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Application of statistical parametric mapping to SPET in the assessment of intractable childhood epilepsy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Statistical parametric mapping (SPM) quantification and analysis has been successfully applied to functional imaging studies of partial epilepsy syndromes in adults. The present study evaluated whether localisation of the epileptogenic zone (determined by SPM) improves upon visually examined single-photon emission tomography (SPET) imaging in presurgical assessment of children with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The patient sample consisted of 24 children (15 males) aged 2.1–17.8 years (9.8±4.3 years; mean±SD) with intractable TLE or FLE. SPET imaging was acquired routinely in presurgical evaluation. All patient images were transformed into the standard stereotactic space of the adult SPM SPET template prior to SPM statistical analysis. Individual patient images were contrasted with an adult control group of 22 healthy adult females. Resultant statistical parametric maps were rendered over the SPM canonical magnetic resonance imaging (MRI). Two corresponding sets of ictal and interictal SPM and SPET images were then generated for each patient. Experienced clinicians independently reviewed the image sets, blinded to clinical details. Concordance of the reports between SPM and SPET images, syndrome classification and MRI abnormality was studied. A fair level of inter-rater reliability (kappa=0.73) was evident for SPM localisation. SPM was concordant with SPET in 71% of all patients, the majority of the discordance being from the FLE group. SPM and SPET localisation were concordant with epilepsy syndrome in 80% of the TLE cases. Concordant localisation to syndrome was worse for both SPM (33%) and SPET (44%) in the FLE group. Data from a small sample of patients with varied focal structural pathologies suggested that SPM performed poorly relative to SPET in these cases. Concordance of SPM and SPET with syndrome was lower in patients younger than 6 years than in those aged 6 years and above. SPM is effective in localising the potential epileptogenic zone but does not provide additional benefit beyond SPET in presurgical assessment of children with intractable epilepsy. The impact of different pathologies on the efficacy of SPM warrants further study.

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Acknowledgments

The Brain Foundation (Australia) and Sydney Children’s Hospital Foundation provided financial support for this work. Tara Stevermuer (Centre for Health Service Development, University of Wollongong, NSW, Australia) and Sue Middleton (School of Mathematics, University of New South Wales, NSW, Australia) gave statistical support. Analyze software was supplied by Professor Richard A. Robb (Biomedical Imaging Resource, MAYO Foundation, Rochester, Minnesota, USA). We also thank Dr. Leighton Barnden (Department of Nuclear Medicine, Queen Elizabeth Hospital, Woodville, South Australia, Australia), for providing the adult control SPET images.

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Authors and Affiliations

  1. Department of Neurology, Sydney Children’s Hospital and School of Women’s & Children’s Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia

    Jason M. Bruggemann, John A. Lawson, Anne M. Cunningham & Ann M. E. Bye

  2. Department of Neurology, Sydney Children’s Hospital, High Street, Randwick, NSW, 2031, Australia

    Ann M. E. Bye

  3. Department of Nuclear Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia

    Seu S. Som & Walter Haindl

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  1. Jason M. Bruggemann
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  2. Seu S. Som
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  3. John A. Lawson
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Correspondence to Ann M. E. Bye.

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Bruggemann, J.M., Som, S.S., Lawson, J.A. et al. Application of statistical parametric mapping to SPET in the assessment of intractable childhood epilepsy. Eur J Nucl Med Mol Imaging 31, 369–377 (2004). https://doi.org/10.1007/s00259-003-1366-z

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  • DOI: https://doi.org/10.1007/s00259-003-1366-z

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