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A Novel method of seizure onset zone localization by serial Tc-99 m ECD brain perfusion SPECT clearance patterns

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Abstract

In this prospective study, we postulate that there is a difference between clearance of [99mTc]Tc- ethyl cysteinate dimer (ECD) in the seizure onset zone (SOZ) and other brain areas and thus SOZ localization by clearance patterns might become a potential novel method for SOZ localization in epilepsy. The parametric images of brain ECD clearance were generated by linear regression model analysis from serial brain SPECT scans from 30 to 240 min after ECD injection (7-times point) in 7 patients with drug-resistant epilepsy and 3 normal volunteers. Clearance patterns of the SOZ confirmed by good surgical outcome or consensus with other investigations were analyzed quantitatively and semi-quantitatively by visual grading (slower or faster washout than contralateral brain regions). The average [99mTc]Tc-ECD clearance rates of SOZs were + 1.08% ± 2.57%/hr (wash in), -7.02% ± 2.56%/hr (washout), and -5.37% ± 1.71%/hr (washout) in ictal, aura and interictal states, respectively. Paired t-tests between the SOZ and contralateral regions showed statistically significant difference (p = 0.039 in interictal state). Clearance patterns that can define the SOZs were 1) wash in and slow washout on ictal slope, 2) fast washout on aura slope and interictal slope with 100% (6/6), 100% (2/2) and 75% (6/8) localization using ictal, aura, and interictal slope maps, respectively. Our study provided the evidence that clearance pattern methods are potential additive diagnostic tools for SOZ localization when routine one-time point SPECT are unable to define the SOZ.

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Acknowledgements

The authors would like to express their gratitude to Prof. Patrick Dupont and Dr. Geoff Warnock for data analysis counseling, to Dr. Suda Jirasakuldej and EMU team for taking care of the patients and sending patients for recruitment, to Research Affairs Department, Faculty of Medicine, Chulalongkorn University for providing statistical consultation and English editing, to Assoc.Prof.Tawachai Chaiwatanarat for his useful comments regarding the proposal, and to all Nuclear Medicine technologists in King Chulalongkorn Memorial Hospital for their help in data collection and image acquisition.

Funding

This work was supported by Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand [grant number RA61/035].

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Chanan Sukprakun & Panya Pasawang

  2. Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Chusak Limotai

  3. Chulalongkorn Comprehensive Epilepsy Center of Excellence (CCEC), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Chusak Limotai & Supatporn Tepmongkol

  4. Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Kitiwat Khamwan & Supatporn Tepmongkol

  5. Chulalongkorn University Biomedical Imaging Group (CUBIG), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Kitiwat Khamwan & Supatporn Tepmongkol

  6. Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

    Kitiwat Khamwan & Supatporn Tepmongkol

Authors
  1. Chanan Sukprakun
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  2. Chusak Limotai
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  5. Supatporn Tepmongkol
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Contributions

Author contributions included conception and study design (CS and ST), data collection or acquisition (CS, CL, KK and PP), statistical analysis (CS), interpretation of results (CS, KK and ST), drafting the manuscript work or revising it critically for important intellectual content (CS and ST) and approval of final version to be published and agreement to be accountable for the integrity and accuracy of all aspects of the work (All authors).

Corresponding author

Correspondence to Supatporn Tepmongkol.

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Ethics approval

This study was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (COA No. 078/2018 and IRB No. 680/60).

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Informed consent was obtained from all individual participants included in the study.

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Sukprakun, C., Limotai, C., Khamwan, K. et al. A Novel method of seizure onset zone localization by serial Tc-99 m ECD brain perfusion SPECT clearance patterns. Brain Imaging and Behavior 16, 1646–1656 (2022). https://doi.org/10.1007/s11682-022-00640-x

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