Bruggemann Jason M, Som Seu S, Lawson John A, Haindl Walter, Cunningham Anne M, Bye Ann M E
Department of Neurology, Sydney Children's Hospital and School of Women's & Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia.
Eur J Nucl Med Mol Imaging. 2004 Mar;31(3):369-77. doi: 10.1007/s00259-003-1366-z. Epub 2003 Nov 28.
Statistical parametric mapping (SPM) quantification and analysis has been successfully applied to functional imaging studies of partial epilepsy syndromes in adults. The present study evaluated whether localisation of the epileptogenic zone (determined by SPM) improves upon visually examined single-photon emission tomography (SPET) imaging in presurgical assessment of children with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The patient sample consisted of 24 children (15 males) aged 2.1-17.8 years (9.8+/-4.3 years; mean+/-SD) with intractable TLE or FLE. SPET imaging was acquired routinely in presurgical evaluation. All patient images were transformed into the standard stereotactic space of the adult SPM SPET template prior to SPM statistical analysis. Individual patient images were contrasted with an adult control group of 22 healthy adult females. Resultant statistical parametric maps were rendered over the SPM canonical magnetic resonance imaging (MRI). Two corresponding sets of ictal and interictal SPM and SPET images were then generated for each patient. Experienced clinicians independently reviewed the image sets, blinded to clinical details. Concordance of the reports between SPM and SPET images, syndrome classification and MRI abnormality was studied. A fair level of inter-rater reliability (kappa=0.73) was evident for SPM localisation. SPM was concordant with SPET in 71% of all patients, the majority of the discordance being from the FLE group. SPM and SPET localisation were concordant with epilepsy syndrome in 80% of the TLE cases. Concordant localisation to syndrome was worse for both SPM (33%) and SPET (44%) in the FLE group. Data from a small sample of patients with varied focal structural pathologies suggested that SPM performed poorly relative to SPET in these cases. Concordance of SPM and SPET with syndrome was lower in patients younger than 6 years than in those aged 6 years and above. SPM is effective in localising the potential epileptogenic zone but does not provide additional benefit beyond SPET in presurgical assessment of children with intractable epilepsy. The impact of different pathologies on the efficacy of SPM warrants further study.
统计参数映射（SPM）定量分析已成功应用于成人部分癫痫综合征的功能成像研究。本研究评估了在颞叶癫痫（TLE）和额叶癫痫（FLE）患儿的术前评估中，由SPM确定的致痫区定位是否比视觉检查的单光子发射断层扫描（SPET）成像更具优势。患者样本包括24名年龄在2.1 - 17.8岁（9.8±4.3岁；均值±标准差）的儿童（15名男性），患有难治性TLE或FLE。在术前评估中常规采集SPET成像。在进行SPM统计分析之前，所有患者图像都被转换为成人SPM SPET模板的标准立体定向空间。将个体患者图像与22名健康成年女性的成人对照组进行对比。所得统计参数图在SPM标准磁共振成像（MRI）上呈现。然后为每位患者生成两组相应的发作期和发作间期的SPM和SPET图像。经验丰富的临床医生在对临床细节不知情的情况下独立审查图像集。研究了SPM和SPET图像报告之间的一致性、综合征分类以及MRI异常情况。SPM定位显示出相当程度的评分者间可靠性（kappa = 0.73）。在所有患者中，71%的SPM与SPET结果一致，大多数不一致情况来自FLE组。在80%的TLE病例中，SPM和SPET定位与癫痫综合征一致。在FLE组中，SPM（33%）和SPET（44%）与综合征的一致定位情况较差。来自一小部分具有不同局灶性结构病变患者的数据表明，在这些病例中SPM相对于SPET表现不佳。6岁以下患者中SPM和SPET与综合征的一致性低于6岁及以上患者。SPM在定位潜在致痫区方面有效，但在难治性癫痫患儿的术前评估中，相较于SPET并无额外优势。不同病变对SPM疗效的影响值得进一步研究。
