Abstract
Introduction: Subtraction of ictal-interictal SPECT co-registered to MRI (SISCOM) is a quantification tool that can improve the sensitivity and specificity of the epileptogenic zone (EZ) localization. Commercially available image analysis software packages for SISCOM are costly, and Statistical Parametric Mapping (SPM) could be an alternative free software for the definition of the EZ. There are only a few studies that compare SISCOM using SPM (SISCOM-SPM) with visual analysis.Aim: To compare SISCOM-SPM vs. visual analysis for localization of the EZ in patients with pharmacoresistant focal epilepsies.Materials and methods: We evaluated all our patients with focal epilepsies that underwent ictal and interictal SPECT. We defined the reference standard to locate the EZ by pathology and follow-up (in patients submitted to surgery), or seizure semiology, serial EEG, long-term video-EEG, 18F-FDG PET/CT, and MRI (in patients who were not operated). We compared the location of the EZ by visual analysis of SPECT images and by SISCOM-SPM to the reference standard and classified as concordant, discordant, or partially concordant.Results: We included 23 patients. Visual analysis was concordant with the EZ reference standard in only 13 patients (56.5%), while SISCOM-SPM was concordant in 18 cases (78.3%), providing a 21.8% increase in the location of EZ. However, this difference was not significant due to the small sample size (p = 0.0856).Conclusion: Our preliminary results demonstrate that, in clinical practice, SISCOM-SPM has the potential to add information that might help localize the EZ compared to visual analysis. SISCOM-SPM has a lower cost than other commercially available SISCOM software packages, which is an advantage for developing countries. Studies with more patients are necessary to confirm our findings.
Highlights
Subtraction of ictal-interictal SPECT co-registered to Magnetic resonance imaging (MRI) (SISCOM) is a quantification tool that can improve the sensitivity and specificity of the epileptogenic zone (EZ) localization
We reviewed their medical data to determine seizure semiology, seizure frequency, serial electroencephalograph (EEG) recordings, long-term video-EEG monitoring, brain MRI, and positron emission tomography fused to computed tomography (PET/CT) with fluorodeoxyglucose labeled with fluorine-18 (18F-FDG)
Subtraction of ictal-interictal SPECT co-registered to MRI (SISCOM)-Statistical Parametric Mapping (SPM) was concordant with the reference standard in 18 cases (78.3%), while visual analysis was concordant in only 13 cases (56.5%)
Summary
Subtraction of ictal-interictal SPECT co-registered to MRI (SISCOM) is a quantification tool that can improve the sensitivity and specificity of the epileptogenic zone (EZ) localization. Epilepsy is a brain disorder characterized by an ongoing tendency for recurrent epileptic seizures [1]. It is widely distributed, affecting between 0.5 and 1% of the world population [2]. Magnetic resonance imaging (MRI) is the most used imaging method to localize the epileptogenic lesion; it cannot determine the EZ in 20–30% of temporal lobe epilepsy and in 20–40% of extratemporal epilepsy [8]. In this scenario, functional imaging methods play an essential role
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