Zaknun John J, Bal Chandrasekhar, Maes Alex, Tepmongkol Supatporn, Vazquez Silvia, Dupont Patrick, Dondi Maurizio
Department of Nuclear Medicine, University Hospital of Innsbruck, Innsbruck, Austria.
Eur J Nucl Med Mol Imaging. 2008 Jan;35(1):107-15. doi: 10.1007/s00259-007-0526-y. Epub 2007 Sep 26.
MR imaging, ictal single-photon emission CT (SPECT) and ictal EEG play important roles in the presurgical localization of epileptic foci. This multi-center study was established to investigate whether the complementary role of perfusion SPECT, MRI and EEG for presurgical localization of temporal lobe epilepsy could be confirmed in a prospective setting involving centers from India, Thailand, Italy and Argentina.
We studied 74 patients who underwent interictal and ictal EEG, interictal and ictal SPECT and MRI before surgery of the temporal lobe. In all but three patients, histology was reported. The clinical outcome was assessed using Engel's classification. Sensitivity values of all imaging modalities were calculated, and the add-on value of SPECT was assessed.
Outcome (Engel's classification) in 74 patients was class I, 89%; class II, 7%; class III, 3%; and IV, 1%. Regarding the localization of seizure origin, sensitivity was 84% for ictal SPECT, 70% for ictal EEG, 86% for MRI, 55% for interictal SPECT and 40% for interictal EEG. Add-on value of ictal SPECT was shown by its ability to correctly localize 17/22 (77%) of the seizure foci missed by ictal EEG and 8/10 (80%) of the seizure foci not detected by MRI.
This prospective multi-center trial, involving centers from different parts of the world, confirms that ictal perfusion SPECT is an effective diagnostic modality for correctly identifying seizure origin in temporal lobe epilepsy, providing complementary information to ictal EEG and MRI.
磁共振成像（MR）、发作期单光子发射计算机断层扫描（SPECT）和发作期脑电图在癫痫病灶的术前定位中发挥着重要作用。本多中心研究旨在探讨在一项涉及印度、泰国、意大利和阿根廷多个中心的前瞻性研究中，灌注SPECT、MRI和脑电图对颞叶癫痫术前定位的互补作用是否能够得到证实。
我们研究了74例在颞叶手术前行发作间期和发作期脑电图、发作间期和发作期SPECT及MRI检查的患者。除3例患者外，均报告了组织学检查结果。采用恩格尔分类法评估临床结局。计算所有成像方式的敏感度值，并评估SPECT的附加价值。
74例患者的结局（恩格尔分类）为：I级，89%；II级，7%；III级，3%；IV级，1%。关于癫痫发作起源的定位，发作期SPECT的敏感度为84%，发作期脑电图为70%，MRI为86%，发作间期SPECT为55%，发作间期脑电图为40%。发作期SPECT的附加价值表现为其能够正确定位发作期脑电图遗漏的22个癫痫病灶中的17个（77%）以及MRI未检测到的10个癫痫病灶中的8个（80%）。
这项涉及来自世界不同地区多个中心的前瞻性多中心试验证实，发作期灌注SPECT是正确识别颞叶癫痫发作起源的一种有效诊断方法，可为发作期脑电图和MRI提供补充信息。
