Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. II: Methodological considerations on hyper- and hypoperfusion
Research output: Contribution to journal › Journal article › Research › peer-review
Standard
Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. II : Methodological considerations on hyper- and hypoperfusion. / Prener, Martin; Drejer, Veronica; Ziebell, Morten; Jensen, Per; Madsen, Camilla Gøbel; Olsen, Svitlana; Thomsen, Gerda; Pinborg, Lars H; Paulson, Olaf B.
In: Epilepsia open, Vol. 8, No. 4, 2023, p. 1503-1511.Research output: Contribution to journal › Journal article › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. II
T2 - Methodological considerations on hyper- and hypoperfusion
AU - Prener, Martin
AU - Drejer, Veronica
AU - Ziebell, Morten
AU - Jensen, Per
AU - Madsen, Camilla Gøbel
AU - Olsen, Svitlana
AU - Thomsen, Gerda
AU - Pinborg, Lars H
AU - Paulson, Olaf B
N1 - © 2023 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
PY - 2023
Y1 - 2023
N2 - OBJECTIVE: Single-photon emission computed tomography (SPECT) with the tracer 99m Tc-HMPAO is a method to visualize the cerebral hyperperfusion during an epileptic seizure and thus localize the epileptogenic zone and seizure propagation. Subtraction of interictal from Ictal SPECT Co-registered to MRI (SISCOM) visualizes areas with relative increases in cerebral blood flow. The purpose of this retrospective study is to explore the added value of visualizing areas of hypoperfusion as well as hyperperfusion, so-called reversed SISCOM.METHODS: Fifty-six patients operated for epilepsy who had been investigated with SISCOM were included in the analysis. The patients were divided into two groups based on seizure duration after tracer injection, above or below 30 s. The preoperative SISCOM description was compared to the area of resection and given a concordance score. The 56 SISCOM were recalculated visualizing also areas of hypoperfusion and again compared to the site of resection using the same scale of concordance. The reversed SISCOM were categorized into three subgroups: "Altered Conclusion," "Confirmed Conclusion," and "Adds Nothing." If an area of hyperperfusion had an area of hypoperfusion in close proximity, it was re-interpreted as noise, thus possibly altering the conclusion. If the areas of hypoperfusion were in the opposite hemisphere it was interpreted as confirming factor. Further the concordance scores from conventional SISCOM and reversed SISCOM was compared to surgical outcome to explore the difference in sensitivity, positive predictive value (PPV), and odds ratio.RESULTS: In approximately half of the cases reversed SISCOM added additional value, meaning either altered the conclusion or confirmed the conclusion. The sensitivity, PPV, and odds ratio was also better in the subgroup of long, >30 s seizure duration after injection, and got worse in the group with short, <30 s seizure duration after injection.SIGNIFICANCE: Adding reversed SISCOM performed better than conventional SISCOM at predicting good surgical outcome.
AB - OBJECTIVE: Single-photon emission computed tomography (SPECT) with the tracer 99m Tc-HMPAO is a method to visualize the cerebral hyperperfusion during an epileptic seizure and thus localize the epileptogenic zone and seizure propagation. Subtraction of interictal from Ictal SPECT Co-registered to MRI (SISCOM) visualizes areas with relative increases in cerebral blood flow. The purpose of this retrospective study is to explore the added value of visualizing areas of hypoperfusion as well as hyperperfusion, so-called reversed SISCOM.METHODS: Fifty-six patients operated for epilepsy who had been investigated with SISCOM were included in the analysis. The patients were divided into two groups based on seizure duration after tracer injection, above or below 30 s. The preoperative SISCOM description was compared to the area of resection and given a concordance score. The 56 SISCOM were recalculated visualizing also areas of hypoperfusion and again compared to the site of resection using the same scale of concordance. The reversed SISCOM were categorized into three subgroups: "Altered Conclusion," "Confirmed Conclusion," and "Adds Nothing." If an area of hyperperfusion had an area of hypoperfusion in close proximity, it was re-interpreted as noise, thus possibly altering the conclusion. If the areas of hypoperfusion were in the opposite hemisphere it was interpreted as confirming factor. Further the concordance scores from conventional SISCOM and reversed SISCOM was compared to surgical outcome to explore the difference in sensitivity, positive predictive value (PPV), and odds ratio.RESULTS: In approximately half of the cases reversed SISCOM added additional value, meaning either altered the conclusion or confirmed the conclusion. The sensitivity, PPV, and odds ratio was also better in the subgroup of long, >30 s seizure duration after injection, and got worse in the group with short, <30 s seizure duration after injection.SIGNIFICANCE: Adding reversed SISCOM performed better than conventional SISCOM at predicting good surgical outcome.
U2 - 10.1002/epi4.12833
DO - 10.1002/epi4.12833
M3 - Journal article
C2 - 37750050
VL - 8
SP - 1503
EP - 1511
JO - Epilepsia open
JF - Epilepsia open
SN - 2470-9239
IS - 4
ER -
ID: 371912433