Comparative analysis of MR imaging, positron emission tomography, and ictal single-photon emission CT in patients with neocortical epilepsy.

BACKGROUND AND PURPOSE MR imaging, positron emission tomography (PET), and single-photon emission CT (SPECT) play important roles in presurgical localization of epileptic foci. However, comparative study of these imaging methods for cases of neocortical epilepsy has been limited. The purpose of this study was to compare the sensitivities of these three imaging methods for presurgical localization of neocortical epileptogenic foci. METHODS We studied 117 consecutive patients who underwent surgery for intractable neocortical epilepsy. The pathologic substrates were neuronal migration disorder (n = 77), tumor (n = 15), and others (n = 25). MR imaging was compared retrospectively with (18)F-fluorodeoxyglucose PET and ictal technetium-99m hexamethylpropyleneamine oxime SPECT regarding their capability to correctly localize the epileptogenic foci. The pathologic findings were used as the standard of reference. RESULTS Overall, MR imaging, PET, and ictal SPECT correctly localized the lesions for 59.8%, 77.7%, and 70.3% of the patients, respectively, with a 38% concordance rate among the three methods. PET was most sensitive (71-100%) in detecting all substrates. MR imaging was as sensitive (100%) as PET in detecting tumor but was least sensitive (48.1%) in detecting neuronal migration disorder. Ictal SPECT was more sensitive (75.8%) than MR imaging in detecting neuronal migration disorder. Patients with imaging abnormalities achieved good outcomes in 81.4% of the cases, in contrast to 59.5% for those without imaging abnormalities (P <.05). CONCLUSION PET and ictal SPECT were overall more sensitive than was MR imaging, despite the low concordance rate and variable sensitivity depending on substrates. The detection of abnormalities by MR imaging was associated with good outcome. PET or ictal SPECT can be well used as complementary tools, particularly in cases of negative MR imaging findings.