title: Perfusion SPECT, SISCOM and PET (18)F-FDG in the assessment of drug- refractory epilepsy patients candidates for epilepsy surgery.
abstract: OBJECTIVE
  Brain perfusion SPECT (ictal-interictal), SPECT images and subtraction ictal SPECT coregistered to MRI (SISCOM) and (18)F-FDG-PET (interictal), play an important role in the pre-surgical diagnosis of patients with medically refractory epilepsy. This study aimed to establish: the reproducibility of visual ictal-interictal SPECT and SISCOM analysis altogether with the capacity of SPECT, SISCOM and PET to determine the epileptogenic zone.
  
  
  METHODS
  (99m)Tc-HMPAO SPECT ictal-interictal and SISCOM (Analyze 7.0) were performed on 47 refractory epilepsy patients (24 F, 19-60 yrs). In 13 patients, SISCOM was also performed using a new program (Focus DET). Ictal-interictal SPECT and SISCOM images were analysed independently by two nuclear medicine physicians (observer 1 and 2). Kappa concordance coefficient was used to evaluate the reproducibility. In sixteen patients, SPECT, SISCOM and PET findings were compared with the resected area during the surgery, and surgical outcome using Engel scale or with the stereo EEG-(SEEG).
  
  
  RESULTS
  The ictal-interictal SPECT interobserver agreement was 91%, Kappa index 0.86, SISCOM (Analyze 7.0) interobserver agreement percentage was 82%, Kappa index 0.80, Analyze 7.0 showed a higher inconclusive results than visual SPECT analysis. SISCOM FocusDET interobserver agreement was 92%, Kappa index 0.87, with lower inconclusive results than Analyze 7.0. SPECT, SISCOM and PET combined findings identified 87% seizure onset zone: 79% temporal, 26% parieto-temporal and 7% frontal.
  
  
  CONCLUSIONS
  Ictal-interictal SPECT and SISCOM showed a high reproducibility in this sample of patients with drug-refractory epilepsy. SPECT,SISCOM and PET combined findings improved detection of epileptogenic zone in comparison with the individual assessment.
authors.affiliation: Servicio de Medicina Nuclear, Hospital del Mar, Parc de Salut Mar, Barcelona, España. Electronic address: CRC0809@parcdesalutmar.cat.
authors.forename: M
authors.initials: M
authors.lastname: Suárez-Piñera
authors.affiliation: Servicio de Medicina Nuclear, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Mestre-Fusco
authors.affiliation: Unidad de Epilepsia, Servicio de Neurología, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Ley
authors.affiliation: Servicio de Radiología, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: González
authors.affiliation: Servicio de Radiología, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: Medrano
authors.affiliation: Unidad de Epilepsia, Servicio de Neurología, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Principe
authors.affiliation: Departamento de Estadística en Investigación Biomédica, Instituto Mar de Investigaciones Médicas (IMIM), Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: Mojal
authors.affiliation: Servicio de Neurocirugía, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: G
authors.initials: G
authors.lastname: Conesa
authors.affiliation: Unidad de Epilepsia, Servicio de Neurología, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: R
authors.initials: R
authors.lastname: Rocamora
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D002560:Cerebrovascular Circulation; D004351:Drug Resistance; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D059906:Neuroimaging / Q000379:methods*; D015588:Observer Variation; D055420:Perfusion Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013382:Subtraction Technique; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D000927:Anticonvulsants; D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D019690:Technetium Tc 99m Exametazime
keywords: (18)F-FDG-PET; 18F-FDG-PET; Epilepsia; Epilepsy; Ictal-interictal SPECT; SISCOM; SPECT ictal-interictal