Comparative analysis of MR imaging, Ictal SPECT and EEG in temporal lobe epilepsy: a prospective IAEA multi-center study
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Background and purpose
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.
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- Comparative analysis of MR imaging, Ictal SPECT and EEG in temporal lobe epilepsy: a prospective IAEA multi-center study
European Journal of Nuclear Medicine and Molecular Imaging
Volume 35, Issue 1 , pp 107-115
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Refractory epilepsy
- Epilepsy surgery
- Ictal SPECT
- Industry Sectors
- Author Affiliations
- 1. Department of Nuclear Medicine, University Hospital of Innsbruck, Innsbruck, Austria
- 8. Nuclear Medicine Section, Division of Human Health, International Atomic Energy Agency (IAEA), Vienna, Austria
- 9. Nuclear Medicine Section, Division of Human Health, IAEA, Wagramer Strasse 5, P.O. Box 100, 1400, Wien, Austria
- 2. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
- 3. Katholieke Universiteit Leuven, Leuven, Belgium
- 4. Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
- 5. Nuclear Medicine Division, Department of Radiology, Chulalongkorn University, Bangkok, Thailand
- 6. Department of Radiology, Instituto de Investigaciones Neurologicas, FLENI, Buenos Aires, Argentina
- 7. Department of Nuclear Medicine, Ospedale Maggiore, Bologna, Italy