High-resolution inter-ictal SPET and phased-array MRI in partial epilepsy: an imaging comparison with video/EEG and outcome correlation.
To assess the clinical utility of high-resolution inter-ictal single photon emission tomography (SPET) of regional cerebral perfusion and high-resolution magnetic resonance imaging (MRI) of the brain with a phased-array temporal lobe coil, 35 patients with presumed partial epilepsy were evaluated prospectively by these techniques in addition to prolonged video/electroencephalographic (EEG) monitoring. Twenty of these patients had surgical treatment of partial epilepsy with outcome determinations spanning from 12 months to 3 years at follow-up. There were four categories of imaging findings as compared to scalp/sphenoidal EEG localization. Category I included 12 patients (34% of total) in whom there was complete imaging and EEG concordance. Category II included 4 patients (11%) in whom MRI and EEG were concordant but SPET was divergent or normal. Category III included 13 patients (37%) in whom SPET and EEG were concordant but MRI was divergent or normal. Category IV included 4 patients (11%) in whom neither SPET nor MRI was concordant with EEG. In this study, the relative sensitivities of SPET and MRI for localization of partial epilepsy based on prolonged scalp/sphenoidal video/EEG recordings were 76% and 49%, respectively. We conclude that these neuroimaging techniques (phased-array MRI and inter-ictal cerebral perfusion SPET) are complementary and useful in the pre-operative evaluation of patients with partial epilepsy.
Lewis
D H
DH
Division of Nuclear Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle 98104, USA.
Ory
P
P
Holmes
M D
MD
Wilensky
A J
AJ
Cohen
W A
WA
Schneider
J
J
Ojemann
L M
LM
Ojemann
G A
GA
D000293:Adolescent; D000328:Adult; D000368:Aged; D003545:Cysteine / Q000031:analogs & derivatives; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D017029:Epilepsy, Complex Partial / Q000000981:diagnostic imaging; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000000981:diagnostic imaging; D013997:Time Factors; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome; D014743:Videotape Recording
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; C059659:technetium Tc 99m bicisate; D003545:Cysteine