Interictal rCBF SPECT, MRI and Surgical Outcome of Intractable Temporal Lobe Epilepsy

난치성 측두엽간질의 발작간 뇌혈류 SPECT, MRI와 수술성과 비교

  • Zeon, Seok-Kil (Department of Diagnostic Radiology, Keimyung University, School of Medicine) ;
  • Joo, Yang-Goo (Department of Diagnostic Radiology, Keimyung University, School of Medicine) ;
  • Lee, Sang-Doe (Department of Neurology, Keimyung University, School of Medicine) ;
  • Son, Eun-Ik (Department of Neurosurgery, Keimyung University, School of Medicine) ;
  • Lee, Young-Hwan (Department of Radiology, Ulsan Dongkang Hospital)
  • 전석길 (계명대학교 의과대학 진단방사선과학교실) ;
  • 주양구 (계명대학교 의과대학 진단방사선과학교실) ;
  • 이상도 (계명대학교 의과대학 신경과학교실) ;
  • 손은익 (계명대학교 의과대학 신경외과학교실) ;
  • 이영환 (울산동강병원 방사선과)
  • Published : 1994.11.30

Abstract

Interictal single photon emission computed tomography of regional cerebral blood flow (rCBF SPECT) in 18 intractable temporal lobe epilepsy patients(8 male and 10 female patients: average 23.5 years old) were compared with 2.0 T magnetic resonance imaging (MRI). And surgical outcome was analysed with the findings, symptom duration and lateralization of temporal lobe. Preoperatively rCBF SPECT was done in all 18 patients with intravenous injection of 740 MBq 99mTc-HMPAO. MRI was also done preoperatively in 13 patients. Surgical outcome was classified by Engel's outcome classification(four-part classification recommended at the first Palm Desert conference). rCBF SPECT detected correctly lateralising abnormality of temporal lobe hypoperfusion in 13/18(72.2%), contralateral temporal lobe hypoperfusion in 2/18(11.1%) and showed no def-inite abnormality in 3/18(16.7%). The positive predictive value of unilateral temporal lobe hypoperfusion was 87%. MRI detected correct localising abnormality in 8/13(61.5%), such as hippocampal atrophy(7/13), asymmetric temporal horn(6/13), anterior temporal lobe atrophy(1/13), increased signal intensity from hippocampus(1/13) and calcific density(1/13), and no abnormal finding was noted in 5/13(38.5%). There was no false positive findings and the positive predictive value of MRI was 100%. Only 2 cases showed same lateralization findings in rCBF SPECT and MRI. There was no significant correlation between symptom duration and no abnormal findings on SPECT or MRI. Surgical outcome showed class I in 15/18(83.3%), and class II in 2/18(11.1%). One case of no abnormal finding in both SPECT and MRI showed class III surgical outcome. No class IV surgical outcome was noted. Surgical outcome, lateralization of epileptic focus in temporal lobe and abnormal findings in rCBR SPECT or MRI were not significantly correlated.

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