Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus
Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus
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DOI：
10.1212/wnl.50.2.445
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发表时间：
1998-02-01
期刊：
影响因子：
9.9
通讯作者：
Sharbrough, FW
中科院分区：
文献类型：
--
作者：
O'Brien, TJ;So, EL;Sharbrough, FW
发作期和发作间期单光子发射计算机断层扫描(SPECT)的传统并排视觉解释在确定手术病灶方面可能很困难，特别是在发作外或以其他方式未定位的顽固性癫痫患者。计算机辅助减影发作期SPECT与MRI联合注册(SISCOM)可提高SPECT在外科癫痫灶定位中的临床应用价值。我们对51例顽固性部分性癫痫患者进行了发作间期和发作期扫描。SPECT研究被盲目审查，并被归类为要么定位到16个大脑部位中的1个，要么不定位。SISCOM图像定位45例(88.2%)，传统的发作期和发作间期SPECT图像并行检查20例(39.2%)(p<；0.0001)。SISCOM的两个独立评价者的评价者之间的一致性更好(84.3%对41.2%，kappa=0.83vs0.26；p<；0.0001)。SISCOM的癫痫定位与更成熟的测试的一致性也更高。延迟注射放射性示踪剂(45秒)，但不是癫痫的二次泛化，与错误定位或非定位的SISCOM有关。SISCOM定位与手术部位一致的癫痫手术患者比SISCOM定位不一致或不定位的患者更有可能获得良好的预后(62.5%[10/16]vs 20%[2/10]；p<；0.05)。另一方面，传统SPECT检查的癫痫定位与术后预后无明显相关性。我们认为，SISCOM提高了SPECT在癫痫手术中定位癫痫灶的敏感性和特异性。SISCOM定位与手术部位的一致性预示着术后癫痫预后的改善。
Traditional side-by-side visual interpretation of ictal and interictal single-photon emission computed tomography (SPECT) scans can be difficult in identifying the surgical focus, particularly in patients with extratemporal or otherwise unlocalized intractable epilepsy. Computer-aided subtraction ictal SPECT co-registered to MRI (SISCOM) may improve the clinical usefulness of SPECT in localizing the surgical seizure focus. We studied 51 consecutive intractable partial epilepsy patients who had interictal and ictal scans. The SPECT studies were blindly reviewed and classified as either localizing to 1 of 16 sites in the brain or as nonlocalizing. SISCOM images were localizing in 45 of 51 (88.2%) compared with 20 of 51 (39.2%) for traditional side-by-side inspection of ictal and interictal SPECT images (p < 0.0001). Inter-rater agreement for two independent reviewers was better for SISCOM (84.3% versus 41.2%, kappa = 0.83 versus 0.26; p < 0.0001). Concordance of seizure localization with the more established tests was also higher for SISCOM. Late injection of the radiotracer (>45 seconds), but not secondary generalization of the seizure, was associated with a falsely localizing or nonlocalizing SISCOM. Epilepsy surgery patients whose SISCOM localization was concordant with the surgical site were more likely to have excellent outcome than patients with nonconcordant or nonlocalizing findings (62.5% [10/16] versus 20% [2/10]; p < 0.05). On the other hand, seizure localization by the traditional method of SPECT inspection had no significant association with postsurgical outcome. We conclude that SISCOM improves the sensitivity and the specificity of SPECT in localizing the seizure focus for epilepsy surgery. Concordance between SISCOM localization and site of surgery is predictive of postsurgical improvement in seizure outcome.