Automatic and remote controlled ictal SPECT injection for seizure focus localization by use of a commercial contrast agent application pump.
OBJECTIVE
In the presurgical evaluation of patients with partial epilepsy, the ictal single photon emission computed tomography (SPECT) is a useful noninvasive diagnostic tool for seizure focus localization. To achieve optimal SPECT scan quality, ictal tracer injection should be carried out as quickly as possible after the seizure onset and under highest safety conditions possible. Compared to the commonly used manual injection, an automatic administration of the radioactive tracer may provide higher quality standards for this procedure. In this study, therefore, we retrospectively analyzed efficiency and safety of an automatic injection system for ictal SPECT tracer application.


METHODS
Over a 31-month period, 26 patients underwent ictal SPECT by use of an automatic remote-controlled injection pump originally designed for CT-contrast agent application. Various factors were reviewed, including latency of ictal injection, radiation safety parameters, and ictal seizure onset localizing value.


RESULTS
Times between seizure onset and tracer injection ranged between 3 and 48 s. In 21 of 26 patients ictal SPECT supported the localization of the epileptogenic focus in the course of the presurgical evaluation. In all cases ictal SPECT tracer injection was performed with a high degree of safety to patients and staff.


CONCLUSIONS
Ictal SPECT by use of a remote-controlled CT-contrast agent injection system provides a high scan quality and is a safe and confirmatory presurgical evaluation technique in the epilepsy-monitoring unit.
Feichtinger
Michael
M
Department of Neurology, Medical University Graz, Graz, Austria. mi.feichtinger@meduni-graz.at
Eder
Hans
H
Holl
Alexander
A
Körner
Eva
E
Zmugg
Gerda
G
Aigner
Reingard
R
Fazekas
Franz
F
Ott
Erwin
E
D001931:Brain Mapping; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D003287:Contrast Media / Q000008:administration & dosage*; D004569:Electroencephalography / Q000706:statistics & numerical data; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007260:Infusion Pumps; D007267:Injections / Q000295:instrumentation; D008279:Magnetic Resonance Imaging; D011300:Preoperative Care; D011835:Radiation Protection; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation*; D019690:Technetium Tc 99m Exametazime / Q000008:administration & dosage*; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation / Q000379:methods*
D003287:Contrast Media; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime