Dikhra Khan, Sambit Sagar, Jasim Jaleel, Mohammad Umar, Madhavi Tripathi, Manjari Tripathi, M C Sharma, Chandrasekhar Bal
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Ictal & interictal perfusion SPECT studies were performed with Tc-99 m Ethylene Cysteinate Dimer (Tc-99 m ECD) followed by SISCOS analysis using SPM2 and Bioimage Suite 2.6. Concordance for localization was determined by comparing with the surgical resection site and post-surgical outcomes were assessed using the ILAE classification.</p><p><strong>Results: </strong>The concordance for EZ localization demonstrated by SISCOS was 73.8% and MRI was 82.1%. 52 patients (61.9%) had good surgical outcome and 31(59%) of these were FCD type 2. In patients with discordant MRI findings, SISCOS was able to provide localisation in 86% (13/15), with 69.2% showing good surgical outcomes. Sensitivity of SISCOS and MRI was 73% (95% CI = 59-84.8%) and 78% (95% CI = 67.5-90.3%) respectively with no significant difference between the two. In FCD type I, both SISCOS and MRI revealed a similar a sensitivity of 76.4% (95%CI = 50.1-93.2%). Concordant cases exhibited higher seizure-free odds ratios for both modalities.</p><p><strong>Conclusion: </strong>SISCOS is effective in localizing the EZ in FCD patients, comparable to MRI. Integrating SISCOS and MRI enhances lesion detection, especially in MRI discordant cases. A comprehensive diagnostic approach utilizing SISCOS and MRI can optimize the non-invasive pre-surgical assessment in DRE thereby guiding surgical decision-making in a resource-limited setting.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":"1993-2001"},"PeriodicalIF":2.4000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"SISCOS in focal cortical dysplasia: localization and comparative analysis with MRI.\",\"authors\":\"Dikhra Khan, Sambit Sagar, Jasim Jaleel, Mohammad Umar, Madhavi Tripathi, Manjari Tripathi, M C Sharma, Chandrasekhar Bal\",\"doi\":\"10.1007/s00234-024-03434-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>This study evaluates the efficacy of SISCOS (Subtraction ictal-interictal SPECT coregistered to SPECT) in localizing the epileptogenic zone (EZ) in focal cortical dysplasia (FCD), comparing its predictive performance with MRI and post-surgical outcomes based on ILAE classification.</p><p><strong>Methods: </strong>84 patients with drug refractory epilepsy (DRE) who were operated and had histopathology consistent with FCD, were included in the study. 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引用次数: 0
摘要
目的：本研究评估了SISCOS（抽取发作期-发作间期SPECT与SPECT连接）在局灶性皮质发育不良（FCD）致痫区（EZ）定位中的疗效，并根据ILAE分类比较了SISCOS与MRI的预测性能和手术后疗效。所有患者均接受了完整的检查，包括SISCOS和用于EZ定位的核磁共振成像，并在手术前在多学科癫痫手术会议上进行了讨论。使用 Tc-99 m 乙撑半胱氨酸二聚体（Tc-99 m ECD）进行椎间期和发作间期灌注 SPECT 研究，然后使用 SPM2 和 Bioimage Suite 2.6 进行 SISCOS 分析。通过与手术切除部位的比较确定定位的一致性，并使用 ILAE 分类评估手术后的结果：SISCOS和MRI的EZ定位吻合率分别为73.8%和82.1%。52例患者（61.9%）手术效果良好，其中31例（59%）为FCD 2型。在磁共振成像结果不一致的患者中，SISCOS 能够为 86% 的患者（13/15）提供定位，其中 69.2% 的患者手术效果良好。SISCOS和磁共振成像的灵敏度分别为73%（95% CI = 59-84.8%）和78%（95% CI = 67.5-90.3%），两者之间无显著差异。在 FCD I 型中，SISCOS 和 MRI 的敏感性相似，均为 76.4% (95%CI = 50.1-93.2%)。结论：SISCOS对局部FCD有效：结论：SISCOS能有效定位FCD患者的EZ，其效果与磁共振成像相当。将 SISCOS 与核磁共振成像相结合可提高病灶检测率，尤其是在核磁共振成像不一致的病例中。利用 SISCOS 和 MRI 的综合诊断方法可以优化 DRE 的无创术前评估，从而在资源有限的情况下指导手术决策。
SISCOS in focal cortical dysplasia: localization and comparative analysis with MRI.
Purpose: This study evaluates the efficacy of SISCOS (Subtraction ictal-interictal SPECT coregistered to SPECT) in localizing the epileptogenic zone (EZ) in focal cortical dysplasia (FCD), comparing its predictive performance with MRI and post-surgical outcomes based on ILAE classification.
Methods: 84 patients with drug refractory epilepsy (DRE) who were operated and had histopathology consistent with FCD, were included in the study. All patients had undergone a complete work-up including SISCOS and MRI for EZ localization, followed by discussion in the multidisciplinary epilepsy surgery meeting prior to surgery. Ictal & interictal perfusion SPECT studies were performed with Tc-99 m Ethylene Cysteinate Dimer (Tc-99 m ECD) followed by SISCOS analysis using SPM2 and Bioimage Suite 2.6. Concordance for localization was determined by comparing with the surgical resection site and post-surgical outcomes were assessed using the ILAE classification.
Results: The concordance for EZ localization demonstrated by SISCOS was 73.8% and MRI was 82.1%. 52 patients (61.9%) had good surgical outcome and 31(59%) of these were FCD type 2. In patients with discordant MRI findings, SISCOS was able to provide localisation in 86% (13/15), with 69.2% showing good surgical outcomes. Sensitivity of SISCOS and MRI was 73% (95% CI = 59-84.8%) and 78% (95% CI = 67.5-90.3%) respectively with no significant difference between the two. In FCD type I, both SISCOS and MRI revealed a similar a sensitivity of 76.4% (95%CI = 50.1-93.2%). Concordant cases exhibited higher seizure-free odds ratios for both modalities.
Conclusion: SISCOS is effective in localizing the EZ in FCD patients, comparable to MRI. Integrating SISCOS and MRI enhances lesion detection, especially in MRI discordant cases. A comprehensive diagnostic approach utilizing SISCOS and MRI can optimize the non-invasive pre-surgical assessment in DRE thereby guiding surgical decision-making in a resource-limited setting.
期刊介绍：
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
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