Image Fusion of Benzodiazepine Receptor SPECT and Brain MRI in Presurgical Assessment of Temporal Lobe Epilepsy.
Abstract number :
1.228
Submission category :
Year :
2001
Submission ID :
1703
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M. Wissmeyer, Department of Nuclear Medicine, University of Berne, Berne, Switzerland; R. Wiest, M.D., Department of Neurology, University of Berne, Berne, Switzerland; K. Schindler, M.D., Ph.D., Department of Neurology, University of Berne, Berne, Switze
RATIONALE: The aim of this study was to evaluate the usefulness of the image fusion of benzodiazepine receptor (BDR) SPECT using 123I-Iomazenil and brain MRI in the presurgical assessment of patients (pts) with therapy-refractory temporal lobe epilepsy (TLE).
METHODS: We evaluated 21 pts with therapy-refractory TLE due to mesiotemporal sclerosis or other focal brain anomalies. 16 pts have been operated, 5 pts were inoperable due to the extent of the focal brain anomalies. To delineate the epileptogenic zone and to locate the presumed extent of resection, clinical evaluation, video EEG recordings using scalp and semi-invasive foramen ovale electrodes, high resolution brain MRI, interictal rCBF SPECT using 99mTc-ECD and BDR SPECT were performed. Brain MRI and BDR SPECT were fused using a standardized computerized brain atlas (CBA, Applied Medical Imaging AB).
RESULTS: Of the 16 pts treated operatively, 10 pts had a 12-month outcome of Engel class I, 5 pts of Engel class II and 1 patient of Engel class III. Ictal semi-invasive foramen ovale EEG recordings located the epileptogenic focus in all pts in the temporal region. With BDR-SPECT, reduced BDR density and correct delineation of the epileptogenic focus concordant to the ictal EEG findings was shown in 20/21 pts. Brain MRI failed to detect morphological lesions in 2 pts, whereas BDR SPECT revealed a focal anomaly in both cases. There is a significant correlation between positive EEG/MRI findings and BDR SPECT resulting in a sensitivity, a specificity and a positive predictive value of 0.94 for this functional imaging technique. The additionally performed interictal rCBF SPECT localized the epileptogenic focus correctly in 16/21 pts, corresponding to a sensitivity of 0.80, a specificity of 0.90 and a positive predictive value of 0.89.
CONCLUSIONS: BDR SPECT using 123I-Iomazenil fused with brain MRI is a non-invasive procedure that provides useful functional information in the delineation of foci in temporal lobe epilepsy, especially in pts with negative morphological imaging techniques.
Support: The Swiss National Fund.
Disclosure: Grant - Partial financial granting by the Swiss National Fund