Difference images calculated from ictal and interictal technetium-99m-HMPAO SPECT scans of epilepsy.
Image processing techniques were applied to SPECT brain images to aid in the localization of epileptic foci.


METHODS
Ictal and interictal cerebral perfusion SPECT images were acquired from 12 epilepsy patients (6 temporal, 6 extratemporal) after injection of 20 mCi 99mTc-HMPAO. Each ictal scan was registered to the same patient's interictal scan. Normalization of the three-dimensional data was applied to account for global percent brain uptake and total injected activity. After registration, normalization and subtraction of the SPECT images and functional difference images were computed. Difference images were calculated, which give a quantitative measure of perfusion alterations during ictus. The resulting difference images were also registered with each patient's MRI scan which permits localization of perfusion changes onto anatomical structures.


RESULTS
Areas in the brain where significant perfusion increases occur correlate with areas confirmed to be seizure foci. Four of the six patients with known temporal lobe seizure foci exhibited significant perfusion increases on the difference images. These areas demonstrate a percent increase of perfusion larger than 40%. For the extratemporal seizure patients, four of the four confirmed seizure sites were diagnosed with difference images. Results on the remaining two patients were inconclusive.


CONCLUSIONS
When compared to side-by-side visual interpretation of the ictal and interictal SPECT images, registration of SPECT and MR images together with calculated difference maps greatly enhances the ability to localize epileptic seizure foci. This offers the potential to locate epileptic seizure foci using a noninvasive, inexpensive imaging procedure and data processing algorithm.
Zubal
I G
IG
Department of Diagnostic Radiology, Yale University, New Haven, Connecticut, USA.
Spencer
S S
SS
Imam
K
K
Seibyl
J
J
Smith
E O
EO
Wisniewski
G
G
Hoffer
P B
PB
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001921:Brain / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging*; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D015609:Organotechnetium Compounds; D010091:Oximes; D013382:Subtraction Technique; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime