원저 : 발작기와 발작간기 뇌 관류 SPECT 감산영상을 이용한 간질원인 병소 진단 ( Diagnosis of Ictal Hyperperfusion Using Subtraction Image of Ictal and Interictal Brain Perfusion SPECT ) () |
Author |
이동수(Dong Soo Lee),서종모(Jong Mo Seo),이재성(Jae Sung Lee),이상건(Sang Kun Lee),김현집(Hyun Jip Kim),정준기(June Key Chung),이명철(Myung Chul Lee),고창순(Chang Soon Koh), |
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Affiliation |
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Abstract |
A robust algorithm to disclose and display the
difference of ictal and interictal perfusion may
facilitate the detection of ictal hyperfusion foci.
Diagnostic performance of localizing epileptogenic
zones with subtracted SPECT images was compared with
the visual diagnosis using ictal and interictal SPECT,
MR, or PET. Ictal and interictal Tc-99m-HMPAO cerebral
perfusion SPECT images of 48 patients(pts) were
processed to get parametric subtracted images.
Epileptogenic foci of all pts were diagnosed by seizure
free state after resection of epileptogenic zones. In
subtraction SPECT, we used normalized difference ratio
of pixel counts((ictal-interictal)/interictal¡¿100%)
after correcting coordinates of ictal and interictal
SPECT in semi-automatized 3-dimensional fashion. We
found epileptogenic zones in subtraction SPECT and
compared the performance with visual diagnosis of ictal
and interictal SPECT, MR and PET using post-surgical
diagnosis as gold standard. The concordance of
subtraction SPECT and ictal-interictal SPECT was
moderately good(kappa=0.49). The sensitivity of ictal-
interictal SPECT was 73% and that of subtraction SPECT
58%. Positive predictive value of ictal-interictal
SPECT was 76% and that of subtraction SPECT was 64%.
There was no statistical difference between sensitivity
or positive predictive values of subtraction SPECT and
ictal-interictal SPECT, MR or PET. Such was also the
case when we divided patients into temporal lobe
epilepsy and neocortical epilepsy. We conclude that
subtraction SPECT we produced had equivalent diagnostic
performance compared with ictal-interictal SPECT in
localizing epileptogenic zones. Additional value of
these subtraction SPECT in clinical interpretation of
ictal and interictal SPECT should be further evaluated. |
Keyword |
Epilepsy, Image registration, Subtraction, Ictal SPECT, Epileptogenic zones |
Full text Article |
28502115.pdf
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