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Objective <p>The aim of this study was to determine the diagnostic accuracy of single and combined brain perfusion SPECT parameters (maximum perfusion [MP], maximum change [MC], maximum extension [ME], and subtraction ictal SPECT co-registered to MRI [SISCOM]) for seizure onset zone (SOZ) localization in patients with drug-resistant epilepsy (DRE), including temporal lobe epilepsy (TLE) and extra-temporal lobe epilepsy (ETLE).</p> Methods <p>This retrospective study included 49 patients with DRE who underwent ictal and interictal SPECT imaging from March 2012 to March 2022 and had favorable surgical outcomes (Engel class I–II) with at least 2 years follow-up. SPECT images were evaluated independently by two nuclear medicine physicians using visual criteria for MP, MC, ME, and SISCOM parameters, including the single largest hyperperfusion region (SIL). Diagnostic accuracy was assessed against the surgical SOZ as the reference standard, calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Inter-rater agreement was evaluated using Cohen’s kappa.</p> Results <p>Among single SPECT parameters, ME and MC showed strong diagnostic performance with accuracies of 89.2% and 88.2%, respectively, while SIL had the highest specificity (94.3%). Combined SPECT parameters significantly improved accuracy and specificity; notably, the combination SIL_MC_ME achieved 91.1% accuracy and 97.0% specificity. Further improvements were observed by combining MRI with SPECT parameters; particularly, MRI combined with SIS (MRI_SIS) achieved the highest accuracy (95.9%) and excellent specificity (99.2%). MRI alone exhibited the highest overall diagnostic accuracy (96.2%). The ETLE subgroup (n=16) showed similar improvements in accuracy and specificity with combined parameters (up to 88.8%). Cohen’s kappa indicated substantial inter-rater agreement, especially for SIL (κ = 0.80).</p> Conclusions <p>SPECT-derived parameters, particularly when combined with each other or integrated with MRI, demonstrate significant improvements in diagnostic accuracy for seizure localization in DRE patients. Combined parameters such as SIL_MC_ME and MRI-integrated approaches (MRI_SIS) are recommended for enhancing clinical decision-making and pre-surgical planning, particularly when MRI findings alone are inconclusive.</p>

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Diagnostic accuracy of brain perfusion SPECT parameters for seizure onset zone localization in drug-resistant epilepsy

  • 期刊论文

  • 发表日期：

    2025年11月25日

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  • Chanan Sukprakun,
  • Supatporn Tepmongkol

摘要

Objective

The aim of this study was to determine the diagnostic accuracy of single and combined brain perfusion SPECT parameters (maximum perfusion [MP], maximum change [MC], maximum extension [ME], and subtraction ictal SPECT co-registered to MRI [SISCOM]) for seizure onset zone (SOZ) localization in patients with drug-resistant epilepsy (DRE), including temporal lobe epilepsy (TLE) and extra-temporal lobe epilepsy (ETLE).

Methods

This retrospective study included 49 patients with DRE who underwent ictal and interictal SPECT imaging from March 2012 to March 2022 and had favorable surgical outcomes (Engel class I–II) with at least 2 years follow-up. SPECT images were evaluated independently by two nuclear medicine physicians using visual criteria for MP, MC, ME, and SISCOM parameters, including the single largest hyperperfusion region (SIL). Diagnostic accuracy was assessed against the surgical SOZ as the reference standard, calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Inter-rater agreement was evaluated using Cohen’s kappa.

Results

Among single SPECT parameters, ME and MC showed strong diagnostic performance with accuracies of 89.2% and 88.2%, respectively, while SIL had the highest specificity (94.3%). Combined SPECT parameters significantly improved accuracy and specificity; notably, the combination SIL_MC_ME achieved 91.1% accuracy and 97.0% specificity. Further improvements were observed by combining MRI with SPECT parameters; particularly, MRI combined with SIS (MRI_SIS) achieved the highest accuracy (95.9%) and excellent specificity (99.2%). MRI alone exhibited the highest overall diagnostic accuracy (96.2%). The ETLE subgroup (n=16) showed similar improvements in accuracy and specificity with combined parameters (up to 88.8%). Cohen’s kappa indicated substantial inter-rater agreement, especially for SIL (κ = 0.80).

Conclusions

SPECT-derived parameters, particularly when combined with each other or integrated with MRI, demonstrate significant improvements in diagnostic accuracy for seizure localization in DRE patients. Combined parameters such as SIL_MC_ME and MRI-integrated approaches (MRI_SIS) are recommended for enhancing clinical decision-making and pre-surgical planning, particularly when MRI findings alone are inconclusive.