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

T. J. O'Brien, Benjamin Brinkmann, B. P. Mullan, E. L. So, M. F. Hauser, M. K. O'Connor, J. Hung, Clifford R Jr. Jack

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objectives - Most studies that clinically validated peri-ictal SPECT in intractable partial epilepsy had used technetium-99m-hexamethylpropylene amine oxime (99mTC-HMPAO or 99mTc-exametazime) as the radiopharmaceutical. Because of some theoretical advantages, technetium-99m-ethyl cysteinate diethylester (99mTc-ECD or 99mTc-bicisate) is increasingly being used instead. This study compares unstabilised 99mTc-HMPAO and 99mTc-ECD in the performance of peri-ictal SPECT in partial epilepsy. Methods - The injection timing and localisation rates in 49 consecutive patients with partial epilepsy who had peri-ictal injections with unstabilised 99mTc-HMPAO were compared with 49 consecutive patients who had peri-ictal injections with 99mTc-ECD. Quantitative cortical/subcortical and cortical/extracerebral uptake ratios were also compared. Subtraction SPECT coregistered to MRI (SISCOM) was performed in patients whose interictal SPECTS were available. Results - In the 99mTc-ECD patients, the latency from seizure commencement to injection was shorter (median 34 v 80 seconds, p < 0.0001) and there was a lower rate of postictal injections (16.3% v 57.1%, p < 0.0001). The cortical/extracerebral and cortical/subcortical uptake ratios were greater in the 99mTc-ECD images (median 5.0 v 3.6, and 2.5 v 2.2 respectively; both p < 0.005), but the relative peri-ictal increase in uptake in the cortical focus did not differ significantly (median 37.0% v 37.0%; p > 0.05). Blinded review of the SISCOM images were localising in a higher proportion of the 99mTc-ECD patients (40/45 (88.9%) v 25/37 (67.6%), p < 0.05), and had a better concordance with EEG, MRI, and with the discharge diagnosis. Conclusion - 99mTc-ECD compares favourably with unstabilised 99mTc-HMPAO as a radiopharmaceutical for peri-ictal SPECT studies. Its use results in earlier injections and less frequent postictal injections than unstabilised 99mTc-HMPAO, thereby enhancing the sensitivity and the specificity of peri-ictal SPECT for the localisation of intractable partial epilepsy.

Original languageEnglish (US)
Pages (from-to)331-339
Number of pages9
JournalJournal of Neurology Neurosurgery and Psychiatry
Volume66
Issue number3
StatePublished - 1999

Fingerprint

Technetium Tc 99m Exametazime
Single-Photon Emission-Computed Tomography
Partial Epilepsy
Stroke
Injections
Radiopharmaceuticals
Technetium
Oximes
Amines
technetium Tc 99m bicisate
Electroencephalography
Seizures
Sensitivity and Specificity

Keywords

  • Tc-ECD
  • Tc-HMPAO
  • Ictal SPECT

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Neuroscience(all)
  • Psychiatry and Mental health

Cite this

Comparative study of 99mTc-ECD and 99mTc-HMPAO for peri-ictal SPECT : Qualitative and quantitative analysis. / O'Brien, T. J.; Brinkmann, Benjamin; Mullan, B. P.; So, E. L.; Hauser, M. F.; O'Connor, M. K.; Hung, J.; Jack, Clifford R Jr.

In: Journal of Neurology Neurosurgery and Psychiatry, Vol. 66, No. 3, 1999, p. 331-339.

Research output: Contribution to journalArticle

@article{c325f63fcb854c94aacda110a00d7d36,
title = "Comparative study of 99mTc-ECD and 99mTc-HMPAO for peri-ictal SPECT: Qualitative and quantitative analysis",
abstract = "Objectives - Most studies that clinically validated peri-ictal SPECT in intractable partial epilepsy had used technetium-99m-hexamethylpropylene amine oxime (99mTC-HMPAO or 99mTc-exametazime) as the radiopharmaceutical. Because of some theoretical advantages, technetium-99m-ethyl cysteinate diethylester (99mTc-ECD or 99mTc-bicisate) is increasingly being used instead. This study compares unstabilised 99mTc-HMPAO and 99mTc-ECD in the performance of peri-ictal SPECT in partial epilepsy. Methods - The injection timing and localisation rates in 49 consecutive patients with partial epilepsy who had peri-ictal injections with unstabilised 99mTc-HMPAO were compared with 49 consecutive patients who had peri-ictal injections with 99mTc-ECD. Quantitative cortical/subcortical and cortical/extracerebral uptake ratios were also compared. Subtraction SPECT coregistered to MRI (SISCOM) was performed in patients whose interictal SPECTS were available. Results - In the 99mTc-ECD patients, the latency from seizure commencement to injection was shorter (median 34 v 80 seconds, p < 0.0001) and there was a lower rate of postictal injections (16.3{\%} v 57.1{\%}, p < 0.0001). The cortical/extracerebral and cortical/subcortical uptake ratios were greater in the 99mTc-ECD images (median 5.0 v 3.6, and 2.5 v 2.2 respectively; both p < 0.005), but the relative peri-ictal increase in uptake in the cortical focus did not differ significantly (median 37.0{\%} v 37.0{\%}; p > 0.05). Blinded review of the SISCOM images were localising in a higher proportion of the 99mTc-ECD patients (40/45 (88.9{\%}) v 25/37 (67.6{\%}), p < 0.05), and had a better concordance with EEG, MRI, and with the discharge diagnosis. Conclusion - 99mTc-ECD compares favourably with unstabilised 99mTc-HMPAO as a radiopharmaceutical for peri-ictal SPECT studies. Its use results in earlier injections and less frequent postictal injections than unstabilised 99mTc-HMPAO, thereby enhancing the sensitivity and the specificity of peri-ictal SPECT for the localisation of intractable partial epilepsy.",
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T1 - Comparative study of 99mTc-ECD and 99mTc-HMPAO for peri-ictal SPECT

T2 - Qualitative and quantitative analysis

AU - O'Brien, T. J.

AU - Brinkmann, Benjamin

AU - Mullan, B. P.

AU - So, E. L.

AU - Hauser, M. F.

AU - O'Connor, M. K.

AU - Hung, J.

AU - Jack, Clifford R Jr.

PY - 1999

Y1 - 1999

N2 - Objectives - Most studies that clinically validated peri-ictal SPECT in intractable partial epilepsy had used technetium-99m-hexamethylpropylene amine oxime (99mTC-HMPAO or 99mTc-exametazime) as the radiopharmaceutical. Because of some theoretical advantages, technetium-99m-ethyl cysteinate diethylester (99mTc-ECD or 99mTc-bicisate) is increasingly being used instead. This study compares unstabilised 99mTc-HMPAO and 99mTc-ECD in the performance of peri-ictal SPECT in partial epilepsy. Methods - The injection timing and localisation rates in 49 consecutive patients with partial epilepsy who had peri-ictal injections with unstabilised 99mTc-HMPAO were compared with 49 consecutive patients who had peri-ictal injections with 99mTc-ECD. Quantitative cortical/subcortical and cortical/extracerebral uptake ratios were also compared. Subtraction SPECT coregistered to MRI (SISCOM) was performed in patients whose interictal SPECTS were available. Results - In the 99mTc-ECD patients, the latency from seizure commencement to injection was shorter (median 34 v 80 seconds, p < 0.0001) and there was a lower rate of postictal injections (16.3% v 57.1%, p < 0.0001). The cortical/extracerebral and cortical/subcortical uptake ratios were greater in the 99mTc-ECD images (median 5.0 v 3.6, and 2.5 v 2.2 respectively; both p < 0.005), but the relative peri-ictal increase in uptake in the cortical focus did not differ significantly (median 37.0% v 37.0%; p > 0.05). Blinded review of the SISCOM images were localising in a higher proportion of the 99mTc-ECD patients (40/45 (88.9%) v 25/37 (67.6%), p < 0.05), and had a better concordance with EEG, MRI, and with the discharge diagnosis. Conclusion - 99mTc-ECD compares favourably with unstabilised 99mTc-HMPAO as a radiopharmaceutical for peri-ictal SPECT studies. Its use results in earlier injections and less frequent postictal injections than unstabilised 99mTc-HMPAO, thereby enhancing the sensitivity and the specificity of peri-ictal SPECT for the localisation of intractable partial epilepsy.

AB - Objectives - Most studies that clinically validated peri-ictal SPECT in intractable partial epilepsy had used technetium-99m-hexamethylpropylene amine oxime (99mTC-HMPAO or 99mTc-exametazime) as the radiopharmaceutical. Because of some theoretical advantages, technetium-99m-ethyl cysteinate diethylester (99mTc-ECD or 99mTc-bicisate) is increasingly being used instead. This study compares unstabilised 99mTc-HMPAO and 99mTc-ECD in the performance of peri-ictal SPECT in partial epilepsy. Methods - The injection timing and localisation rates in 49 consecutive patients with partial epilepsy who had peri-ictal injections with unstabilised 99mTc-HMPAO were compared with 49 consecutive patients who had peri-ictal injections with 99mTc-ECD. Quantitative cortical/subcortical and cortical/extracerebral uptake ratios were also compared. Subtraction SPECT coregistered to MRI (SISCOM) was performed in patients whose interictal SPECTS were available. Results - In the 99mTc-ECD patients, the latency from seizure commencement to injection was shorter (median 34 v 80 seconds, p < 0.0001) and there was a lower rate of postictal injections (16.3% v 57.1%, p < 0.0001). The cortical/extracerebral and cortical/subcortical uptake ratios were greater in the 99mTc-ECD images (median 5.0 v 3.6, and 2.5 v 2.2 respectively; both p < 0.005), but the relative peri-ictal increase in uptake in the cortical focus did not differ significantly (median 37.0% v 37.0%; p > 0.05). Blinded review of the SISCOM images were localising in a higher proportion of the 99mTc-ECD patients (40/45 (88.9%) v 25/37 (67.6%), p < 0.05), and had a better concordance with EEG, MRI, and with the discharge diagnosis. Conclusion - 99mTc-ECD compares favourably with unstabilised 99mTc-HMPAO as a radiopharmaceutical for peri-ictal SPECT studies. Its use results in earlier injections and less frequent postictal injections than unstabilised 99mTc-HMPAO, thereby enhancing the sensitivity and the specificity of peri-ictal SPECT for the localisation of intractable partial epilepsy.

KW - Tc-ECD

KW - Tc-HMPAO

KW - Ictal SPECT

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