Localizing value of ictal-interictal SPECT analyzed by SPM (ISAS)
Localizing value of ictal-interictal SPECT analyzed by SPM (ISAS)
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DOI：
10.1111/j.1528-1167.2005.06705.x
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发表时间：
2005-09-01
期刊：
影响因子：
5.6
通讯作者：
Blumenfeld, H
中科院分区：
文献类型：
--
作者：
McNally, KA;Paige, AL;Blumenfeld, H
目的：癫痫神经影像学的目的是定位癫痫发作区域。在癫痫发作期间注射示踪剂的单光子发射计算机断层扫描（纵向SPECT）是一种很有前途的癫痫发作定位工具。然而，关于如何解释晚期注射或癫痫发作结束后注射（SPECT后）存在很多不确定性。需要一种广泛可用和客观的方法来解释模糊的头侧和后侧扫描，在多个大脑区域的变化。方法：采用[Tc-99m]标记的六甲基丙烯胺肟（HMPAO）进行间歇期或间歇期SPECT扫描，并与每位患者的间歇期扫描图像进行比较分析。本文对47例局限性癫痫进行了研究。我们使用的方法可以在任何地方实现，基于免费下载的软件和正常的SPECT数据库（http://spect.yale.edu）。统计参数映射（SPM）用于定位单个癫痫发作区域，该区域基于每个患者的初（或正）和间期差异图像。我们将这种方法称为SPM （ISAS）分析的初-间期SPECT。结果：使用这种方法，在71%的内侧颞叶癫痫病例和83%的新皮质癫痫病例中，即使是晚期注射，初始SPECT也能识别出一个明确的癫痫发作区域，并且所有病例（100%）的定位都是正确的。相反，在癫痫发作后不久进行注射的SPECT，在基于灌注增加或减少的单一区域定位方面非常差，通常是因为多个脑区域的变化相似。然而，用正极SPECT测量哪个半球总体上有更多的灌注减少，在80%的病例中，癫痫发作的侧边指向正确的一侧。结论：ISAS为癫痫SPECT分析和解释提供了一种有效且易于获得的方法。结果还强调需要在癫痫发作期间获得SPECT注射，以实现明确的定位。
Purpose: The goal of neuroimaging in epilepsy is to localize the region of seizure onset. Single-photon emission computed tomography with tracer injection during seizures (ictal SPECT) is a promising tool for localizing seizures. However, much uncertainty exists about how to interpret late injections, or injections done after seizure end (postictal SPECT). A widely available and objective method is needed to interpret ambiguous ictal and postictal scans, with changes in multiple brain regions.Methods: Ictal or postictal SPECT scans were performed by using [Tc-99m]-labeled hexamethyl-propylene-amine-oxime (HMPAO), and images were analyzed by comparison with interictal scans for each patient. Forty-seven cases of localized epilepsy were studied. We used methods that can be implemented anywhere, based on freely downloadable software and normal SPECT databases (http://spect.yale.edu). Statistical parametric mapping (SPM) was used to localize a single region of seizure onset based on ictal (or postictal) versus interictal difference images for each patient. We refer to this method as ictal-interictal SPECT analyzed by SPM (ISAS).Results: With this approach, ictal SPECT identified a single unambiguous region of seizure onset in 71% of mesial temporal and 83% of neocortical epilepsy cases, even with late injections, and the localization was correct in all (100%) cases. Postictal SPECT, conversely, with injections performed soon after seizures, was very poor at localizing a single region based on either perfusion increases or decreases, often because changes were similar in multiple brain regions. However, measuring which hemisphere overall had more decreased perfusion with postictal SPECT, lateralized seizure onset to the correct side in similar to 80% of cases.Conclusions: ISAS provides a validated and readily available method for epilepsy SPECT analysis and interpretation. The results also emphasize the need to obtain SPECT injections during seizures to achieve unambiguous localization.