M Suárez-Piñera1, A Mestre-Fusco2, M Ley3, S González4, S Medrano4, A Principe3, S Mojal5, G Conesa6, R Rocamora3. 1. Servicio de Medicina Nuclear, Hospital del Mar, Parc de Salut Mar, Barcelona, España. Electronic address: CRC0809@parcdesalutmar.cat. 2. Servicio de Medicina Nuclear, Hospital del Mar, Parc de Salut Mar, Barcelona, España. 3. Unidad de Epilepsia, Servicio de Neurología, Hospital del Mar, Parc de Salut Mar, Barcelona, España. 4. Servicio de Radiología, Hospital del Mar, Parc de Salut Mar, Barcelona, España. 5. Departamento de Estadística en Investigación Biomédica, Instituto Mar de Investigaciones Médicas (IMIM), Barcelona, España. 6. Servicio de Neurocirugía, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
Abstract
AIMS: Brain perfusion SPECT (ictal-interictal), SPECT images and subtraction ictal SPECT coregistered to MRI (SISCOM) and (18)F-FDG-PET (interictal), play an important role in the pre-surgical diagnosis of patients with medically refractory epilepsy. This study aimed to establish: the reproducibility of visual ictal-interictal SPECT and SISCOM analysis altogether with the capacity of SPECT, SISCOM and PET to determine the epileptogenic zone. MATERIAL AND METHODS: (99m)Tc-HMPAO SPECT ictal-interictal and SISCOM (Analyze 7.0) were performed on 47 refractory epilepsy patients (24 F, 19-60 yrs). In 13 patients, SISCOM was also performed using a new program (Focus DET). Ictal-interictal SPECT and SISCOM images were analysed independently by two nuclear medicine physicians (observer 1 and 2). Kappa concordance coefficient was used to evaluate the reproducibility. In sixteen patients, SPECT, SISCOM and PET findings were compared with the resected area during the surgery, and surgical outcome using Engel scale or with the stereo EEG-(SEEG). RESULTS: The ictal-interictal SPECT interobserver agreement was 91%, Kappa index 0.86, SISCOM (Analyze 7.0) interobserver agreement percentage was 82%, Kappa index 0.80, Analyze 7.0 showed a higher inconclusive results than visual SPECT analysis. SISCOM FocusDET interobserver agreement was 92%, Kappa index 0.87, with lower inconclusive results than Analyze 7.0. SPECT, SISCOM and PET combined findings identified 87% seizure onset zone: 79% temporal, 26% parieto-temporal and 7% frontal. CONCLUSIONS: Ictal-interictal SPECT and SISCOM showed a high reproducibility in this sample of patients with drug-refractory epilepsy. SPECT,SISCOM and PET combined findings improved detection of epileptogenic zone in comparison with the individual assessment.
AIMS: Brain perfusion SPECT (ictal-interictal), SPECT images and subtraction ictal SPECT coregistered to MRI (SISCOM) and (18)F-FDG-PET (interictal), play an important role in the pre-surgical diagnosis of patients with medically refractory epilepsy. This study aimed to establish: the reproducibility of visual ictal-interictal SPECT and SISCOM analysis altogether with the capacity of SPECT, SISCOM and PET to determine the epileptogenic zone. MATERIAL AND METHODS: (99m)Tc-HMPAO SPECT ictal-interictal and SISCOM (Analyze 7.0) were performed on 47 refractory epilepsypatients (24 F, 19-60 yrs). In 13 patients, SISCOM was also performed using a new program (Focus DET). Ictal-interictal SPECT and SISCOM images were analysed independently by two nuclear medicine physicians (observer 1 and 2). Kappa concordance coefficient was used to evaluate the reproducibility. In sixteen patients, SPECT, SISCOM and PET findings were compared with the resected area during the surgery, and surgical outcome using Engel scale or with the stereo EEG-(SEEG). RESULTS: The ictal-interictal SPECT interobserver agreement was 91%, Kappa index 0.86, SISCOM (Analyze 7.0) interobserver agreement percentage was 82%, Kappa index 0.80, Analyze 7.0 showed a higher inconclusive results than visual SPECT analysis. SISCOM FocusDET interobserver agreement was 92%, Kappa index 0.87, with lower inconclusive results than Analyze 7.0. SPECT, SISCOM and PET combined findings identified 87% seizure onset zone: 79% temporal, 26% parieto-temporal and 7% frontal. CONCLUSIONS: Ictal-interictal SPECT and SISCOM showed a high reproducibility in this sample of patients with drug-refractory epilepsy. SPECT,SISCOM and PET combined findings improved detection of epileptogenic zone in comparison with the individual assessment.
Authors: Enrique de Font-Réaulx; Javier Terrazo-Lluch; Luis Guillermo Díaz-López; Miguel Ángel Collado-Corona; Paul Shkurovich-Bialik; Adalberto González-Astiazarán Journal: Surg Neurol Int Date: 2022-01-12
Authors: Carla Oliveira Young; Elba C S C Etchbehere; Edna Marina Souza; Sergio Querino Brunetto; Allan de Oliveira Santos; Mariana C L Lima; Sebastian Ortiz-De la Rosa; Marina Alvim; Clarissa Lin Yasuda; Celso Darío Ramos; Fernando Cendes; Barbara Juarez Amorim Journal: Front Neurol Date: 2020-05-29 Impact factor: 4.003