delhi, India.
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17
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Abstract
OBJECTIVE. The purpose of this article is to summarize the role of molecular imaging of the brain by use of SPECT, FDG PET, and non-FDG PET radiotracers in epilepsy. CONCLUSION. Quantitative image analysis with PET and SPECT has increased the diagnostic utility of these modalities in localizing epileptogenic onset zones. A multi-modal platform approach integrating the functional imaging of PET and SPECT with the morphologic information from MRI in presurgical evaluation of epilepsy can greatly improve outcomes.
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18
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Hwang Y, Lee HR, Jo H, Kim D, Joo EY, Seo DW, Hong SB, Shon YM. Regional Ictal Hyperperfusion in the Contralateral Occipital Area May Be a Poor Prognostic Marker of Anterior Temporal Lobectomy: A SISCOM Analysis of MTLE Cases. Neuropsychiatr Dis Treat 2021; 17:2421-2427. [PMID: 34326640 PMCID: PMC8314682 DOI: 10.2147/ndt.s317915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Subtraction of ictal SPECT coregistered to MRI (SISCOM) provides complementary information for detecting the ictal onset zone, especially in patients with MRI-negative focal epilepsy, and provides additional useful information for predicting long-term postresection outcomes. This study sought to investigate the relationship between surgical failure and increased cerebral blood flow (CBF) pattern using SPECT in patients with mesial temporal lobe epilepsy with unilateral hippocampal sclerosis (MTLE-HS). METHODS Among 42 subjects who underwent anterior temporal lobectomy with amygdalohippocampectomy (ATL-AH) for MTLE-HS, 29 (69.0%) were seizure-free (SF group). Hyperperfusion was compared in 14 ipsilateral and contralateral brain regions in SISCOM images between the two groups. RESULTS The pattern of ictal hyperperfusion in temporal regions did not vary significantly between the SF and non-seizure-free (NSF) groups. However, CBF increases in the contralateral occipital area was more frequent in the NSF group than in the SF group. Furthermore, ictal hyperperfusion of the ipsilateral occipital and contralateral parietal areas tended to be more frequent in the NSF group. CONCLUSION The results indicate that poor ATL-AH surgical outcome is associated with a tendency of ictal hyperperfusion of the contralateral occipital cortex based on SISCOM analysis. The pattern of early ictal CBF changes implicating the propagation from temporal to occipital cortices can be considered a marker of poor surgical outcomes of ATL-AH in MTLE-HS patients.
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Affiliation(s)
- Yoonha Hwang
- Department of Neurology, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
| | - Hwa Reung Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunjin Jo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Dongyeop Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Dae-Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Seung Bong Hong
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Young-Min Shon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAHIST), Sungkyunkwan University, Seoul, Korea
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19
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Focal cortical dysplasia: etiology, epileptogenesis, classification, clinical presentation, imaging, and management. Childs Nerv Syst 2020; 36:2939-2947. [PMID: 32766946 DOI: 10.1007/s00381-020-04851-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Focal cortical dysplasia (FCD) is the most prevalent cause of intractable epilepsy in children. It was first described by Taylor et al. in 1971. In 2011, the International League against Epilepsy described an international consensus of classification for FCD. However, the exact mechanism causing this pathology remains unclear. The diagnosis and recognition of FCD increase with the advances in neuroradiology and electrophysiology. FOCUS OF REVIEW In this paper, we discuss the literature regarding management of FCD with a focus on etiology, pathophysiology, classification, clinical presentation, and imaging modalities. We will also discuss certain variables affecting surgical outcome of patients with FCD. CONCLUSION Based on our review findings, it is concluded that surgical management with complete resection of the lesion following preoperative localization of the epileptogenic zone in patients with FCD subtypes can provide a seizure-free outcome.
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20
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Oliveira Young C, Etchbehere ECSC, Souza EM, Brunetto SQ, Santos ADO, Lima MCL, Ortiz-De la Rosa S, Alvim M, Yasuda CL, Ramos CD, Cendes F, Amorim BJ. Clinical Usefulness of SISCOM-SPM Compared to Visual Analysis to Locate the Epileptogenic Zone. Front Neurol 2020; 11:467. [PMID: 32547479 PMCID: PMC7273921 DOI: 10.3389/fneur.2020.00467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/29/2020] [Indexed: 01/28/2023] Open
Abstract
Introduction: Subtraction of ictal-interictal SPECT co-registered to MRI (SISCOM) is a quantification tool that can improve the sensitivity and specificity of the epileptogenic zone (EZ) localization. Commercially available image analysis software packages for SISCOM are costly, and Statistical Parametric Mapping (SPM) could be an alternative free software for the definition of the EZ. There are only a few studies that compare SISCOM using SPM (SISCOM-SPM) with visual analysis. Aim: To compare SISCOM-SPM vs. visual analysis for localization of the EZ in patients with pharmacoresistant focal epilepsies. Materials and methods: We evaluated all our patients with focal epilepsies that underwent ictal and interictal SPECT. We defined the reference standard to locate the EZ by pathology and follow-up (in patients submitted to surgery), or seizure semiology, serial EEG, long-term video-EEG, 18F-FDG PET/CT, and MRI (in patients who were not operated). We compared the location of the EZ by visual analysis of SPECT images and by SISCOM-SPM to the reference standard and classified as concordant, discordant, or partially concordant. Results: We included 23 patients. Visual analysis was concordant with the EZ reference standard in only 13 patients (56.5%), while SISCOM-SPM was concordant in 18 cases (78.3%), providing a 21.8% increase in the location of EZ. However, this difference was not significant due to the small sample size (p = 0.0856). Conclusion: Our preliminary results demonstrate that, in clinical practice, SISCOM-SPM has the potential to add information that might help localize the EZ compared to visual analysis. SISCOM-SPM has a lower cost than other commercially available SISCOM software packages, which is an advantage for developing countries. Studies with more patients are necessary to confirm our findings.
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Affiliation(s)
- Carla Oliveira Young
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Elba C S C Etchbehere
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Edna Marina Souza
- Center of Biomedical Engineering, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Allan de Oliveira Santos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mariana C L Lima
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Marina Alvim
- Division of Epilepsy, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Clarissa Lin Yasuda
- Division of Epilepsy, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Celso Darío Ramos
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernando Cendes
- Division of Epilepsy, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Barbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, University of Campinas (UNICAMP), Campinas, Brazil
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21
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Song LY, Lin Q, Li LB, Cheng X. Clinical exploration of marking targeting biopsy in the intraoperative localization value of colon polypectomy. Pak J Med Sci 2020; 36:100-104. [PMID: 32063940 PMCID: PMC6994903 DOI: 10.12669/pjms.36.2.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the feasibility and safety of marking targeting biopsy (MTB) in the intraoperative localization value of colon polypectomy. Methods The clinical data from patients with polyp of colon discovered under colonoscopy from January 2014 to January 2016 were retrospectively analyzed. A total of 87 patients conformed to the inclusion criteria, among them, 43 received colonoscopic polypectomy one week after MTB (MTB group), while 44 underwent colonoscopic polypectomy one week after conventional biopsy (conventional group). The time consumption in colonoscopic treatment, polypectomy rate and postoperative complications between two groups were compared. Results The time consumed in operation in the MTB group was 25.5 (±8.6) minutes, while that in conventional group was 42.0 (±20.5) minutes, and the difference was statistically significant (P<0.01). There were a total of 86 polyps in the MTB group, among which 83 were removed, yielding the removal rate of 96.5%. There were altogether 88 polyps in the conventional group, among which 54 were removed, resulting in the removal rate of 61.4%, and the difference was statistically significant (P<0.05). three polyps in the MTB group were detached after MTB, or the wound surface became flat after gross polyp removal, and no polypectomy was required, but the marking targeting solution was clearly visible. two respective polyps in 12 cases in conventional group could not be found in colonoscopic treatment, and 10 of them had respective one polyp that could not be found again. 12 cases in MTB group suffered from abdominal pain after surgery, and no hemorrhage was seen intraoperatively and postoperatively. 10 cases in the conventional group had abdominal pain after surgery, and one case had delayed hemorrhage after surgery. The results between two groups displayed no statistical significance (P>0.05). Conclusions The localization value of MTB in colon polypectomy is definitely feasible, safe and effective, which can greatly shorten the time of endoscopic colon polypectomy, mitigate patient sufferings, and reduce the incidence of false negative rate of polyp. It displays favorable clinical application value and is worthy of being promoted in clinic.
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Affiliation(s)
- Ling Yun Song
- Dr. Ling Yun Song, M.D. Department of Gastroenterology, Yinzhou No 2. Hospital, Ningbo, Zhejiang, China
| | - Qi Lin
- Dr. Qi Lin, M.D, Department of Gastroenterology, Yinzhou No 2. Hospital, Ningbo, Zhejiang, China
| | - Lian Biao Li
- Dr. Lian-Biao Li, M.D, Department of Gastroenterology, Yinzhou No 2. Hospital, Ningbo, Zhejiang, China
| | - Xiu Cheng
- Dr. Xiu Cheng, M.D, Department of Gastroenterology, Yinzhou No 2. Hospital, Ningbo, Zhejiang, China
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22
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Diagnostica per immagini funzionale nell’epilessia. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)43296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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Foiadelli T, Lagae L, Goffin K, Theys T, De Amici M, Sacchi L, Van Loon J, Savasta S, Jansen K. Subtraction Ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy. Epilepsia Open 2019; 5:61-72. [PMID: 32140644 PMCID: PMC7049808 DOI: 10.1002/epi4.12373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 01/26/2023] Open
Abstract
Objective To assess feasibility and efficacy of subtraction ictal SPECT coregistered to MRI (SISCOM) for epilepsy localization in children who are candidates for resective surgery. Methods We retrospectively reviewed all patients ≤16 years with drug‐resistant epilepsy screened for epilepsy surgery in the University Hospital of Leuven from January 2009 to January 2018. Fifty‐eight hospitalizations for ictal SPECT and 51 SISCOM analyses in 44 patients were included. Mean age was 9.1 years. Hospitalizations for SISCOM were analyzed in terms of multiple variables affecting feasibility and efficacy. The localization of SISCOM was compared with the localization of the presumed epileptogenic zone (PEZ) as determined by video‐EEG. Results SISCOM was feasible in terms of chronic medication management, rescue antiepileptic therapy during hospitalization, and operative timings. Radiotracer injection occurred within 30 seconds from seizure onset in 91.4% of the patients. ictal SPECT imaging was performed within two hours from injection in 100% of the patients (mean: 40 minutes). SISCOM was able to localize the PEZ in 51.0% (26/51) and to additionally lateralize the PEZ in 17.6% (9/51), achieving better localizations than ictal SPECT, FDG‐PET, and MRI (P < .01). SISCOM was useful to localize the PEZ in 25% of patients with poorly localizing video‐EEG and in 27.8% of MRI‐negative cases. The occurrence of habitual seizures during injection for ictal SPECT and the temporal localization of the PEZ both correlated with a better SISCOM localization (P < .05). 36.4% (16/44) patients were finally selected for resective surgery, with a 87.5% seizure‐free rate at 12 months. A localizing SISCOM was associated with seizure freedom in 66.7% and with a Engel I‐II in 75.0% of our patients. Significance SISCOM is a reliable tool to localize the epileptogenic zone in clinical practice and is both feasible and useful in children, adding precious presurgical information especially in patients with noninformative MRI or a poorly localizing video‐EEG.
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Affiliation(s)
- Thomas Foiadelli
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo University of Pavia Pavia Italy
| | - Lieven Lagae
- Department of Development and Regeneration University Hospitals Leuven Leuven Belgium
| | - Karolien Goffin
- Nuclear Medicine and Molecular Imaging University Hospitals Leuven KU Leuven Leuven Belgium
| | - Tom Theys
- Neurosurgery Department University Hospitals Leuven Leuven Belgium
| | - Mara De Amici
- Laboratory of Immuno-Allergology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Lucia Sacchi
- Department of Electrical, Computer, and Biomedical Engineering University of Pavia Pavia Italy
| | | | - Salvatore Savasta
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo University of Pavia Pavia Italy
| | - Katrien Jansen
- Department of Development and Regeneration University Hospitals Leuven Leuven Belgium
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A Novel Noninvasive Approach Based on SPECT and EEG for the Location of the Epileptogenic Zone in Pharmacoresistant Non-Lesional Epilepsy. MEDICINA-LITHUANIA 2019; 55:medicina55080478. [PMID: 31416172 PMCID: PMC6722599 DOI: 10.3390/medicina55080478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 11/30/2022]
Abstract
Background and objectives: The aim of this study is to propose a methodology that combines non-invasive functional modalities electroencephalography (EEG) and single photon emission computed tomography (SPECT) to estimate the location of the epileptogenic zone (EZ) for the presurgical evaluation of patients with drug-resistant non-lesional epilepsy. Materials and Methods: This methodology consists of: (i) Estimation of ictal EEG source imaging (ESI); (ii) application of the subtraction of ictal and interictal SPECT co-registered with MRI (SISCOM) methodology; and (iii) estimation of ESI but using the output of the SISCOM as a priori information for the estimation of the sources. The methodology was implemented in a case series as an example of the application of this novel approach for the presurgical evaluation. A gold standard and a coincidence analysis based on measures of sensitivity and specificity were used as a preliminary assessment of the proposed methodology to localize EZ. Results: In patients with good postoperative evolution, the estimated EZ presented a spatial coincidence with the resection site represented by high values of sensitivity and specificity. For the patient with poor postoperative evolution, the methodology showed a partial incoherence between the estimated EZ and the resection site. In cases of multifocal epilepsy, the method proposed spatially extensive epileptogenic zones. Conclusions: The results of the case series provide preliminary evidence of the methodology’s potential to epileptogenic zone localization in non-lesion drug-resistant epilepsy. The novelty of the article consists in estimating the sources of ictal EEG using SISCOM result as a prior for the inverse solution. Future studies are necessary in order to validate the described methodology. The results constitute a starting point for further studies in order to support the clinical reliability of the proposed methodology and advocate for their implementation in the presurgical evaluation of patients with intractable non-lesional epilepsy.
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25
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Oldan JD, Shin HW, Khandani AH, Zamora C, Benefield T, Jewells V. Subsequent experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy. Seizure 2018; 61:128-134. [DOI: 10.1016/j.seizure.2018.07.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022] Open
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Challenges in managing epilepsy associated with focal cortical dysplasia in children. Epilepsy Res 2018; 145:1-17. [DOI: 10.1016/j.eplepsyres.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 04/30/2018] [Accepted: 05/12/2018] [Indexed: 12/15/2022]
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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.
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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.
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Abstract
The goal of any epilepsy surgery is to improve patient's quality of life by achieving seizure freedom or by reducing the frequency of severely debilitating seizures. To achieve this goal, non-invasive and invasive diagnostic methods must precisely delineate the epileptogenic zone (EZ), which is defined as the area that needs to be resected to obtain seizure freedom. At the same time, the correct identification of eloquent brain areas is inevitable to avoid new neurological deficits from surgery. In recent years, the technical advances in diagnostics have enabled us to achieve these goals in an increasing number of cases. As a consequence, and with new surgical treatment options available, the number of patients who might benefit from epilepsy surgery is constantly increasing. Especially in pediatric epilepsy, early surgical intervention is becoming frequently advocated as it has been shown to improve cognitive and behavioral outcome. Specialized epilepsy centers and multidisciplinary teams are required to provide adequate care and treatment. The goal of this review is to describe important diseases that are accessible to epilepsy surgery and to give an overview of current diagnostic methods. The focus lies on established as well as novel techniques in epilepsy surgery. The presurgical work-up and patient selection is outlined.
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Affiliation(s)
- Johannes Herta
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria -
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