From the Departments of Neurology (V.S., B.H.B., D.T.J., G.D.C., L.C.W.-K., J.W.B., E.L.S., G.A.W.) and Radiology (M.L.S., B.P.M., R.E.W.) and Biomedical Imaging Resource (S.S., D.P.H., D.R.H., R.A.R.), Mayo Clinic, Rochester, MN; International Clinical Research Center (V.S., D.H.), St. Anne's University Hospital, Brno; and the Department of Neurology (V.S.), 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
Neurology. 2014 Mar 18;82(11):932-9. doi: 10.1212/WNL.0000000000000209. Epub 2014 Feb 14.
To evaluate the benefit of statistical SPECT processing over traditional subtraction methods, we compared ictal-interictal SPECT analyzed by statistical parametric mapping (SPM) (ISAS), statistical ictal SPECT coregistered to MRI (STATISCOM), and subtraction ictal-interictal SPECT coregistered with MRI (SISCOM) in patients with MRI-negative focal temporal lobe epilepsy (nTLE) and extratemporal lobe epilepsy (nETLE).
We retrospectively identified 49 consecutive cases of drug-resistant focal epilepsy that had a negative preoperative MRI and underwent interictal and ictal SPECT prior to resective epilepsy surgery. Interictal and ictal SPECT scans were analyzed using SISCOM, ISAS, and STATISCOM to create hyperperfusion and hypoperfusion maps for each patient. Reviewers blinded to clinical data and the SPECT analysis method marked the site of probable seizure origin and indicated their confidence in the localization.
In nTLE and nETLE, the hyperperfusions detected by STATISCOM (71% nTLE, 57% nETLE) and ISAS (67% nTLE, 53% nETLE) were more often colocalized with surgery resection site compared to SISCOM (38% nTLE, 36% nETLE). In nTLE, localization of the hyperperfusion to the region of surgery was associated with an excellent outcome for STATISCOM (p = 0.005) and ISAS (p = 0.027), but not in SISCOM (p = 0.071). This association was not present in nETLE for any method.
In an unselected group of patients with normal MRI and focal epilepsy, SPM-based methods of SPECT processing showed better localization of SPECT hyperperfusion to surgical resection site and higher interobserver agreement compared to SISCOM. These results show the benefit of statistical SPECT processing methods and further highlight the challenge of nETLE.
为了评估统计 SPECT 处理相对于传统减影方法的优势，我们比较了 MRI 配准的统计参数图分析发作间期-发作期 SPECT（ISAS）、MRI 配准的统计发作期 SPECT（STATISCOM）和 MRI 配准的发作间期-发作期 SPECT 减影（SISCOM）在 MRI 阴性局灶性颞叶癫痫（nTLE）和非颞叶癫痫（nETLE）患者中的应用。
我们回顾性地确定了 49 例药物难治性局灶性癫痫患者，这些患者术前 MRI 阴性，并在接受癫痫手术前进行了发作间期和发作期 SPECT。使用 SISCOM、ISAS 和 STATISCOM 分析发作间期和发作期 SPECT 扫描，为每位患者创建高灌注和低灌注图。对临床数据和 SPECT 分析方法不知情的审阅者标记可能的癫痫起源部位，并表示他们对定位的信心。
在 nTLE 和 nETLE 中，STATISCOM（71%nTLE，57%nETLE）和 ISAS（67%nTLE，53%nETLE）检测到的高灌注与手术切除部位的重合率高于 SISCOM（38%nTLE，36%nETLE）。在 nTLE 中，STATISCOM（p=0.005）和 ISAS（p=0.027）的高灌注定位与手术区域相关，结果良好，但 SISCOM 无此相关性（p=0.071）。对于任何方法，nETLE 中均未出现这种相关性。
在一组无选择的 MRI 正常的局灶性癫痫患者中，与 SISCOM 相比，基于 SPM 的 SPECT 处理方法显示出更好的 SPECT 高灌注定位到手术切除部位的能力，并且观察者间的一致性更高。这些结果表明了统计 SPECT 处理方法的优势，并进一步强调了 nETLE 的挑战性。
