Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome
Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome
复制标题
DOI：
10.1212/wnl.55.11.1668
复制
发表时间：
2000-12-12
期刊：
影响因子：
9.9
通讯作者：
Meyer, FB
中科院分区：
文献类型：
--
作者：
O'Brien, TJ;So, EL;Meyer, FB
目的：确定使用与MRI联合配准的减影发作SPECT（SISCOM）对颞外癫痫进行定位是否可以预测切除性癫痫手术后的结果，与标准测试相比，SISCOM图像是否提供预后重要信息，以及SISCOM图像上的血流变化是否有助于确定所需切除的部位和程度。背景：SISCOM在预测颞外癫痫手术结果中的价值尚不清楚，尤其是MRI表现不局限的情况。研究方法：36例连续患者的SISCOM图像由盲法评审员分类为“定位且与手术部位一致“、”定位但与手术部位不一致”或“非定位”。“SISCOM图像与术后MRI共配准，评审员目视确定SISCOM病灶下方的大脑皮层是否已完全切除、部分切除或未切除。结果：24例（66.7%）患者有局限性SISCOM，其中13例（76.5%）患者无局灶性MRI病变。19例SISCOM定位与手术部位一致的患者中有11例（57.9%），而17例非定位或不一致的SISCOM中有3例（17.6%），结局良好（p < 0.05）。Logistic回归分析显示，SISCOM结果可预测术后结果，与MRI或头皮发作EEG结果无关（p < 0.05）。SISCOM病灶皮质区域的切除程度与优良结局率显著相关（完全切除为100%，部分切除为60%，未切除为20%，p < 0.05）。结论：SISCOM图像可用于指导颞外癫痫手术切除的部位和范围。
Objectives: To determine whether localization of extratemporal epilepsy with subtraction ictal SPECT coregistered with MRI (SISCOM) is predictive of outcome after resective epilepsy surgery, whether SISCOM images provide prognostically important information compared with standard tests, and whether blood flow change on SISCOM images is useful in determining site and extent of excision required. Background: The value of SISCOM in predicting surgical outcome for extratemporal epilepsy is unknown, especially if MRI findings are nonlocalizing. Methods: SISCOM images in 36 consecutive patients were classified by blinded reviewers as "localizing and concordant with site of surgery, "localizing but nonconcordant with site of surgery," or "nonlocalizing." SISCOM images were coregistered with postoperative MRI, and reviewers visually determined whether cerebral cortex underlying the SISCOM focus had been completely resected, partially resected, or not resected. Results: Twenty-four patients (66.7%) had localizing SISCOM, including 13 (76.5%) of those without a focal MRI lesion. Eleven of 19 patients (57.9%) with localizing SISCOM concordant with the surgical site, compared with 3 of 17 (17.6%) with nonlocalizing or nonconcordant SISCOM, had an excellent outcome (p < 0.05). With logistic regression analysis, SISCOM findings were predictive of postsurgical outcome, independently of MRI or scalp ictal EEG findings (p < 0.05). The extent of resection of the cortical region of the SISCOM focus was significantly associated with the rate of excellent outcome (100% with complete resection, 60% with partial resection, and 20% with nonresection, p < 0.05). Conclusion: SISCOM images may be useful in guiding the location and extent of resection in extratemporal epilepsy surgery.