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Ictal and interictal brain SPECT imaging in epilepsy using technetium-99m-ECD
F Grünwald1, C Menzel, L Pavics
1Department of Nuclear Medicine, University of Bonn, Germany.
Summary
99mTc-ethyl cysteinate dimer (ECD) effectively images brain perfusion in epilepsy patients. This tracer is useful for early ictal SPECT studies, aiding presurgical evaluation in medically intractable cases.
Area of Science:
- Neurology
- Nuclear Medicine
- Radiopharmacology
Background:
- Medically intractable epilepsy requires precise presurgical evaluation.
- Cerebral perfusion imaging plays a crucial role in localizing seizure foci.
- 99mTc-ethyl cysteinate dimer (ECD) is a radiotracer used in SPECT imaging.
Purpose of the Study:
- To evaluate the efficacy of 99mTc-ECD (99mTc-bicisate) in the presurgical assessment of epilepsy.
- To determine the utility of ictal and interictal 99mTc-ECD SPECT in identifying hypoperfusion and hyperperfusion zones.
Main Methods:
- Performed 23 brain SPECT studies (8 ictal, 15 interictal) on 16 epilepsy patients.
- Utilized a high-resolution annular SPECT system (CERASPECT).
- Administered 99mTc-ECD within 2-20 seconds of seizure onset for ictal scans.
Main Results:
- Interictal SPECT revealed circumscribed hypoperfusions in all patients.
- Ictal SPECT demonstrated increased tracer uptake in all studies.
- Significant asymmetry index changes were observed between interictal (0.88) and ictal (1.23) studies in temporal lobe epilepsy patients.
Conclusions:
- 99mTc-ECD is an effective marker for cerebral perfusion imaging in epilepsy.
- High in vitro stability makes 99mTc-ECD particularly suitable for early ictal SPECT.
- Findings support the use of 99mTc-ECD in presurgical epilepsy evaluation.