Oliveira A J, da Costa J C, Hilário L N, Anselmi O E, Palmini A
Porto Allegre Epilepsy Surgery Program, Department of Internal Medicine, Hospital São Lucas, Pontificia Universidade Católica do Rio Grande do Sul, Brazil.
Epilepsia. 1999 Jun;40(6):693-702. doi: 10.1111/j.1528-1157.1999.tb00765.x.
To evaluate the accuracy, feasibility and clinical value of both ictal and interictal 99mTc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) in patients with medically refractory epilepsy.
The study included 75 consecutive patients, 48 with temporal lobe epilepsy (TLE group), and 27 with extratemporal epilepsy (ExT group). The accuracy of SPECT was analyzed considering the final diagnosis reached by convergence of clinical, electrophysiologic, structural, pathologic and outcome data.
Ictal SPECT correctly identified the epileptogenic zone in 21 (91.3%) of 23 patients, whereas interictal SPECTs could correctly identify the epileptogenic zone in only 41 (62.1%) of 66 patients (chi2 = 5.56, df = 1, p < 0.05). Results were similar when the two study groups were analyzed separately. Moreover, ictal studies had significantly higher specificity (91.3 vs. 60.6%) and positive predictive value (91.3 vs. 66.2%) than interictal studies for the whole series of patients. Considering all tools used in the preoperative workup of these patients, ictal SPECT significantly contributed to the final topographic diagnosis in seven of 14 patients from TLE group and in six of nine patients from the ExT group. In these patients, ictal SPECT either obviated the need for invasive EEG or helped to define where to concentrate the efforts of invasive investigation.
These data demonstrate that ictal SPECT can be easily achieved by using 99mTc-ECD and can accurately localize the epileptogenic zone in both temporal and extratemporal epilepsies. Ictal ECD SPECT proved to be significantly more sensitive and specific than interictal ECD SPECT, and clinically useful in the definition of the epileptogenic zone.
评估发作期和发作间期99m锝-乙基半胱氨酸二聚体（ECD）单光子发射计算机断层扫描（SPECT）在药物难治性癫痫患者中的准确性、可行性及临床价值。
该研究纳入75例连续患者，其中48例为颞叶癫痫（颞叶癫痫组），27例为颞叶外癫痫（颞叶外癫痫组）。根据临床、电生理、结构、病理及转归数据综合得出的最终诊断来分析SPECT的准确性。
发作期SPECT在23例患者中的21例（91.3%）中正确识别出癫痫发作起源区，而发作间期SPECT在66例患者中仅41例（62.1%）能正确识别癫痫发作起源区（χ² = 5.56，自由度 = 1，p < 0.05）。对两个研究组分别进行分析时结果相似。此外，对于整个系列患者，发作期研究的特异性（91.3%对60.6%）和阳性预测值（91.3%对66.2%）显著高于发作间期研究。考虑到这些患者术前检查所使用的所有手段，发作期SPECT对颞叶癫痫组14例患者中的7例以及颞叶外癫痫组9例患者中的6例的最终定位诊断有显著贡献。在这些患者中，发作期SPECT要么避免了进行侵入性脑电图检查的必要，要么有助于确定侵入性检查的重点部位。
这些数据表明，使用99mTc-ECD可轻松实现发作期SPECT，且能在颞叶癫痫和颞叶外癫痫中准确定位癫痫发作起源区。发作期ECD SPECT被证明比发作间期ECD SPECT显著更敏感和特异，并且在癫痫发作起源区的界定方面具有临床实用性。
