Comparison of Ictal SPECT with 99mTc-HMPAO versus MRI for the Epileptic Seizure Onset Zone Detection in Saudi Patients

ORIGINAL ARTICLE
Sahar Mansour, Ghada Algaloud, Madhawi Aldhawi, Maram Alamri, Ruaa Baghdadi, Sara Alhoshan, Shahd Khayyat, Wajd Alsuhibani, Rawan Alamri, Gaafar Faqeeh

 
For citation: Mansour S, Algaloud G, Aldhawi M, Alamri M, Baghdadi R, Alhoshan S, Khayyat S, Alsuhibani W, Alamri R, Faqeeh G. Comparison of Ictal SPECT with 99mTc-HMPAO versus MRI for the Epileptic Seizure Onset Zone Detection in Saudi Patients. International Journal of Biomedicine. 2024;14(1):88-92. doi:10.21103/Article14(1)_OA13
 
Originally published March 1, 2024

Abstract: 

Background: In the presurgical evaluation of patients with drug-resistant epilepsy, magnetic resonance imaging (MRI) and ictal brain perfusion SPECT with the chemical microspheres 99mTc-HMPAO are widely used for diagnosing the seizure onset zone (SOZ). For both modalities, there is theoretical controversy over favoring one over the other. This study aimed to compare the performance of 99mTc-HMPAO SPECT with MRI for SOZ identification in EEG-proved epileptic Saudi patients.
Methods and Results: For this observational retrospective study, the database of the nuclear medicine departments at the Prince Sultan Military Medical City (PSMMC) and King Abdullah bin Abdulaziz University Hospital (KAAUH) were searched for male and female patients with suspected unifocal epilepsy in whom ictal brain perfusion SPECT and MRI had been performed for presurgical evaluation. A total of 14 adult epileptic patients above 18 years were included who have undergone SPECT scans using 99mTc-HMPAO and MRI between Jan 2014 and Dec 2021.
99mTc-HMPAO SPECT and MRI scans were performed simultaneously for each patient, and there was almost general agreement that 99mTc-HMPAO SPECT accurately localized and detected the SOZ in 12/14 patients (sensitivity 85.71%). It was superior to MRI, which detected and localized the SOZ in only 7/14 patients (sensitivity 50.0%). Unfortunately, the specificity of ictal brain perfusion SPECT, by using 99mTc-HMPAO in seizure localization in epileptic patients, was not detected due to the shortage of data that led to all the EEG findings being 100% positive.
Conclusion: This study reported that ictal SPECT using 99mTc-HMPAO provides more valuable information about SOZ localization than MRI. However, future studies with a larger sample size are needed to assess the specificity of 99mTc-HMPAO SPECT in detecting the SOZ.

Keywords: 
epilepsy • seizure, perfusion • 99mTc-HMPAO • ictal SPECT
References: 
  1. Issabekov G, Matsumoto T, Hoshi H, Fukasawa K, Ichikawa S, Shigihara Y. Resting-state brain activity distinguishes patients with generalised epilepsy from others. Seizure. 2024 Feb;115:50-58. doi: 10.1016/j.seizure.2024.01.001. Epub 2024 Jan 2. PMID: 38183828.
  2. Anwar H, Khan QU, Nadeem N, Pervaiz I, Ali M, Cheema FF. Epileptic seizures. Discoveries (Craiova). 2020 Jun 12;8(2):e110. doi: 10.15190/d.2020.7. PMID: 32577498; PMCID: PMC7305811.
  3. Stafstrom CE, Carmant L. Seizures and epilepsy: an overview for neuroscientists. Cold Spring Harb Perspect Med. 2015 Jun 1;5(6):a022426. doi: 10.1101/cshperspect.a022426. PMID: 26033084; PMCID: PMC4448698.
  4. Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, Pringsheim T, Lorenzetti DL, Jetté N. Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology. 2017 Jan 17;88(3):296-303. doi: 10.1212/WNL.0000000000003509. Epub 2016 Dec 16. Erratum in: Neurology. 2017 Aug 8;89(6):642. PMID: 27986877; PMCID: PMC5272794.
  5. Chen Z, Brodie MJ, Ding D, Kwan P. Editorial: Epidemiology of epilepsy and seizures. Front in Epidemiol. 2023; 3:1273163.
  6. Anyanwu C, Motamedi GK. Diagnosis and Surgical Treatment of Drug-Resistant Epilepsy. Brain Sci. 2018 Mar 21;8(4):49. doi: 10.3390/brainsci8040049. PMID: 29561756; PMCID: PMC5924385.
  7. Jaber M, Taherpour J, Voges B, Apostolova I, Sauvigny T, House PM, Lanz M, Lindenau M, Klutmann S, Martens T, Stodieck S, Buchert R. No Evidence to Favor 99mTc-HMPAO or 99mTc-ECD for Ictal Brain Perfusion SPECT for Identification of the Seizure Onset Zone. Clin Nucl Med. 2021 Nov 1;46(11):890-895. doi: 10.1097/RLU.0000000000003791. PMID: 34238801.
  8. West S, Nolan SJ, Cotton J, Gandhi S, Weston J, Sudan A, Ramirez R, Newton R. Surgery for epilepsy. Cochrane Database Syst Rev. 2015 Jul 1;(7):CD010541. doi: 10.1002/14651858.CD010541.pub2. Update in: Cochrane Database Syst Rev. 2019 Jun 25;6:CD010541. PMID: 26130264.
  9. Hines K, Wu C. Epilepsy Networks and Their Surgical Relevance. Brain Sci. 2023 Dec 28;14(1):31. doi: 10.3390/brainsci14010031. PMID: 38248246; PMCID: PMC10813558.
  10. Jehi L. The Epileptogenic Zone: Concept and Definition. Epilepsy Curr. 2018 Jan-Feb;18(1):12-16. doi: 10.5698/1535-7597.18.1.12. PMID: 29844752; PMCID: PMC5963498.
  11. Duncan JS, Winston GP, Koepp MJ, Ourselin S. Brain imaging in the assessment for epilepsy surgery. Lancet Neurol. 2016 Apr;15(4):420-33. doi: 10.1016/S1474-4422(15)00383-X. Epub 2016 Feb 24. PMID: 26925532; PMCID: PMC6736670.
  12. Theodore WH. Presurgical Focus Localization in Epilepsy: PET and SPECT. Semin Nucl Med. 2017 Jan;47(1):44-53. doi: 10.1053/j.semnuclmed.2016.09.008. Epub 2016 Oct 17. PMID: 27987556.
  13. Neirinckx RD, Canning LR, Piper IM, Nowotnik DP, Pickett RD, Holmes RA, Volkert WA, Forster AM, Weisner PS, Marriott JA, et al. Technetium-99m d,l-HM-PAO: a new radiopharmaceutical for SPECT imaging of regional cerebral blood perfusion. J Nucl Med. 1987 Feb;28(2):191-202. PMID: 3492596.
  14. Kim S, Mountz JM. SPECT Imaging of Epilepsy: An Overview and Comparison with F-18 FDG PET. Int J Mol Imaging. 2011;2011:813028. doi: 10.1155/2011/813028. Epub 2011 Jul 14. PMID: 21785722; PMCID: PMC3139140.
  15. Colamussi P, Calò G, Sbrenna S, Uccelli L, Bianchi C, Cittanti C, Siniscalchi A, Giganti M, Roveri R, Piffanelli A. New insights on flow-independent mechanisms of 99mTc-HMPAO retention in nervous tissue: in vitro study. J Nucl Med. 1999 Sep;40(9):1556-62. PMID: 10492379.
  16. Schwartz TH, Bonhoeffer T. In vivo optical mapping of epileptic foci and surround inhibition in ferret cerebral cortex. Nat Med. 2001 Sep;7(9):1063-7. doi: 10.1038/nm0901-1063. PMID: 11533712.
  17. Van Paesschen W. Qualitative and quantitative imaging of the hippocampus in mesial temporal lobe epilepsy with hippocampal sclerosis. Neuroimaging Clin N Am. 2004 Aug;14(3):373-400, vii. doi: 10.1016/j.nic.2004.04.004. PMID: 15324854.
  18. Duncan R, Patterson J, Roberts R, Hadley DM, Bone I. Ictal/postictal SPECT in the pre-surgical localisation of complex partial seizures. J Neurol Neurosurg Psychiatry. 1993 Feb;56(2):141-8. doi: 10.1136/jnnp.56.2.141. PMID: 8437001; PMCID: PMC1014811.
  19. Sample Size calculator. understanding sample sizes [cited 2023; Available from: https://www.surveymonkey.com/mp/sample-size-calculator/.
  20. Kapucu OL, Nobili F, Varrone A, Booij J, Vander Borght T, Någren K, Darcourt J, Tatsch K, Van Laere KJ. EANM procedure guideline for brain perfusion SPECT using 99mTc-labelled radiopharmaceuticals, version 2. Eur J Nucl Med Mol Imaging. 2009 Dec;36(12):2093-102. doi: 10.1007/s00259-009-1266-y. PMID: 19838703.
  21. Juhász C, John F. Utility of MRI, PET, and ictal SPECT in presurgical evaluation of non-lesional pediatric epilepsy. Seizure. 2020 Apr;77:15-28. doi: 10.1016/j.seizure.2019.05.008. Epub 2019 May 11. PMID: 31122814; PMCID: PMC6842677.
  22. von Oertzen TJ, Gröppel G, Katletz S, Weiß M, Sonnberger M, Pichler R. SPECT and PET in nonlesional epilepsy. Clinical Epileptology. 2023; 36:104-110.
  23. Spencer SS, Theodore WH, Berkovic SF. Clinical applications: MRI, SPECT, and PET. Magn Reson Imaging. 1995;13(8):1119-24. doi: 10.1016/0730-725x(95)02021-k. PMID: 8750325.
  24. Won HJ, Chang KH, Cheon JE, Kim HD, Lee DS, Han MH, Kim IO, Lee SK, Chung CK. Comparison of MR imaging with PET and ictal SPECT in 118 patients with intractable epilepsy. AJNR Am J Neuroradiol. 1999 Apr;20(4):593-9. PMID: 10319968; PMCID: PMC7056008.
  25. Lee DS, Lee SK, Kim YK, Lee JS, Cheon GJ, Kang KW, Kim ES, Chung JK, Lee MC. Superiority of HMPAO ictal SPECT to ECD ictal SPECT in localizing the epileptogenic zone. Epilepsia. 2002 Mar;43(3):263-9. doi: 10.1046/j.1528-1157.2002.23001.x. PMID: 11906511.
  26. Pardoe H, Kuzniecky R. Advanced Imaging Techniques in the Diagnosis of Nonlesional Epilepsy: MRI, MRS, PET, and SPECT. Epilepsy Curr. 2014 May;14(3):121-4. doi: 10.5698/1535-7597-14.3.121. PMID: 24940151; PMCID: PMC4038272.
  27. Prener M, Drejer V, Ziebell M, Jensen P, Madsen CG, Olsen S, Thomsen G, Pinborg LH, Paulson OB. Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. I: Predictive value and methodological considerations. Epilepsia Open. 2023 Sep;8(3):1064-1074. doi: 10.1002/epi4.12786. Epub 2023 Jul 25. PMID: 37464953; PMCID: PMC10472396.
  28. Kim SK, Lee DS, Lee SK, Kim YK, Kang KW, Chung CK, Chung JK, Lee MC. Diagnostic performance of [18F]FDG-PET and ictal [99mTc]-HMPAO SPECT in occipital lobe epilepsy. Epilepsia. 2001 Dec;42(12):1531-40. doi: 10.1046/j.1528-1157.2001.21901.x. PMID: 11879363.

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Received January 31, 2024.
Accepted February 26, 2024.
©2024 International Medical Research and Development Corporation.