Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Ictal single-photon emission computed tomography with slow dye injection for determining primary epileptic foci in infantile spasms

영아연축에서 추적자의 느린 점적주사를 이용한 발작기 SPECT

  • Hur, Yun Jung (Department of Pediatrics, Pochon Cha University College of Medicine) ;
  • Lee, Joon Soo (Department of Pediatrics, Handicapped Children's Institute, Yonsei University College of Medicine) ;
  • Kang, Hoon Chul (Department of Pediatrics, Handicapped Children's Institute, Yonsei University College of Medicine) ;
  • Park, Hye Jung (Department of Diagnostic Radiology, Yonsei University College of Medicine) ;
  • Yun, Mi Jin (Department of Diagnostic Radiology, Yonsei University College of Medicine) ;
  • Kim, Heung Dong (Department of Pediatrics, Handicapped Children's Institute, Yonsei University College of Medicine)
  • 허윤정 (포천중문대학교 의과대학 소아과학교실) ;
  • 이준수 (연세대학교 의과대학 소아과학교실, 장애아동 연구소) ;
  • 강훈철 (연세대학교 의과대학 소아과학교실, 장애아동 연구소) ;
  • 박해정 (연세대학교 의과대학 진단방사선과학교실) ;
  • 윤미진 (연세대학교 의과대학 진단방사선과학교실) ;
  • 김흥동 (연세대학교 의과대학 소아과학교실, 장애아동 연구소)
  • Received : 2009.04.08
  • Accepted : 2009.06.11
  • Published : 2009.07.15
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Abstract

Purpose : We investigated whether ictal single-photon emission computed tomography (SPECT) with prolonged injection of technetium-99m (99mTc) ethyl cysteinate dimer during repeated spasms can localize the epileptogenic foci in children with infantile spasms. Methods : Fourteen children with infantile spasms (11 boys, 3 girls; mean age, $2.2{\pm}1.3$ years) were examined. When a cluster of spasms was detected during video electroencephalography (EEG) monitoring, $^{99m}Tc$ ethyl cysteinate dimer was slowly and continuously injected for 2 minutes to determine the presence of ictal SPECT. For 7 children, the ictal and interictal SPECT images were visually analyzed, while for the remaining 7 children, the SPECT images were analyzed using the subtraction ictal SPECT coregistered to magnetic resonance imaging (MRI) (SISCOM) technique. Subsequently, we analyzed the association between the ictal SPECT findings and those of other diagnostic modalities such as EEG, MRI, and positron emission tomography (PET). Results : Increase in cerebral blood flow on ictal SPECT involved the epileptogenic foci in 10 cases6 cases analyzed by visual assessment and 4 analyzed by the SISCOM technique. The ictal SPECT and video-EEG findings showed moderate agreement (Kappa=0.57; 95% confidence interval, 0.18-0.96). Conclusion : Ictal SPECT with prolonged injection of a tracer could provide supplementary information to localize the epileptogenic foci in infantile spasms.

목 적 : 영아연축은 이차성 전신간질중의 하나로 간질 병소를 발견하기 힘든 질환중의 하나이다. 이에 저자들은 $^{99m}Tc-ECD$ 추적자의 느린 점적 주사를 이용한 발작기 SPECT를 통하여 영아 연축 환아에서 간질 병소를 찾아보고자 하였다. 방 법 : 2005년 3월부터 2007년 2월까지 연세대학교 의과대학 소아과에 내원한 영아 연축 14명의 환아를 대상으로 첫 연축이 발생하는 시점에 $^{99m}Tc-ECD$ 를 2분에 걸쳐 천천히 같은 속도로 주입하였다. 발작간기와 발작기 간의 SPECT 의 차이를 비교하였으며 객관적인 비교를 위하여 SISCOM기법을 사용하였다. 또한 간질 병소를 발견할 수 있는 진단기법인 뇌파, 자기공명영상, 양전자단층촬영(PET) 등과 비교 분석하였다. 결 과 : 전체 14례의 추적자의 느린 점적 주사를 이용한 발작기 SPECT 중 10례에서 간질 병소의 혈류가 증가하였다. 비디오 뇌파와 발작기 SPECT에서 간질병소의 일치율은 Kappa=0.57, 95% confidence interval: 0.18-0.96로 높게 나왔다. 이 중 6례에서 발작기 SPECT와 비디오 뇌파에 근거하여 간질 수술을 시행하였으며 수술적 예후가 Engle class I으로 좋은 결과를 보였다. 결 론 : 추적자의 느린 점적 주사를 이용한 발작기 SPECT는 간질 병소를 찾기 어려운 영아 연축 환아에서 간질 병소를 찾아내는데 중요한 역할을 하는 것을 알 수 있었다. 그러나 보다 큰 규모의 전향적인 연구가 필요할 것으로 사료된다.

Keywords

Acknowledgement

Supported by : Korean abbott incorporation

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