^<123>I-Iomazenil Brain SPECT with MRI-based Partial Volume Correction Improves the Detectability of Intractable Epileptogenic Foci(<SPECIAL ISSUE>Neuroimaging Update)

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  • Hatazawa Jun
    Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine
  • Kato Hiroki
    Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine

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  • てんかん焦点の検出におけるイオマゼニルSPECTの有用性と応用(<特集>最新の画像診断法)

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^<123>I-Iomazenil brain SPECT is employed for the detection of epileptogenic foci in patients with intractable epilepsy when surgical treatment is chosen. While epileptogenic foci show a reduction in ^<123>I-iomazenil accumulation, non-pathological cerebral cortices also show similar findings due to the heterogenous thickness of the cortical gray matter, atrophy of local cortices, or pathologic brain structures. The present ^<123>I-Iomazenil brain SPECT, therefore, is limited by sensitivity and specificity for detecting true epileptogenic foci. In order to overcome these limitations of ^<123>I-Iomazenil brain SPECT, we created ^<123>I-iomazenil SPECT images corrected for gray matter volume using MRI and tested whether the detectability of the epileptogenic foci improved. Seven patients (mean age±SD, 34±17y) had surgical resection of the cerebral cortex after surface electroencephalography. Histopathologic examination of the resected specimens and a good outcome after surgery were considered markers of epileptogenic foci. These patients underwent ^<123>I-iomazenil SPECT and 3-dimensional T1-weighted MRI examinations before their operations. Each SPECT image was coregistered to the corresponding MR image. The partialvolume effect (PVE) was corrected on a voxel-by-voxel basis with a smoothed gray matter distribution image. The sensitivity, specificity, and accuracy for detecting epileptogenic foci by visual inspection by 4 nuclear medicine physicians were higher after PVE correction (88%, 99%, and 98%, respectively) than before correction (50%, 92%, and 87%, respectively). MRI-based PVE correction for ^<123>I-iomazenil brain SPECT improved the sensitivity and specificity of the detection of cortical epileptogenic foci in patients with intractable epilepsy. A prospective multicenter study in a larger population is now being conducted.

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