Higher Validity, Lower Radiation: A New Ictal Single-Photon Emission Computed Tomography Framework

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY

Annals of Neurology Pub Date : 2024-08-21 DOI:10.1002/ana.27061

Felix Bitzer BSc, Lennart Walger MSc, Tobias Bauer MD, BSc, Freya Schulte, Florian C. Gaertner MD, Matthias Schmitz, Martin Schidlowski PhD, Randi von Wrede MD, Attila Rácz MD, Tobias Baumgartner MD, Vadym Gnatkovsky MD, Daniel Paech MD, Valeri Borger MD, Hartmut Vatter MD, Bernd Weber MD, Dominik L. Michels PhD, Tony Stöcker PhD, Markus Essler MD, Josemir W. Sander MD, PhD, Alexander Radbruch MD, JD, Rainer Surges MD, MHBA, Theodor Rüber MD

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引用次数: 0

Abstract

Objective

To assess whether arterial spin labeling perfusion images of healthy controls can enhance ictal single-photon emission computed tomography analysis and whether the acquisition of the interictal image can be omitted.

Methods

We developed 2 pipelines: The first uses ictal and interictal images and compares these to single-photon emission computed tomography and arterial spin labeling of healthy controls. The second pipeline uses only the ictal image and the analogous healthy controls. Both pipelines were compared to the gold standard analysis and evaluated on data of individuals with epilepsy who underwent ictal single-photon emission computed tomography imaging during presurgical evaluation between 2010 and 2022. Fifty healthy controls prospectively underwent arterial spin labeling imaging. The correspondence between the detected hyperperfusion and the postoperative resection cavity or the presumably affected lobe was assessed using Dice score and mean Euclidean distance. Additionally, the outcomes of the pipelines were automatically assigned to 1 of 5 concordance categories.

Results

Inclusion criteria were met by 43 individuals who underwent epilepsy surgery and by 73 non-surgical individuals with epilepsy. Compared to the gold standard analysis, both pipelines resulted in significantly higher Dice scores and lower mean distances (p < 0.05). The combination of both provided localizing results in 85/116 cases, compared to 54/116 generated by the current gold standard analysis and the ictal image alone produced localizing results in 60/116 (52%) cases.

Interpretation

We propose a new ictal single-photon emission computed tomography protocol; it finds relevantly more ictal hyperperfusion, and halves the radiation dose in about half of the individuals. ANN NEUROL 2024;96:1160–1173

Abstract Image

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更高的有效性，更低的辐射：新型椎体单光子发射计算机断层扫描框架

目的评估健康对照组的动脉自旋标记灌注图像能否增强发作期单光子发射计算机断层扫描分析，以及能否省略发作间期图像的采集：我们开发了两个管道：第一个管道使用发作期和发作间期图像，并将其与健康对照组的单光子发射计算机断层扫描和动脉自旋标记进行比较。第二种方法只使用发作期图像和类似的健康对照组。两个管道都与金标准分析进行了比较，并对 2010 年至 2022 年期间在手术前评估期间接受发作期单光子发射计算机断层扫描成像的癫痫患者数据进行了评估。50 名健康对照组前瞻性地接受了动脉自旋标记成像。使用 Dice 评分和平均欧氏距离评估检测到的高灌注与术后切除腔或推测受影响脑叶之间的对应关系。此外，管道结果被自动分配到 5 个一致性类别中的 1 个：43名接受癫痫手术的患者和73名未接受手术的癫痫患者符合纳入标准。与金标准分析相比，两种管道的 Dice 得分都明显较高，平均距离也较低（p 解释）：我们提出了一种新的发作期单光子发射计算机断层扫描方案；它能发现更多相关的发作期高灌注，并将大约一半患者的辐射剂量减半。ann neurol 2024.

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.