Combined study of99mTc-HMPAO SPECT and computerized electroencephalographic topography (CET) in patients with medically refractory complex partial epilepsy
Tóm tắt
For successful surgery for drug-resistant partial epilepsy the site of the seizure focus needs to be known exactly. The purpose of this study was to compare the evaluation of the regional cerebral blood flow (rCBF) (localization and degree of disturbances) by99mTc-hexamethylpropylene-amineoxime (HMPAO) single photon emission computed tomography (SPECT) with computerized electroencephalographic topography (CET) and transmission computed X-ray tomography (CT) in partial epilepsy. The study included 20 patients with medically refractory complex partial seizures. Of the 20 patients included, 15 were studied interictally, four ictally and one in both states, interictally and ictally.
99mTc-HMPAO SPECT detected rCBF changes in 95% of the patients. Interictal studies demonstrated focal areas of hypoperfusion in 93% of the patients. Ictal studies demonstrated an area of hyperperfusion in all patients. Blood flow disturbances in deeper structures of the brain, such as basal ganglia, could be detected. The areas with abnormal99mTc-HMPAO uptake were concordant, in localization, with CET in 85% of the patients. Abnormal data with CT scans were found in only 45% of the patients. Focal lesions were found in 20% of the patients by CT scans.
99mTc-HMPAO SPECT combined with CET may be a useful screening procedure prior to referral for invasive diagnostic procedures in future management of patients with medically refractory complex partial seizures.
Tài liệu tham khảo
Isselt JW, Huffelen AC, Bentum AME, Rijk PP. Localization of epileptogenic foci with123I-iomazenil SPECT.In Nuclear medicine —the state of the art of nuclear medicine in Europe, Schmidt HAE, Van derSchoot JB (eds.), Stuttgart-New York, Schattauer, pp. 219–221, 1991.
Costa DC, Ell PJ. rCBF SPET imaging in disease: epilepsy. In Brain blood flow in neurology and psychiatry, London, Churchill Livingstone, pp. 72–76, 1991.
Holman BL, Devous MD. Functional brain SPECT: the emergence of a powerful clinical method.J Nucl Med 33: 1888–1904, 1992.
Alavi A, Hirsh LJ. Studies of central nervous system disorders with single photon emission computed tomography and positron emission tomography: evolution over the past 2 decades.Sem Nucl Med 21: 58–81, 1991.
Gzesh D, Goldstein S Complex partial epilepsy: the role of neuroimaging in localizing a seizure focus prior surgical intervention.J Nucl Med 31: 1839–1843, 1990.
Harner R, Jackel R, Mawhinney-Hee M, Sussman N. Computed EEG topography in epilepsy.Revue Neurologique 143: 457–461, 1987.
Bottger IG, Sclarke HP, Husstedt IW. Cerebral blood flow by99mTc-HMPAO and SPECT in vascular headache syndromes. In Nuclear medicine—quantitative analysis in imaging and function, Schmidt HAE, Chambron J (eds.), Stuttgart-New York, Schattauer, pp. 364–366, 1990.
Royal HD, Hill TC, Holman BL. Clinical brain imaging with isopropyliodoamphetamine and SPECT.Sem Nucl Med 15: 357–376, 1985.
Bartenstein P, Ludolph A, Schober O, Lottes G, Scheidhauer K, Sciuk J, et al. Benzodiazepine receptors and cerebral blood flow in partial epilepsy.Eur J Nucl Med 18: 11–18, 1991.
Duffy FH, Burchfiel JL, Lombroso CT. Brain electrical activity mapping (BEAM): a method for extending the clinical utility of EEG and evoked potential data.Ann Neurol 5: 309–321, 1989.
Swartz RB, Carvalho PA, Alexander E, Loeffler JS, Folkerth R, Holman BL. Radiation necrosis vs. high-grade recurrent glioma: differentiation by using dual-isotope SPECT with201Tl and99mTc-HMPAO.AJNR 12: 1187–1192, 1992.