The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
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The Performance of Ictal Brain SPECT Localizing for Epileptogenic Zone in Neocortical Epilepsy

신피질성 간질에서 발작기 $^{99m}Tc$-HMPAO 뇌혈류 SPECT의 간질병소 국소화 성능

  • Kim, Eun-Sil (Departments of Nuclear Medicine, Seoul National University Hospital) ;
  • Lee, Dong-Soo (Departments of Nuclear Medicine, Seoul National University Hospital) ;
  • Hyun, In-Young (Departments of Nuclear Medicine, Seoul National University Hospital) ;
  • Chung, June-Key (Departments of Nuclear Medicine, Seoul National University Hospital) ;
  • Lee, Myung-Chul (Departments of Nuclear Medicine, Seoul National University Hospital) ;
  • Koh, Chang-Soon (Departments of Nuclear Medicine, Seoul National University Hospital) ;
  • Lee, Sang-Kun (Departments of Neurology, Seoul National University Hospital) ;
  • Chang, Kee-Hyun (Departments of Diagnostic Radiology, Seoul National University Hospital)
  • 김은실 (서울대학교병원 핵의학과) ;
  • 이동수 (서울대학교병원 핵의학과) ;
  • 현인영 (서울대학교병원 핵의학과) ;
  • 정준기 (서울대학교병원 핵의학과) ;
  • 이명철 (서울대학교병원 핵의학과) ;
  • 고창순 (서울대학교병원 핵의학과) ;
  • 이상건 (서울대학교병원 신경과) ;
  • 장기현 (서울대학교병원 진단방사선과)
  • Published : 1995.12.25
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Abstract

The epileptogenic zones should be localized precisely before surgical resection of these zones in intractable epilepsy. The localization is more difficult in patients with neocortical epilepsy than in patients with temporal lobe epilepsy. This study aimed at evaluation of the usefulness of ictal brain perfusion SPECT for the localization of epileptogenic zones in neocortical epilepsy. We compared the performance of ictal SPECT with MRI referring to ictal scalp electroencephalography(sEEG). Ictal $^{99m}Tc$-HMPAO SPECT were done in twenty-one patients. Ictal EEG were also obtained during video monitoring. MRI were reviewd. According to the ictal sEEG and semiology, 8 patients were frontal lobe epilepsy, 7 patients were lateral temporal lobe epilepsy, 2 patients were parietal lobe epilepsy, and 4 patients were occipital lobe epilepsy. Ictal SPECT showed hyperperfusion in 14 patients(67%) in the zones which were suspected to be epileptogenic according to ictal EEG and semiology. MRI found morphologic abnormalities in 9 patients(43%). Among the 12 patients, in whom no epileptogenic zones were revealed by MRI, ictal SPECT found zones of hyperperfusion concordant with ictal SEEG in 9 patients(75%). However, no zones of hyperperfusion were found in 4 among 9 patients who were found to have cerebromalacia, abnormal calcification and migration anomaly in MRI. We thought that ictal SPECT was useful for localization of epileptogenic zones in neocortical epilepsy and especially in patients with negative findings in MRI.

신피질성 간질에서 발작기 뇌혈류 SPECT는 발작기 표면뇌파도를 기준으로 국소화했을때 67%의 국소화성능을 보였다. MR에 병변을 찾지 못한 57%(12예)에서도 혈류증가부위를 9예에서 찾을 수 있었다. 그리드삽입을 위한 수술부위 결정에 도움을 받은 경우가 MR에 나타난 병변유무와 상관없었다. 반면 MR에서는 43%에서 병변을 찾았다. 일부예에서 혈류증가부위의 확산을 관찰할 수 있었고 드물게 확산이 반대쪽 반구를 포함하는 경우가 있으나 대부분 국소화에 도움이 되는 자료로 사용할 수 있었다. 수술후 간질발작이 가라앉는 것을 확인한 결과를 준거로 성능비교 연구를 확장하여야 한다고 생각하였다.

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