Prospective localization of epileptogenic foci: comparison of PET and SPECT with site of surgery and clinical outcome.
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.
Mastin
S T
ST
Department of Radiology, University of Florida, College of Medicine, Gainesville, Fl 32610, USA.
Drane
W E
WE
Gilmore
R L
RL
Helveston
W R
WR
Quisling
R G
RG
Roper
S N
SN
Eikman
E A
EA
Browd
S R
SR
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
D005462:Fluorine Radioisotopes; D015609:Organotechnetium Compounds; D010091:Oximes; D019788:Fluorodeoxyglucose F18; D019690:Technetium Tc 99m Exametazime; D003847:Deoxyglucose