Sensitivity and specificity of quantitative difference SPECT analysis in seizure localization.
Sensitivity and specificity of quantitative difference SPECT analysis in seizure localization.
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发表时间：
1999-05
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通讯作者：
M. Spanaki;S. Spencer;M. Corsi;J. MacMullan;J. Seibyl;Zubal Ig
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作者：
M. Spanaki;S. Spencer;M. Corsi;J. MacMullan;J. Seibyl;Zubal Ig
未标记的真正发作SPECT可以准确地显示癫痫区域的灌注增加，但通常需要专门的人员在床边等待完成注射。我们研究了在难治性部分性癫痫中，通过发作或发作后即刻SPECT测量灌注变化在定位致痫区域中的价值。方法对53例难治性癫痫患者的发作间期SPECT图像进行配准、归一化、相减，计算出定量灌注差值图像。将灌注差异SPECT结果与目视解释SPECT、头皮脑电图（EEG）、MRI、PET和颅内EEG进行比较。结果：43例患者（81%）出现离散性灌注增加（发作期注射）或灌注减少（发作后注射）。发作间期头皮EEG定位28例（53%），发作期头皮EEG定位35例（66%），颅内EEG定位22例（85%）（26例进行有创性检查）。MRI定位34例（64%），PET定位32例（71%），发作间期SPECT定位26例（49%），发作期SPECT（视觉判读）定位30例（57%）。与颅内EEG定位标准相比，SPECT减影分析的敏感性为86%，特异性为75%。结论SPECT脑灌注差异分析对癫痫灶定位的敏感性和特异性高于其他无创性定位标准，定位准确性可与颅内EEG相媲美。为了获得这些结果，必须应用发作注射相对于癫痫发作发生的时间的知识。
UNLABELLED True ictal SPECT can accurately demonstrate perfusion increases in the epileptogenic area but often requires dedicated personnel waiting at the bedside to accomplish the injection. We investigated the value of perfusion changes as measured by ictal or immediate postictal SPECT in localizing the epileptogenic region in refractory partial epilepsy. METHODS Quantitative perfusion difference images were calculated by registering, normalizing and subtracting ictal (or immediate postictal) from interictal SPECT for 53 patients with refractory epilepsy. Perfusion difference SPECT results were compared with visually interpreted SPECT, scalp electroencephalography (EEG), MRI, PET and intracranial EEG. RESULTS In 43 patients (81%), discrete areas of increased perfusion (with ictal injections) or decreased perfusion (with postictal injections) were noted. Interictal scalp EEG was localizing in 28 patients (53%), ictal scalp EEG was localizing in 35 patients (66%) and intracranial EEG was localizing in 22 patients (85%) (of 26 patients who underwent invasive study). MRI was localizing in 34 patients (64%), PET was localizing in 32 of 45 patients (71%), interictal SPECT was localizing in 26 patients (49%) and peri-ictal SPECT (visual interpretation) was localizing in 30 patients (57%). By comparison with an intracranial EEG standard of localization, SPECT subtraction analysis had 86% sensitivity and 75% specificity. CONCLUSION Our data provide evidence that SPECT perfusion difference analysis has higher sensitivity and specificity than any other noninvasive localizing criterion and can localize epileptogenic regions with accuracy comparable with that of intracranial EEG. To obtain these results, one must apply knowledge of the timing of the ictal injection relative to seizure occurrence.