title: Clinical Role of Subtraction Ictal SPECT Coregistered to MR Imaging and (18)F-FDG PET in Pediatric Epilepsy.
abstract: A precise assessment of the drug-resistant epileptic pediatric population for surgical candidacy is often challenging, and to date there are no evidence-based guidelines for presurgical identification of the epileptogenic zone. To evaluate the usefulness of radionuclide imaging techniques for presurgical evaluation of epileptic pediatric patients, we compared the results of video-electroencephalography (EEG), brain MR imaging, interictal SPECT, ictal SPECT, subtraction ictal SPECT coregistered to MR imaging (SISCOM), and interictal PET with (18)F-FDG.
  
  
  METHODS
  Fifty-four children with drug-resistant epilepsy who had undergone video-EEG monitoring, brain MR imaging, interictal and ictal brain perfusion SPECT, SISCOM, and (18)F-FDG PET were included in this study. All abnormal findings revealed by these neuroimaging techniques were compared with the presumed location of the epileptogenic zone (PEZ) as determined by video-EEG and clinical data. The proportion of localizing studies for each technique was statistically compared. In the 18 patients who underwent resective brain surgery, neuroimaging results were compared with histopathology results and surgical outcome.
  
  
  RESULTS
  SISCOM and (18)F-FDG PET concordance with the PEZ was significantly higher than MR imaging (P < 0.05). MR imaging showed localizing results in 21 of 54 cases (39%), SISCOM in 36 of 54 cases (67%), and (18)F-FDG PET in 31 of 54 cases (57%). If we consider SISCOM and (18)F-FDG PET results together, nuclear medicine imaging techniques showed coinciding video-EEG results in 76% of patients (41/54). In those cases in which MR imaging failed to identify any epileptogenic lesion (61% [33/54]), SISCOM or (18)F-FDG PET findings matched PEZ in 67% (22/33) of cases.
  
  
  CONCLUSIONS
  SISCOM and (18)F-FDG PET provide complementary presurgical information that matched video-EEG results and clinical data in three fourths of our sample. SISCOM was particularly useful in those cases in which MR imaging findings were abnormal but no epileptogenic lesion was identified. Radionuclide imaging techniques are both useful and reliable, extending the possibility of surgical treatment to patients who may have been discouraged without a nuclear medicine approach.
authors.affiliation: Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain andres.perissinotti@gmail.com.
authors.forename: Andrés
authors.initials: A
authors.lastname: Perissinotti
authors.affiliation: Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBBAPS), Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Setoain
authors.affiliation: Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBBAPS), Barcelona, Spain Neurology Department, Hospital Clínic, Barcelona, Spain Neurology Department, Hospital Sant Joan de Déu, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Aparicio
authors.affiliation: Nuclear Medicine Department, Hospital Universitari Son Espases, Palma, Spain.
authors.forename: Sebastiá
authors.initials: S
authors.lastname: Rubí
authors.affiliation: Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain University of Barcelona, Barcelona, Spain.
authors.forename: Berta Marti
authors.initials: BM
authors.lastname: Fuster
authors.affiliation: Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBBAPS), Barcelona, Spain Neurology Department, Hospital Clínic, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Donaire
authors.affiliation: Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBBAPS), Barcelona, Spain Neurology Department, Hospital Clínic, Barcelona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Carreño
authors.affiliation: Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBBAPS), Barcelona, Spain Departments of Radiology and Neurosurgery, Hospital Clínic, Barcelona, Spain; and.
authors.forename: Nuria
authors.initials: N
authors.lastname: Bargalló
authors.affiliation: Departments of Radiology and Neurosurgery, Hospital Clínic, Barcelona, Spain; and.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rumiá
authors.affiliation: Neurosurgery Department, Hospital Sant Joan de Déu, Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Garcia-Fructuoso
authors.affiliation: Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Mayoral
authors.affiliation: Neurology Department, Hospital Sant Joan de Déu, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Sanmartí
authors.affiliation: Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBBAPS), Barcelona, Spain University of Barcelona, Barcelona, Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pons
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D004827:Epilepsy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D012189:Retrospective Studies; D013382:Subtraction Technique; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: PET; SISCOM; SPECT; children; epilepsy