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A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
Published on: November 13, 2016
Quantitative evaluation of 99mTc-hexamethylpropylenamineoxime brain SPECT in childhood-onset epilepsy
M J Janicek1, L A O'Tuama, S T Treves
1Department of Radiology, Children's Hospital, Harvard Medical School, Boston, MA 02115.
Insights
Quantitative evaluation of regional cerebral blood flow (rCBF) using SPECT in childhood epilepsy improves detection of seizure foci. This method offers objective rCBF estimates, enhancing EEG localization of epileptogenic zones.
Area of Science:
- Neurology
- Nuclear Medicine
- Epileptology
Background:
- Childhood-onset epilepsy diagnosis relies on correlating clinical, EEG, and neuroimaging data.
- Identifying precise epileptogenic foci is crucial for effective treatment and management.
Purpose of the Study:
- To quantitatively evaluate interictal regional cerebral blood flow (rCBF) in childhood-onset epilepsy.
- To correlate quantitative SPECT findings with electroencephalography (EEG) for seizure focus localization.
Main Methods:
- Ten patients with childhood-onset epilepsy underwent technetium-99m-hexamethylpropylenamine oxime (99mTc HMPAO) SPECT.
- Quantitative analysis of rCBF was performed using regions of interest across neocortical areas.
- Right-left hemisphere comparisons were conducted.
Main Results:
- Quantitative SPECT analysis increased detection of rCBF abnormalities by 26% compared to visual assessment.
- Abnormal EEG patterns correlated with abnormal rCBF in 75% of cases (Phi = 0.788, p < 0.001).
- Discordance between EEG and SPECT was noted in patients with non-localizing EEG.
Conclusions:
- Quantitative evaluation of 99mTc HMPAO SPECT provides objective estimates of interictal rCBF in childhood epilepsy.
- This quantitative approach enhances the precision of detecting epileptogenic foci, complementing EEG findings.
Abstract:
In 10 patients with childhood-onset epilepsy, quantitative evaluation (QE) of interictal regional cerebral blood flow (rCBF) using technetium-99m-hexamethylpropylenamine oxime (99mTc HMPAO) single-photon emission computed tomography (SPECT) was correlated with seizure foci localized by electroencephalography (EEG). Eighty regions of interest (5 x 5 pixels) were placed at five different neocortical areas in both cerebral hemispheres, in coronal and transaxial planes. Mean counts/pixel were calculated for each region and multiple right-left comparisons were done. Quantitative evaluation of 99mTc-HMPAO increased detection of rCBF abnormalities by 26%. Abnormal EEG patterns correlated with abnormal rCBF in 75% of cases (Phi = 0.788, p < 0.001), and with visually detected abnormalities in 50% (Phi = 0.493, p < 0.001). Discordance between EEG and SPECT was most frequent in patients with non-localizing EEG (n = 3). In childhood-onset epilepsy, quantitative evaluation of brain perfusion scans provides: (a) objective estimates of interictal rCBF; (b) more precise detection of epileptogenic foci, when used to complement EEG.
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