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

• Published in: Clinical neurophysiology Vol. 129; no. 9; pp. 1842 - 1848
• Main 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.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2018
• Subjects: Drug-resistant epilepsy; Epilepsy surgery; Pediatric; SISCOM; SISCOM; Drug-resistant epilepsy; Epilepsy surgery; Pediatric
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2018.06.010

•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. 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. 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. 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). Radiotracer injection latency and post-injection seizure duration were not shown to have a statistical significant impact on SISCOM performance in identifying the EZ. This study demonstrates that further study of factors contributing to the performance of SISCOM in EZ identification in children is needed.