ArticleEJNMMI research2024
Brain perfusion SPECT in the presurgical evaluation of epilepsy: is additional ictal SPECT required in case of high-confidence lateralization of the seizure onset zone by interictal SPECT and vice versa?
Article in EJNMMI research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Multimodal Imaging in Epilepsy Surgery for Personalized Neurosurgical Planning.Journal of personalized medicine · 2025Review
- Epilepsy Surgery in Kazakhstan: Outcomes and the Role of Advanced Imaging.Journal of clinical medicine · 2025Article
- The Status of Neuroimaging with SPECT and PET in Germany: Results from the 1st Survey on Nuclear Neuroimaging in Germany in 2023.Nuklearmedizin. Nuclear medicine · 2025Article
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11 authors.
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Abstract
backgroundIctal brain perfusion SPECT provides higher sensitivity for the identification of the epileptic seizure onset zone (SOZ) than interictal SPECT. However, ictal SPECT is demanding due to the unpredictable waiting period for the next seizure to allow for ictal tracer injection. Thus, starting with an interictal scan and skipping the ictal scan if the interictal scan provides a SOZ candidate with high confidence could be an efficient approach. The current study estimated the rate of high-confidence SOZ candidates and the false lateralization rate among them for interictal and ictal SPECT.
methods177 patients (48% females, median age 38y, interquartile range 27-48y) with ictal and interictal SPECT acquired with
resultsThe proportion of "lateralizing with high confidence" cases was 4.5/31.6/38.4% in the "interictal only"/"ictal only"/"full" setting. One (12.5%) of the 8 cases that were "lateralizing with high confidence" in the "interictal only" setting lateralized to the wrong hemisphere. Among the 56 cases that were "lateralizing with high confidence" in the "ictal only" setting, 54 (96.4%) were also lateralizing in the "full" setting, all to the same hemisphere.
conclusionsStarting brain perfusion SPECT in the presurgical evaluation of epilepsy with an interictal scan to skip the ictal scan in case of a high-confidence interictal SOZ candidate is not a useful approach. In contrast, starting with an ictal scan to skip the interictal scan in case of a high-confidence ictal SOZ candidate can be recommended.
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