Ictal and interictal SPECT with 99mTc‐HMPAO in presurgical epilepsy. I: Predictive value and methodological considerations

Author:

Prener Martin1ORCID,Drejer Veronica1,Ziebell Morten2,Jensen Per1ORCID,Madsen Camilla Gøbel3,Olsen Svitlana1,Thomsen Gerda1,Pinborg Lars H.1456,Paulson Olaf B.16ORCID

Affiliation:

1. Department of Neurology, Neurobiology Research Unit Rigshospitalet Blegdamsvej Copenhagen Denmark

2. Department of Neurosurgery Rigshospitalet Copenhagen Denmark

3. Department of Radiology, Centre for Functional and Diagnostic imaging and Research Copenhagen University Hospital Amager and Hvidovre Hvidovre Denmark

4. Department of Neurology, Epilepsy Clinic Rigshospitalet Copenhagen Denmark

5. Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

6. Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Abstract

AbstractObjectiveThis retrospective study investigates the predictive value of ictal subtraction single‐photon emission computed tomography (SPECT) co‐registered to magnetic resonance imaging (MRI) (SISCOM) for successful epilepsy surgery.Methods57 patients examined with SISCOM as a part of epilepsy surgery evaluation were divided into two groups based on seizure duration after tracer injection (group 1: Seizure duration above or equal to 30 s, group 2: Seizure duration under 30 s). SISCOM was compared to the surgical site and categorized as good or poor concordance. Subsequently, Odds ratios (ORs) and positive predictive values (PPVs) were calculated for each group for good surgical outcome, freedom from disabling seizures.ResultsThe PPVs and ORs for good surgical outcome was 74.1% and 5.71 for group 1 and 40% and 0.22 for group 2. SISCOM had a similar positive predictive value regardless of whether the focus was in the same or neighboring lobe, but same hemisphere as the resection.ConclusionIn conclusion, the implementation of a precise definition for a well‐executed ictal SPECT scan with respect to seizure duration after injection enhances the positive predictive value (PPV) and odds ratio (OR) for successful surgical outcome, surpassing previous findings, whether the focus in resected lobe or the neighboring.

Publisher

Wiley

Subject

Neurology (clinical),Neurology

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