SPECT (single photon emission computed tomography) in pediatrics

Area of Science:

• Neuroscience
• Medical Imaging
• Pediatric Neurology

Background:

• Focal epilepsies in children often require surgical intervention.
• Accurate localization of the seizure onset zone is crucial for successful epilepsy surgery.
• Noninvasive functional imaging plays a key role in presurgical evaluation.

Purpose of the Study:

• To evaluate the role of SPECT in presurgical localization of seizure onset zones in pediatric focal epilepsies.
• To assess the utility of peri-ictal SPECT and multimodal imaging (SISCOM) in surgical planning and outcome prediction.
• To explore the potential of interictal SPECT in evaluating cortical maturation and learning disorders.

Main Methods:

• Utilized SPECT, including peri-ictal (ictal and postictal) and interictal scans.
• Employed video-electroencephalography (video-EEG) in conjunction with SPECT.
• Applied SISCOM (subtraction of interictal from peri-ictal SPECT superimposed on MRI) to enhance sensitivity.

Main Results:

• Peri-ictal SPECT is valuable when video-EEG is inconclusive or MRI findings are normal/ambiguous.
• SISCOM significantly increases the sensitivity of peri-ictal SPECT (approx. 70%) and predicts seizure-free outcomes.
• Interictal SPECT may offer insights into functional cortical maturation and learning difficulties.

Conclusions:

• SPECT, particularly when combined with video-EEG and advanced techniques like SISCOM, is a vital tool in the presurgical workup of pediatric focal epilepsies.
• SISCOM enhances the predictive value of SPECT for successful surgical outcomes.
• Interictal SPECT may provide additional diagnostic information beyond seizure localization.