title: Prospective localization of epileptogenic foci: comparison of PET and SPECT with site of surgery and clinical outcome.
abstract: OBJECTIVE
  To correlate prospective imaging findings in patients with intractable partial epilepsy with site of surgery and clinical outcome.
  
  
  METHODS
  Thirty-five patients (25 male, 10 female) underwent positron emission tomography (PET; n=25), interictal single photon emission computed tomography (SPECT; n=33), or postictal SPECT (n=23) for localization of epileptogenic foci. The standard of reference was site of surgery.
  
  
  RESULTS
  Sensitivity was 60%, 61%, and 52%; positive predictive value was 83%, 71%, and 55%; and localization was incorrect in 12% (three of 25 cases), 24% (eight of 33 cases), and 43% (10 of 23 cases) in PET, interictal SPECT, and postictal SPECT, respectively. There was no statistically significant difference in localization capabilities in a comparison of interictal SPECT and PET (correct localization, P=.999; incorrect localization, P=.625). There was a trend toward higher incorrect localization with interictal SPECT.
  
  
  CONCLUSIONS
  Postictal SPECT has low sensitivity and a high incorrect localization rate and should not be performed in these patients. Interictal SPECT with 6-8-mm full-width at half-maximum is an alternative to PET. However, the trend toward higher false-localization rates must be taken into consideration.
authors.affiliation: Department of Radiology, University of Florida, College of Medicine, Gainesville, Fl 32610, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Mastin
authors.forename: W E
authors.initials: WE
authors.lastname: Drane
authors.forename: R L
authors.initials: RL
authors.lastname: Gilmore
authors.forename: W R
authors.initials: WR
authors.lastname: Helveston
authors.forename: R G
authors.initials: RG
authors.lastname: Quisling
authors.forename: S N
authors.initials: SN
authors.lastname: Roper
authors.forename: E A
authors.initials: EA
authors.lastname: Eikman
authors.forename: S R
authors.initials: SR
authors.lastname: Browd
mesh_terms: D000328:Adult; D003847:Deoxyglucose / Q000031:analogs & derivatives; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015609:Organotechnetium Compounds; D010091:Oximes; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011612:Psychosurgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D014055:Tomography, Emission-Computed; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D005462:Fluorine Radioisotopes; D015609:Organotechnetium Compounds; D010091:Oximes; D019788:Fluorodeoxyglucose F18; D019690:Technetium Tc 99m Exametazime; D003847:Deoxyglucose