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Contribution of subtraction ictal SPECT coregistered to MRI to epilepsy surgery: a multicenter study

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Abstract

Objective

A multicenter prospective study was performed to assess the additional value of a subtraction ictal SPECT coregistered to MRI (SISCOM) technique to traditional side-by-side comparison of ictal- and interictal SPECT images in epilepsy surgery.

Methods

One hundred and twenty-three patients with temporal and extratemporal lobe epilepsy who had undergone epilepsy surgery after evaluation of scalp ictal and interictal electroencephalogram (EEG), MRI, and ictal and interictal SPECT scans were followed up in terms of postsurgical outcome for a period of at least 1 year. Three reviewers localized the epileptogenic focus using ictal and interictal SPECT images first by side-by-side comparison and subsequently by SISCOM. Concordance of the localization of the epileptogenic focus by SPECT diagnosis with the surgical site and inter-observer agreement between reviewers was compared between side-by-side comparison and SISCOM. Logistic regression analysis was performed in predicting the surgical outcome with the dependent variable being the achievement of a good postsurgical outcome and the independent variables using the SISCOM, side-by-side comparison of ictal and interictal SPECT images, MRI, and scalp ictal EEG.

Results

The SISCOM presented better concordance in extratemporal lobe epilepsy and less concordance in temporal lobe epilepsy than side-by-side comparison. Inter-observer concordance was higher in SISCOM than in side-by-side comparison. Much higher concordance of the epileptogenic focus by SPECT diagnosis with the surgical site was obtained in patients with good surgical outcome than in those with poor surgical outcome. These differences in concordance between good and poor surgical outcomes were greater in SISCOM than in side-by-side comparison. Logistic regression analysis showed the highest odds ratio of 12.391 (95% confidence interval; 3.319, 46.254) by SISCOM evaluation for concordance of the epileptogenic focus with the surgical site in predicting good surgical outcome.

Conclusions

A SISCOM technique of ictal and interictal SPECT images provides higher predictive value of good surgical outcome and more reliability on the diagnosis of the epileptogenic focus than side-by-side comparison in medically intractable partial epilepsy.

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Acknowledgments

This study was supported by the Japanese Foundation of Neurosciences and Mental Health. We are thankful to Dr. Noriko Tanaka, Department of Clinical Bioinformatics, Graduate School of Medicine, University of Tokyo, for valuable suggestion on statistical analysis of the present study and Mr. John Gelblum for proofreading of this manuscript.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan

    Hiroshi Matsuda, Ichiei Kuji & Etsuko Imabayashi

  2. Department of Neurosurgery, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Shizuoka, Japan

    Kazumi Matsuda

  3. Department of Psychiatry, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Shizuoka, Japan

    Fumihiro Nakamura

  4. Department of Neurosurgery, Epilepsy Center in National Nishi-Niigata Chuo Hospital, Niigata, Japan

    Shigeki Kameyama & Hiroshi Masuda

  5. Department of Neurosurgery, National Center Hospital of Neurology and Psychiatry, Kodaira, Tokyo, Japan

    Taisuke Otsuki & Hideyuki Nakama

  6. Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan

    Hiroshi Shamoto & Nobukazu Nakazato

  7. Department of Neurology, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan

    Masahiro Mizobuchi

  8. Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan

    Joji Nakagawara

  9. Department of Neurosurgery, Kyushu University Hospital, Fukuoka, Japan

    Takato Morioka

  10. Department of Radiology, Kyushu University Hospital, Fukuoka, Japan

    Yasuo Kuwabara

  11. Department of Neurology, Shizuoka Children’s Hospital, Shizuoka, Japan

    Hideo Aiba

  12. Department of Radiology, Shizuoka Children’s Hospital, Shizuoka, Japan

    Masayuki Yano

  13. Department of Neurosurgery, Nara Medical University Hospital, Kashihara, Nara, Japan

    Yeong-Jin Kim & Hiroyuki Nakase

  14. Department of Radiology, National Center Hospital of Neurology and Psychiatry, Kodaira, Tokyo, Japan

    Yoko Hirata & Noriko Sato

  15. Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan

    Sunao Mizumura

Authors
  1. Hiroshi Matsuda
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  2. Kazumi Matsuda
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  3. Fumihiro Nakamura
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  4. Shigeki Kameyama
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  5. Hiroshi Masuda
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  7. Hideyuki Nakama
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  8. Hiroshi Shamoto
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  9. Nobukazu Nakazato
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  10. Masahiro Mizobuchi
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  12. Takato Morioka
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  13. Yasuo Kuwabara
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  14. Hideo Aiba
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  15. Masayuki Yano
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  16. Yeong-Jin Kim
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  17. Hiroyuki Nakase
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  18. Ichiei Kuji
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  19. Yoko Hirata
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  20. Sunao Mizumura
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  21. Etsuko Imabayashi
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  22. Noriko Sato
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Corresponding author

Correspondence to Hiroshi Matsuda.

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Matsuda, H., Matsuda, K., Nakamura, F. et al. Contribution of subtraction ictal SPECT coregistered to MRI to epilepsy surgery: a multicenter study. Ann Nucl Med 23, 283–291 (2009). https://doi.org/10.1007/s12149-009-0236-6

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  • DOI: https://doi.org/10.1007/s12149-009-0236-6

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