Impact of radiotracer injection latency and seizure duration on subtraction ictal SPECT co-registered to MRI (SISCOM) performance in children. Issue 9 (September 2018)

• Record Type: Journal Article
• Authors: Aungaroon, Gewalin; Trout, Andrew; Radhakrishnan, Rupa; Horn, Paul S.; Arya, Ravindra; Tenney, Jeffrey R.; Arthur, Todd M.; Holland, Katherine D.; Mangano, Francesco T.; Leach, James L.; Rozhkov, Leonid; Greiner, Hansel M.
• Is Part Of: Clinical neurophysiology. Volume 129:Issue 9(2018:Sep.)
• Page Start: 1842
• Page End: 1848
• Publication Date: 2018-09
• Subjects: SISCOM -- Pediatric -- Drug-resistant epilepsy -- Epilepsy surgery; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2018.06.010
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Subtraction ictal SPECT coregistered to MRI (SISCOM) sensitivity and specificity in identifying the epileptogenic zone (EZ) was 64.8% and 40.7% in children with drug-resistant epilepsy, respectively. Injection latency and seizure duration did not significantly impact SISCOM performance. Further study of factors contributing to SISCOM performance is needed. Abstract: Objective: We evaluated the impact of radiotracer injection latency and post-injection seizure duration on subtraction ictal SPECT co-registered to MRI (SISCOM) test performance in identifying the epileptogenic zone (EZ) in children with drug-resistant epilepsy who had undergone a resective epilepsy surgery. Methods: SISCOM concordance with the EZ was retrospectively reviewed to evaluate its performance in 113 children. The impact of radiotracer injection latency and post-injection seizure duration was evaluated for their predictive value of SISCOM localization accuracy. Results: The overall sensitivity and specificity of SISCOM in identifying an EZ was 64.8% (95%CI = 50.6–77.3) and 40.7% (95%CI = 28.1–54.3). The positive likelihood ratio and diagnostic odd ratio was 1.09 (95%CI = 0.80–1.48) and 1.26 (95%CI = 0.59–2.71), respectively. Logistic regression showed that injection latency and post-injection seizure duration did not significantly predict the probability of true positive SISCOM (p-value = 0.45 and 0.29, respectively). Conclusion: Radiotracer injection latency and post-injection seizure duration were not shown to have a statistical significant impact on SISCOM performance in identifying the EZ. Significance: This study demonstrates that further study of factors contributing to the performance of SISCOM in EZ identification in children is needed.