Comparative study of 99mTc-ECD and 99mTc-HMPAO for peri-ictal SPECT: qualitative and quantitative analysis

O’Brien, Terence J.; Brinkmann, Benjamin H.; Mullan, Brian P.; So, Elson L.; Hauser, Mary F.; O’Connor, Michael K.; Hung, Joseph C.; Jack, Clifford R.

doi:10.1136/jnnp.66.3.331

Cited by 55 publications

(38 citation statements)

References 32 publications

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“…99m Tc-HMPAO must be constituted immediately before injection, and this delay results in more postictal injections than would occur with use of 99m Tc-ECD. 17 The conventional method of visually comparing ictal with interictal SPECT images has been reported to yield an abnormal focus in as many as 90% of patients with TLE, 18 whereas the rate of STATISCOM detection (84%) and SISCOM detection (66%) of an abnormal focus in our study are lower. However, many conventional visual comparison studies were not blinded to the results of all other diagnostic information, and the reference for localization was scalp EEG findings.…”

Section: Discussioncontrasting

confidence: 47%

Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery

et al. 2010

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Objective: Although subtraction ictal SPECT coregistered to MRI (SISCOM) is clinically useful in epilepsy surgery evaluation, it does not determine whether the ictal-interictal subtraction difference is statistically different from the expected random variation between 2 SPECT studies. We developed a statistical parametric mapping and MRI voxel-based method of analyzing ictalinterictal SPECT difference data (statistical ictal SPECT coregistered to MRI [STATISCOM]) and compared it with SISCOM. Methods:Two serial SPECT studies were performed in 11 healthy volunteers without epilepsy (control subjects) to measure random variation between serial studies from individuals. STATISCOM and SISCOM images from 87 consecutive patients who had ictal SPECT studies and subsequent temporal lobectomy were assessed by reviewers blinded to clinical data and outcome. Results:Interobserver agreement between blinded reviewers was higher for STATISCOM images than for SISCOM images ( ϭ 0.81 vs ϭ 0.36). STATISCOM identified a hyperperfusion focus in 84% of patients, SISCOM in 66% (p Ͻ 0.05). STATISCOM correctly localized the temporal lobe epilepsy (TLE) subtypes (mesial vs lateral neocortical) in 68% of patients compared with 24% by SISCOM (p ϭ 0.02); subgroup analysis of patients without lesions (as determined by MRI) showed superiority of STATISCOM (80% vs 47%; p ϭ 0.04). Moreover, the probability of seizure-free outcome was higher when STATISCOM correctly localized the TLE subtype than when it was indeterminate (81% vs 53%; p ϭ 0.03). Conclusion:Statistical ictal SPECT coregistered to MRI (STATISCOM) was superior to subtraction ictal SPECT coregistered to MRI for seizure localization before temporal lobe epilepsy (TLE) surgery. STATISCOM localization to the correct TLE subtype was prognostically important for postsurgical seizure freedom. Neurology ® 2010;74:70 -76 GLOSSARY CI ϭ confidence interval; ECD ϭ ethyl cysteinate dimer; HMPAO ϭ hexamethyl propylene-amine-oxime; SISCOM ϭ subtraction ictal SPECT coregistered to MRI; SPM ϭ statistical parametric mapping; STATISCOM ϭ statistical ictal SPECT coregistered to MRI; TLE ϭ temporal lobe epilepsy.Early methods of ictal SPECT interpretation relied on a visual comparison of ictal and interictal SPECT images to detect focal hyperperfusion changes (these represented potential sites of ictal hyperperfusion).1 SPECT imaging subsequently was improved by subtraction ictal SPECT with coregistration on MRI (SISCOM).2-5 With SISCOM, ictal SPECT data are subtracted from interictal SPECT data, 6,7 and the "difference image," which shows the focus of altered perfusion, is coregistered with the patient's MRI for anatomic correlation. A recent study that compared several functional imaging modalities showed that positive SISCOM has the greatest association with seizure-free outcome after focal epilepsy surgery. 8Despite the validation of its clinical usefulness, SISCOM detection of abnormal perfusion is based a priori on a defined threshold of perfusion changes, and it does not account for the...

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Section: Discussioncontrasting

confidence: 47%

Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery

et al. 2010

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“…T-contrasts were defined, and results displayed with a significance threshold of P < 0.001 (not corrected for multiple comparisons), and a cluster-level threshold of 125 contiguous voxels (1 cm 3 ) was used (McNally et al, 2005). Prior studies have shown some differences in the uptake patterns of Tc-99m ECD, Tc-99m HMPAO, and other tracers (O'Brien et al, 1999;Inoue et al, 2003). To assess differences in observed asymmetry between different SPECT tracers, we obtained 14 sets of paired resting HMPAO SPECT images of normal volunteers from the Yale University Epilepsy Research Group (http://spect.yale.…”

Section: Statistical Parametric Mappingmentioning

confidence: 99%

Statistical Parametric Mapping Demonstrates Asymmetric Uptake with Tc-99m ECD and Tc-99m HMPAO SPECT in Normal Brain

Brinkmann

Jones

Stead

et al. 2011

J Cereb Blood Flow Metab

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Tc-99m ethyl cysteinate diethylester (ECD) and Tc-99m hexamethyl propylene amine oxime (HMPAO) are commonly used for single-photon emission computed tomography (SPECT) studies of a variety of neurologic disorders. Although these tracers have been very helpful in diagnosing and guiding treatment of neurologic disease, data describing the distribution and laterality of these tracers in normal resting brain are limited. Advances in quantitative functional imaging have demonstrated the value of using resting studies from control populations as a baseline to account for physiologic fluctuations in cerebral perfusion. Here, we report results from 30 resting Tc-99m ECD SPECT scans and 14 resting Tc-99m HMPAO scans of normal volunteers with no history of neurologic disease. Scans were analyzed with regions of interest and with statistical parametric mapping, with comparisons performed laterally (left vs. right), as well as for age, gender, and handedness. The results show regions of significant asymmetry in the normal controls affecting widespread areas in the cerebral hemispheres, but most marked in superior parietotemporal region and frontal lobes. The results have important implications for the use of normal control SPECT images in the evaluation of patients with neurologic disease.

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“…99m Tc-Bicisate was the preferred brain imaging agent at our institution because the early formulation of 99m Tc-exametazime limits stability after reconstitution. Additionally, activity was higher if the agent could be reconstituted with a cold kit (3). The use of 99m Tc-exametazime to evaluate patients with epilepsy has lower localization rates, poorer interobserver agreement, and less concordance with electroencephalogram findings, MRI findings, and discharge diagnosis than does the use of 99m Tc-bicisate.…”

Section: Discussionmentioning

confidence: 99%

“…This study was presented at the Society of Nuclear Medicine Annual Meeting, San Diego, California, June [3][4][5][6][7] 2006.…”

Section: Acknowledgmentsmentioning

confidence: 99%

Trends of Radiopharmaceutical Use at Mayo Clinic Rochester

Mroczenski

Berent

Hall

et al. 2007

Journal of Nuclear Medicine Technology

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The field of radiology is continuously changing. The purpose of this study was to identify the effect of technologic advances on nuclear medicine during the past 15 y. Methods: The number of radiopharmaceutical doses dispensed at Mayo Clinic (Rochester, Minnesota) from 1990 through 2004 was tracked. The number of doses was equivalent to the number of scans performed. Results: Since 1990, the number of bone scans decreased by 38%. Brain scans using The field of radiology is continuously changing.Knowledge of these changes and why they occurred will allow us to predict future use trends in nuclear medicine. Physicians order specific tests on the basis of the patient's symptoms and probable diagnosis. As technology advances, new tests are compared with previously established methods to determine the best method of diagnosing certain diseases. If the new test is superior, it may replace the previously used examination method. The purpose of this study was to identify changes in nuclear medicine use at Mayo Clinic (Rochester, Minnesota) over the past 15 y and determine why those changes occurred. MATERIALS AND METHODSThe number of radiopharmaceutical doses dispensed at Mayo Clinic Rochester from 1990 through 2004 was tracked using Nuclear Pharmacy Manager software (Bristol-Myers Squibb). This program tracks all doses dispensed from our laboratory, and the values correspond to the number of studies performed using a specific radiopharmaceutical agent. We determined the total number of scans performed each year and the number of scans performed using specific radiopharmaceuticals. Data for PET tumor imaging were based on the number of clinical scans performed each year, not the number of doses dispensed.We measured the number of bone scans that used 99m Tcmedronate and 99m Tc-oxidronate; brain scans that used 99m Tcexametazime and 99m Tc-bicisate; myocardial perfusion scans that used 201 Tl-thallous chloride and 99m Tc-sestamibi; lung ventilation and perfusion scans that used 133 Xe gas and 99m Tc-macroaggregated albumin; kidney scans that used 99m Tc-mertiatide, 99m Tcsuccimer (dimercaptosuccinic acid [DMSA]), 99m Tc-pentetate (diethylenetriamine penta-acetic acid [DTPA]), and 131 I-hippuran; and tumor scans that used 111 In-pentetreotide and 18 F-FDG. These radiopharmaceuticals were chosen because of the prevalence of their use and because we suspected that their use patterns changed over time. Only radiopharmaceutical doses dispensed for clinical patients were included in our study (radiopharmaceuticals used in research studies were excluded). As new radiopharmaceuticals were developed, use of other pharmaceuticals typically diminished; older radiopharmaceuticals often were replaced completely by the new agents for imaging of a specific organ system. For example, 99m Tc-DTPA was replaced by 99m Tc-mercaptoacetyltriglycine in renal scintigraphy. When more than one type of radiopharmaceutical was used for a particular imaging modality, values were compared and summed to determine the total number of scans of that orga...

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Comparative study of 99mTc-ECD and 99mTc-HMPAO for peri-ictal SPECT: qualitative and quantitative analysis

Cited by 55 publications

References 32 publications

Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery

Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery

Statistical Parametric Mapping Demonstrates Asymmetric Uptake with Tc-99m ECD and Tc-99m HMPAO SPECT in Normal Brain

Trends of Radiopharmaceutical Use at Mayo Clinic Rochester

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