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Superiority of HMPAO Ictal SPECT to ECD Ictal SPECT in Localizing the Epileptogenic Zone
Author(s) -
Lee Dong Soo,
Lee Sang Kun,
Kim Yu Kyeong,
Lee Jae Sung,
Cheon Gi Jeong,
Kang Keon Wook,
Kim Eun Sil,
Chung JuneKey,
Lee Myung Chul
Publication year - 2002
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1046/j.1528-1157.2002.23001.x
Subject(s) - ictal , ictal interictal spect analysis by spm , nuclear medicine , single photon emission computed tomography , temporal lobe , epilepsy , spect imaging , magnetic resonance imaging , medicine , subtraction , emission computed tomography , positron emission tomography , radiology , mathematics , arithmetic , psychiatry
Summary: Purpose: We examined diagnostic performances of Tc‐99m hexamethylpropylene amine oxime (HMPAO) and Tc‐99m electron capture detection (ECD) ictal single‐photon emission computed tomography (SPECT) to localize the epileptogenic zones in mesial temporal lobe epilepsy (TLE) and neocortical epilepsy (NE). Methods: Epileptogenic zones were identified by invasive EEG or surgical outcome. Ictal SPECT was performed with stabilized Tc‐99m HMPAO (TLE, 17; NE, 23) and with Tc‐99m ECD (TLE, 7; NE, 7). Single‐blind visual interpretation was used to localize the epileptogenic zones. Asymmetric index was calculated. Subtraction ictal SPECT was coregistered to a magnetic resonance imaging (MRI) template. Results: In TLE, the sensitivity of Tc‐99m HMPAO SPECT was 82% (14 of 17) and that of Tc‐99m ECD SPECT was 71% (five of seven). The asymmetric index (AI; 25 ± 10) of Tc‐99m HMPAO SPECT was larger (p = 0.05) than the AI (13 ± 13) of Tc‐99m ECD SPECT in patients with TLE. In NE, the sensitivity of Tc‐99m HMPAO SPECT was 70% (16 of 23), but that of Tc‐99m ECD SPECT was 29% (two of seven). The AI (15 ± 10) of Tc‐99m HMPAO SPECT was significantly larger (p = 0.02) than the AI (4.8 ± 6) of Tc‐99m ECD SPECT in patients with NE. Subtraction ictal SPECT coregistered to MRI supported the visual assessment. Conclusions: We concluded that the sensitivity of Tc‐99m ECD ictal SPECT is similar to that of Tc‐99m HMPAO ictal SPECT in TLE; however, ictal hyperperfusion was higher with the Tc‐99m HMPAO SPECT. In patients with NE, Tc‐99m HMPAO ictal SPECT also was superior to Tc‐99m ECD ictal SPECT in sensitivity and degree of hyperperfusion.