The rate of contradictory lateralization of the epileptic seizure onset zone between ictal and interictal brain perfusion SPECT

Abstract Background: The chemical microspheres 99mTc-HMPAO and 99mTc-ECD are widely used as tracers in ictal brain perfusion SPECT for identification of the seizure onset zone (SOZ) in presurgical evaluation of patients with drug-resistant epilepsy and uncertainty of SOZ localization after standard diagnostic workup. For both tracers there are theoretical arguments to favor it over the other for this task. The aim of this study was to compare the performance of ictal brain perfusion SPECT between 99mTc-HMPAO and 99mTc-ECD in a rather large patient sample.Methods: The study retrospectively included 196 patients from clinical routine in whom ictal perfusion SPECT had been performed with stabilized 99mTc-HMPAO (n = 110) or 99mTc-ECD (n = 86). Lateralization and localization of the SOZ was obtained by the consensus of two independent readers who visually inspected the SPECT images retrospectively. Results: The 99mTc-HMPAO group and the 99mTc-ECD group were well matched with respect to age, sex, age at first seizure, duration of disease, seizure frequency, history of previous brain surgery, and findings of presurgical MRI. The tracer groups differed significantly with respect to the latency of tracer injection (median latency 4 s longer in the 99mTc-HMPAO group), duration of the seizure after tracer injection (25 s shorter in the 99mTc-HMPAO group), tracer dose (70 MBq higher in the 99mTc-HMPAO group), and delay of the SPECT acquisition after tracer injection (63 min longer in the 99mTc-HMPAO group). The fraction of lateralising ictal SPECT did not differ significantly between the 99mTc-HMPAO and the 99mTc-ECD group (65.5% versus 72.1%, p = 0.355). Sensitivity of ictal perfusion SPECT (independent of the tracer) for correct localization of the SOZ in 62 patients with temporal lobe epilepsy and at least worthwhile improvement (Engel scale ≤ III) 12 months after temporal epilepsy surgery was 63%.Conclusions: This study does not provide evidence to favor 99mTc-HMPAO or 99mTc-ECD for identification of the SOZ by ictal perfusion SPECT in patients with drug resistant epilepsy.

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No Evidence to Favor 99mTc-HMPAO or 99mTc-ECD for Ictal Brain Perfusion SPECT for Identification of the Seizure Onset Zone

Clinical Nuclear Medicine ◽

10.1097/rlu.0000000000003791 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Mariam Jaber ◽

Jila Taherpour ◽

Berthold Voges ◽

Ivayla Apostolova ◽

Thomas Sauvigny ◽

...

Keyword(s):

Brain Perfusion ◽

Seizure Onset ◽

Brain Perfusion Spect ◽

Seizure Onset Zone ◽

Perfusion Spect ◽

99Mtc Hmpao

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A Novel Method of Seizure Onset Zone Localization by Serial Tc-99m ECD Brain Perfusion SPECT Clearance Patterns

10.21203/rs.3.rs-672209/v1 ◽

2021 ◽

Author(s):

Chanan Sukprakun ◽

Chusak Limotai ◽

Kitiwat Khamwan ◽

Panya Pasawang ◽

Supatporn Tepmongkol

Keyword(s):

Brain Perfusion ◽

Brain Regions ◽

Diagnostic Tools ◽

Seizure Onset ◽

Visual Grading ◽

Seizure Onset Zone ◽

Significant Difference ◽

Perfusion Spect ◽

Novel Method ◽

Drug Resistant Epilepsy

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 minutes to 240 minutes 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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Brain perfusion SPECT and MRI in foetal alcohol syndrome

Developmental Medicine & Child Neurology ◽

10.1017/s0012162299001358 ◽

1999 ◽

Vol 41 (10) ◽

pp. 652-659 ◽

Cited By ~ 101

Author(s):

R Riikonen ◽

I Salonen ◽

K Partanen ◽

S Verho

Keyword(s):

Brain Perfusion ◽

Brain Perfusion Spect ◽

Foetal Alcohol Syndrome ◽

Perfusion Spect

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High-quality brain perfusion SPECT images may be achieved with a high-speed recording using 360° CZT camera

EJNMMI Physics ◽

10.1186/s40658-020-00334-7 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Manon Bordonne ◽

Mohammad B. Chawki ◽

Pierre-Yves Marie ◽

Timothée Zaragori ◽

Véronique Roch ◽

...

Keyword(s):

Image Quality ◽

High Speed ◽

Brain Perfusion ◽

Fold Increase ◽

Brain Structures ◽

Czt Camera ◽

Recording Time ◽

Brain Perfusion Spect ◽

Central Brain ◽

Perfusion Spect

Abstract Objective The aim of this study was to compare brain perfusion SPECT obtained from a 360° CZT and a conventional Anger camera. Methods The 360° CZT camera utilizing a brain configuration, with 12 detectors surrounding the head, was compared to a 2-head Anger camera for count sensitivity and image quality on 30-min SPECT recordings from a brain phantom and from 99mTc-HMPAO brain perfusion in 2 groups of 21 patients investigated with the CZT and Anger cameras, respectively. Image reconstruction was adjusted according to image contrast for each camera. Results The CZT camera provided more than 2-fold increase in count sensitivity, as compared with the Anger camera, as well as (1) lower sharpness indexes, giving evidence of higher spatial resolution, for both peripheral/central brain structures, with respective median values of 5.2%/3.7% versus 2.4%/1.9% for CZT and Anger camera respectively in patients (p < 0.01), and 8.0%/6.9% versus 6.2%/3.7% on phantom; and (2) higher gray/white matter contrast on peripheral/central structures, with respective ratio median values of 1.56/1.35 versus 1.11/1.20 for CZT and Anger camera respectively in patients (p < 0.05), and 2.57/2.17 versus 1.40/1.12 on phantom; and (3) no change in noise level. Image quality, scored visually by experienced physicians, was also significantly higher on CZT than on the Anger camera (+ 80%, p < 0.01), and all these results were unchanged on the CZT images obtained with only a 15 min recording time. Conclusion The 360° CZT camera provides brain perfusion images of much higher quality than a conventional Anger camera, even with high-speed recordings, thus demonstrating the potential for repositioning brain perfusion SPECT to the forefront of brain imaging.

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