Statistical SPECT processing in MRI-negative epilepsy surgery

Vlastimil Sulc, Samantha Stykel, Dennis P. Hanson, Benjamin Brinkmann, David T Jones, David R. Holmes III, Richard A. Robb, Matthew L. Senjem, Brian P. Mullan, Robert E. Watson, Daniel Horinek, Gregory D Cascino, Lily Wong-Kisiel, Jeffrey W. Britton, Elson L. So, Gregory Alan Worrell

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective: To evaluate the benefit of statistical SPECT processing over traditional subtraction methods, we compared ictal-interictal SPECT analyzed by statistical parametric mapping (SPM) (ISAS), statistical ictal SPECT coregistered to MRI (STATISCOM), and subtraction ictal- interictal SPECT coregistered with MRI (SISCOM) in patients with MRI-negative focal temporal lobe epilepsy (nTLE) and extratemporal lobe epilepsy (nETLE). Methods: We retrospectively identified 49 consecutive cases of drug-resistant focal epilepsy that had a negative preoperativeMRI and underwent interictal and ictal SPECT prior to resective epilepsy surgery. Interictal and ictal SPECT scans were analyzed using SISCOM, ISAS, and STATISCOM to create hyperperfusion and hypoperfusion maps for each patient. Reviewers blinded to clinical data and the SPECT analysis method marked the site of probable seizure origin and indicated their confidence in the localization. Results: In nTLE and nETLE, the hyperperfusions detected by STATISCOM (71% nTLE, 57% nETLE) and ISAS (67% nTLE, 53% nETLE) were more often colocalized with surgery resection site compared to SISCOM (38% nTLE, 36% nETLE). In nTLE, localization of the hyperperfusion to the region of surgery was associated with an excellent outcome for STATISCOM (p = 0.005) and ISAS (p = 0.027), but not in SISCOM (p = 0.071). This association was not present in nETLE for any method. Conclusion: In an unselected group of patients with normal MRI and focal epilepsy, SPM-based methods of SPECT processing showed better localization of SPECT hyperperfusion to surgical resection site and higher interobserver agreement compared to SISCOM. These results show the benefit of statistical SPECT processing methods and further highlight the challenge of nETLE.

Original languageEnglish (US)
Pages (from-to)932-939
Number of pages8
JournalNeurology
Volume82
Issue number11
DOIs
StatePublished - Mar 18 2014

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Single-Photon Emission-Computed Tomography
Epilepsy
Partial Epilepsy
Stroke
Temporal Lobe Epilepsy
Surgery
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ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

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Statistical SPECT processing in MRI-negative epilepsy surgery. / Sulc, Vlastimil; Stykel, Samantha; Hanson, Dennis P.; Brinkmann, Benjamin; Jones, David T; Holmes III, David R.; Robb, Richard A.; Senjem, Matthew L.; Mullan, Brian P.; Watson, Robert E.; Horinek, Daniel; Cascino, Gregory D; Wong-Kisiel, Lily; Britton, Jeffrey W.; So, Elson L.; Worrell, Gregory Alan.

In: Neurology, Vol. 82, No. 11, 18.03.2014, p. 932-939.

Research output: Contribution to journalArticle

Sulc, V, Stykel, S, Hanson, DP, Brinkmann, B, Jones, DT, Holmes III, DR, Robb, RA, Senjem, ML, Mullan, BP, Watson, RE, Horinek, D, Cascino, GD, Wong-Kisiel, L, Britton, JW, So, EL & Worrell, GA 2014, 'Statistical SPECT processing in MRI-negative epilepsy surgery', Neurology, vol. 82, no. 11, pp. 932-939. https://doi.org/10.1212/WNL.0000000000000209
Sulc, Vlastimil ; Stykel, Samantha ; Hanson, Dennis P. ; Brinkmann, Benjamin ; Jones, David T ; Holmes III, David R. ; Robb, Richard A. ; Senjem, Matthew L. ; Mullan, Brian P. ; Watson, Robert E. ; Horinek, Daniel ; Cascino, Gregory D ; Wong-Kisiel, Lily ; Britton, Jeffrey W. ; So, Elson L. ; Worrell, Gregory Alan. / Statistical SPECT processing in MRI-negative epilepsy surgery. In: Neurology. 2014 ; Vol. 82, No. 11. pp. 932-939.
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abstract = "Objective: To evaluate the benefit of statistical SPECT processing over traditional subtraction methods, we compared ictal-interictal SPECT analyzed by statistical parametric mapping (SPM) (ISAS), statistical ictal SPECT coregistered to MRI (STATISCOM), and subtraction ictal- interictal SPECT coregistered with MRI (SISCOM) in patients with MRI-negative focal temporal lobe epilepsy (nTLE) and extratemporal lobe epilepsy (nETLE). Methods: We retrospectively identified 49 consecutive cases of drug-resistant focal epilepsy that had a negative preoperativeMRI and underwent interictal and ictal SPECT prior to resective epilepsy surgery. Interictal and ictal SPECT scans were analyzed using SISCOM, ISAS, and STATISCOM to create hyperperfusion and hypoperfusion maps for each patient. Reviewers blinded to clinical data and the SPECT analysis method marked the site of probable seizure origin and indicated their confidence in the localization. Results: In nTLE and nETLE, the hyperperfusions detected by STATISCOM (71{\%} nTLE, 57{\%} nETLE) and ISAS (67{\%} nTLE, 53{\%} nETLE) were more often colocalized with surgery resection site compared to SISCOM (38{\%} nTLE, 36{\%} nETLE). In nTLE, localization of the hyperperfusion to the region of surgery was associated with an excellent outcome for STATISCOM (p = 0.005) and ISAS (p = 0.027), but not in SISCOM (p = 0.071). This association was not present in nETLE for any method. Conclusion: In an unselected group of patients with normal MRI and focal epilepsy, SPM-based methods of SPECT processing showed better localization of SPECT hyperperfusion to surgical resection site and higher interobserver agreement compared to SISCOM. These results show the benefit of statistical SPECT processing methods and further highlight the challenge of nETLE.",
author = "Vlastimil Sulc and Samantha Stykel and Hanson, {Dennis P.} and Benjamin Brinkmann and Jones, {David T} and {Holmes III}, {David R.} and Robb, {Richard A.} and Senjem, {Matthew L.} and Mullan, {Brian P.} and Watson, {Robert E.} and Daniel Horinek and Cascino, {Gregory D} and Lily Wong-Kisiel and Britton, {Jeffrey W.} and So, {Elson L.} and Worrell, {Gregory Alan}",
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T1 - Statistical SPECT processing in MRI-negative epilepsy surgery

AU - Sulc, Vlastimil

AU - Stykel, Samantha

AU - Hanson, Dennis P.

AU - Brinkmann, Benjamin

AU - Jones, David T

AU - Holmes III, David R.

AU - Robb, Richard A.

AU - Senjem, Matthew L.

AU - Mullan, Brian P.

AU - Watson, Robert E.

AU - Horinek, Daniel

AU - Cascino, Gregory D

AU - Wong-Kisiel, Lily

AU - Britton, Jeffrey W.

AU - So, Elson L.

AU - Worrell, Gregory Alan

PY - 2014/3/18

Y1 - 2014/3/18

N2 - Objective: To evaluate the benefit of statistical SPECT processing over traditional subtraction methods, we compared ictal-interictal SPECT analyzed by statistical parametric mapping (SPM) (ISAS), statistical ictal SPECT coregistered to MRI (STATISCOM), and subtraction ictal- interictal SPECT coregistered with MRI (SISCOM) in patients with MRI-negative focal temporal lobe epilepsy (nTLE) and extratemporal lobe epilepsy (nETLE). Methods: We retrospectively identified 49 consecutive cases of drug-resistant focal epilepsy that had a negative preoperativeMRI and underwent interictal and ictal SPECT prior to resective epilepsy surgery. Interictal and ictal SPECT scans were analyzed using SISCOM, ISAS, and STATISCOM to create hyperperfusion and hypoperfusion maps for each patient. Reviewers blinded to clinical data and the SPECT analysis method marked the site of probable seizure origin and indicated their confidence in the localization. Results: In nTLE and nETLE, the hyperperfusions detected by STATISCOM (71% nTLE, 57% nETLE) and ISAS (67% nTLE, 53% nETLE) were more often colocalized with surgery resection site compared to SISCOM (38% nTLE, 36% nETLE). In nTLE, localization of the hyperperfusion to the region of surgery was associated with an excellent outcome for STATISCOM (p = 0.005) and ISAS (p = 0.027), but not in SISCOM (p = 0.071). This association was not present in nETLE for any method. Conclusion: In an unselected group of patients with normal MRI and focal epilepsy, SPM-based methods of SPECT processing showed better localization of SPECT hyperperfusion to surgical resection site and higher interobserver agreement compared to SISCOM. These results show the benefit of statistical SPECT processing methods and further highlight the challenge of nETLE.

AB - Objective: To evaluate the benefit of statistical SPECT processing over traditional subtraction methods, we compared ictal-interictal SPECT analyzed by statistical parametric mapping (SPM) (ISAS), statistical ictal SPECT coregistered to MRI (STATISCOM), and subtraction ictal- interictal SPECT coregistered with MRI (SISCOM) in patients with MRI-negative focal temporal lobe epilepsy (nTLE) and extratemporal lobe epilepsy (nETLE). Methods: We retrospectively identified 49 consecutive cases of drug-resistant focal epilepsy that had a negative preoperativeMRI and underwent interictal and ictal SPECT prior to resective epilepsy surgery. Interictal and ictal SPECT scans were analyzed using SISCOM, ISAS, and STATISCOM to create hyperperfusion and hypoperfusion maps for each patient. Reviewers blinded to clinical data and the SPECT analysis method marked the site of probable seizure origin and indicated their confidence in the localization. Results: In nTLE and nETLE, the hyperperfusions detected by STATISCOM (71% nTLE, 57% nETLE) and ISAS (67% nTLE, 53% nETLE) were more often colocalized with surgery resection site compared to SISCOM (38% nTLE, 36% nETLE). In nTLE, localization of the hyperperfusion to the region of surgery was associated with an excellent outcome for STATISCOM (p = 0.005) and ISAS (p = 0.027), but not in SISCOM (p = 0.071). This association was not present in nETLE for any method. Conclusion: In an unselected group of patients with normal MRI and focal epilepsy, SPM-based methods of SPECT processing showed better localization of SPECT hyperperfusion to surgical resection site and higher interobserver agreement compared to SISCOM. These results show the benefit of statistical SPECT processing methods and further highlight the challenge of nETLE.

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