title: The usefulness of subtraction ictal SPECT coregistered to MRI in single- and dual-headed SPECT cameras in partial epilepsy.
abstract: OBJECTIVE
  To prove the clinical usefulness of SISCOM and compare SISCOM images derived from single- and dual-headed single-photon computed tomography (SPECT) cameras for localization of partial epileptic seizures.
  
  
  METHODS
  We retrospectively studied 38 partial epilepsy patients, using subtraction SPECT coregistered to magnetic resonance imaging (MRI; SISCOM). SPECT imaging of the first 15 patients was performed by single-headed camera, and the next 23 patients by dual-headed camera. Side-by-side ictal-interictal SPECT evaluation and SISCOM images were blindly reviewed and classified as either localizing to one of 16 sites or nonlocalizing. A third reviewer evaluated cases of disagreement between primary reviewers. Results were compared with seizure localization by any of the following three traditional techniques: surgical outcome, invasive, and noninvasive video-EEG monitoring. The results from the single- and dual-headed SPECT cameras were compared.
  
  
  RESULTS
  Reviewers localized areas of hyperperfusion with SISCOM images more often than with side-by-side SPECT evaluation (71.0 vs. 47.4%; p = 0.01). When we compared results of SPECT evaluation with traditional techniques, SISCOM showed greater concordance than side-by-side SPECT evaluation (60.53 vs. 36.84%; p = 0.006). There were no differences in localization between images derived from single- and dual-headed cameras. Concordance of seizure localization, compared with traditional techniques, also was not different between these groups [kappa = 0.38, 95% confidence interval (CI), 0.18-0.58] vs. kappa = 0.63, 95% CI (0.45-0.81)].
  
  
  CONCLUSIONS
  SISCOM is a worthwhile technique for preoperative evaluation in partial epilepsy patients and improves the sensitivity and specificity of seizure localization of SPECT images derived from both single- and dual-headed SPECT cameras.
authors.affiliation: Department of Neurology, Division of Nuclear Medicine, Saint Louis University, 3635 Vista Avenue at Grand Blvd., St. Louis, MO 63110-0250, U.S.A.
authors.forename: Kitti
authors.initials: K
authors.lastname: Kaiboriboon
authors.forename: Val J
authors.initials: VJ
authors.lastname: Lowe
authors.forename: Sunanta I
authors.initials: SI
authors.lastname: Chantarujikapong
authors.forename: R Edward
authors.initials: RE
authors.lastname: Hogan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013382:Subtraction Technique; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation
chemical_list: D019275:Radiopharmaceuticals