Oliveira Young Carla, de Campos Brunno Machado, de Souza Edna Marina, Brunetto Sergio Querino, Gualberto Maria Julia de Oliveira Santos, Alexandre-Santos Leonardo, de Oliveira Marcos Geraldo Merichelo, Alvim Marina Koutsodontis Machado, Cendes Fernando, Etchebehere Elba, Wichert-Ana Lauro, Amorim Bárbara Juarez
Division of Nuclear Medicine, Department of Radiology and Oncology, University of Campinas (UNICAMP), Campinas, Brazil.
Division of Epilepsy, Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil.
Front Neurol. 2025 Apr 15;16:1552774. doi: 10.3389/fneur.2025.1552774. eCollection 2025.
Pharmacoresistant epilepsy affects around one-third of individuals with epilepsy, requiring precise diagnosis, particularly in cases where surgical resection of the epileptogenic zone (EZ) is an option. Functional imaging techniques, such as ictal-interictal subtraction SPECT coregistered to MRI (SISCOM), have proven useful in pre-surgical evaluation by improving EZ localization accuracy. However, the widespread use of SISCOM is limited by the high costs and technical complexity of commercial software. Statistical Parametric Mapping (SPM) has been demonstrated to be a viable alternative for SISCOM analysis, displaying the potential for cost-effective EZ localization.
In this retrospective study, we evaluated patients with pharmacoresistant temporal lobe epilepsy from two reference centers of epilepsy in Brazil, who underwent ictal and interictal SPECT imaging as part of their pre-surgical evaluation, achieving favorable outcomes (Engel I or II) after surgical resection. The EZ reference standard was determined according to anatomopathological findings and good clinical outcomes. SISCOM was performed using a semi-automated approach with Statistical Parametric Mapping (SPM) and a proprietary software - Analyze. Data from each method were compared to the EZ reference standard and classified as concordant, partially concordant, or discordant.
We included 20 patients, 14 (70%) with left temporal lobe epilepsy and six (30%) with right temporal lobe epilepsy. Hippocampal sclerosis was the most common pathology (80%). Both SPM and Analyze were concordant with the EZ reference standard in 14 cases (70%), showing no difference in sensitivity between the methods. However, SPM generated smaller, more localized clusters, while Analyze produced larger clusters with broader spatial coverage. Concordance between the two methods was poor (Kappa = 0.0179), reflecting methodological differences.
This study evidences technical differences between SISCOM performed with SPM and Analyze, but with similar sensitivity (70%) for EZ localization. Further studies with larger sample sizes are required to confirm these findings. The data presented here suggest that SISCOM-SPM, due to its rapid and semi-automated workflow, may offer a practical and accessible alternative to proprietary software for epilepsy surgical planning.
药物难治性癫痫影响着约三分之一的癫痫患者，需要进行精确诊断，尤其是在考虑对致痫区（EZ）进行手术切除的情况下。功能成像技术，如与MRI配准的发作期-发作间期减影SPECT（SISCOM），已被证明通过提高EZ定位准确性，在术前评估中很有用。然而，SISCOM的广泛应用受到商业软件高成本和技术复杂性的限制。统计参数映射（SPM）已被证明是SISCOM分析的可行替代方法，显示出具有成本效益的EZ定位潜力。
在这项回顾性研究中，我们评估了来自巴西两个癫痫参考中心的药物难治性颞叶癫痫患者，他们在术前评估中接受了发作期和发作间期SPECT成像，并在手术切除后取得了良好的结果（Engel I或II级）。EZ参考标准根据解剖病理学发现和良好的临床结果确定。使用统计参数映射（SPM）和专用软件Analyze通过半自动方法进行SISCOM。将每种方法的数据与EZ参考标准进行比较，并分类为一致、部分一致或不一致。
我们纳入了20例患者，其中14例（70%）为左侧颞叶癫痫，6例（30%）为右侧颞叶癫痫。海马硬化是最常见的病理情况（80%）。SPM和Analyze在14例（70%）中与EZ参考标准一致，两种方法之间的敏感性无差异。然而，SPM生成的簇较小且更局限，而Analyze生成的簇较大且空间覆盖范围更广。两种方法之间的一致性较差（Kappa = 0.0179），反映了方法学上的差异。
本研究证明了使用SPM和Analyze进行SISCOM之间的技术差异，但在EZ定位方面具有相似的敏感性（70%）。需要更大样本量的进一步研究来证实这些发现。此处呈现的数据表明，由于其快速和半自动的工作流程，SISCOM-SPM可能为癫痫手术规划的专用软件提供一种实用且易于使用的替代方案。
