Brain SPECT in mesial temporal lobe epilepsy: comparison between visual analysis and SPM

Abstract

Objective: To compare the accuracy of SPM and visual analysis of brain SPECT in patients with mesial temporal lobe epilepsy (MTLE). Method: Interictal and ictal SPECTs of 22 patients with MTLE were performed. Visual analysis were performed in interictal (VISUAL(inter)) and ictal (VISUAL(ictal/inter)) studies. SPM analysis consisted of comparing interictal (SPM(inter)) and ictal SPECTs (SPM(ictal)) of each patient to control group and by comparing perfusion of temporal lobes in ictal and interictal studies among themselves (SPM(ictal/inter)). Results: For detection of the epileptogenic focus, the sensitivities were as follows: VISUAL(inter)=68%; VISUAL(ictal/inter)=100%; SPM(inter)=45%; SPM(ictal)=64% and SPM(ictal/inter)=77%. SPM was able to detect more areas of hyperperfusion and hypoperfusion. Conclusion: SPM did not improve the sensitivity to detect epileptogenic focus. However, SPM detected different regions of hypoperfusion and hyperperfusion and is therefore a helpful tool for better understand pathophysiology of seizures in MTLE. Key words: brain perfusion, SPECT, SPM, seizures, epilepsy.SpeCT cerebral na epilepsia de lobo temporal mesial: comparação entre análise visual e SpM ReSuMO Objetivo: Comparar a acurácia do SPM com a análise visual na detecção do foco epileptogênico e alterações perfusionais à distância no SPECT cerebral. Método: Foram realizados os SPECTs ictal e interictal de 22 pacientes com epilepsia de lobo temporal mesial (ELTM). A análise visual foi realizada nos estudos interictal (VISUAL(inter)) e ictal (VISUAL(ictal/inter)). Na análise com SPM foi comparado o estudo interictal (SPM(inter)) e ictal (SPM(ictal)) de cada paciente com o grupo controle e comparou-se a perfusão dos lobos temporais entre os estudos ictal e interictal (SPM(ictal/inter)). Resultados: Para a detecção do foco epileptogênico, as sensibilidades foram as seguintes: VISUAL(inter)=68%; VISUAL(ictal/inter)=100%; SPM(inter)=45%; SPM(ictal)=64% and SPM(ictal/inter)=77%. O SPM foi capaz de detectar mais áreas de hiperperfusão e hipoperfusão. Conclusão: O SPM não aumentou a sensibilidade na detecção do foco epileptogênico. Entretanto, o SPM detectou diferentes regiões de hipoperfusão e hiperperfusão e portanto, ele pode ser uma ferramenta de ajuda para se melhor entender a patofisiologia das crises na ELTM.

Application of dynamic susceptibility contrast-enhanced perfusion in temporal lobe epilepsy

“…For TLE lateralization, SPECT and PET are currently the principle imaging modalities used, and not DSC perfusion MRI. Amorim et al (21) found that the sensitivity of SPECT used for ictal TLE surpassed that of interictal TLE, where the sensitivity was low (32.3 -55.3%). In the present study, the results using DSC perfusion MRI showed that the AIs from nine TLE interictal patients were significantly higher than those of the healthy volunteers, and the ipsilateral side could be determined accurately.…”

Evaluating the Role of Single-Photon Emission Computed Tomography in the Assessment of Neurotologic Complaints

“…SPECT is a well-established imaging modality for patients with epilepsy, 2,4 cerebrovascular disease, 2,5 neoplastic processes, 2,6 and dementia. 2,7–9 A few studies have also examined its use in head trauma 10–13 and traumatic anosmia.…”

Functional electrical stimulation improves brain perfusion in cranial trauma patients

“…SPM is an automatic statistical analysis tool for neuroimaging. It has been used in brain SPECT in some pathologies and our group has already applied this tool in epilepsy 7,8 . The purpose of this study was to demonstrate brain perfusion changes due to neuronal activation after functional electrical stimulation in patients with brain stroke and traumatic lesions.…”