MRI and brain spect findings in patients with unilateral temporal lobe epilepsy and normal CT scan

Carrilho, P.G.; Yacubian, E.M.T.; Cukiert, A.; Fiore, L.A.; Buchpiguel, C.A.; Jorge, C.L.; Scapolan, H.B.; Bacheschi, L.A.; Marino Jr, R.

doi:10.1590/S0004-282X1994000200003

Abstracts

26 patients with temporal lobe epilepsy clinically documented by several abnormal interictal surface EEGs with typical unitemporal epileptiform activity and a normal CT scan were studied. Interictal99mTC HMPAO brain SPECT and MRI were performed in all subjects. Abnormalities were shown in 61.5% of MRI (n=16) and 65.4% of SPECT (n=17). Hippocampal atrophy associated to a high signal on T2-weighted MRI slices suggesting mesial temporal sclerosis was the main finding (n=12; 75% of abnormal MRI). MRI correlated well to surface EEG in 50% (n=13). There was also a good correlation between MRI and SPECT in 30.7% (n=8). SPECT and EEG were in agreement in 57.7% (n=l5). MRI, SPECT and EEG were congruent in 26.9% (n=7). These results support the usefulness of interictal brain SPECT and MRI in detecting lateralized abnormalities in temporal lobe epilepsy. On the other hand, in two cases, interictal SPECT correlated poorly with surface EEG. This functional method should not be used isolately in the detection of temporal lobe foci. MRI is more useful than CT as a neuroimaging technique in temporal lobe epilepsy. It may detect small structural lesions and mesial temporal lobe sclerosis which are not easily seen with traditional CT scanning.

epilepsy; temporal lobe; CT; MRI; EEG; SPECT

Foram estudados 26 pacientes com epilepsia do lobo temporal clinicamente documentada por vários EEGs com atividade epileptiforme intercrítica e TC de crânio normal. SPECT com99mTC HMPAO e ressonância magnética (RM) foram realizados em todos os casos. 61.5% (n=16) das RM e 65.4% (n=17) dos SPECTs revelaram algum tipo de anormalidade. Atrofia hipocampal, nas imagens enfatizadas em Tl e presença de hipersinal nas imagens enfatizadas em T2, sugerindo esclerose mesial temporal, foram o principal achado (n=12; 75% das RM anormais). RM correlacionou-se ao EEG em 50% (n=13). Concordância entre RM e SPECT ocorreu em 30.7% (n=8) e entre SPECTe EEG em 57.7% (n=15). RM, SPECT e EEG foram congruentes em 26.9% (n=7). Estes resultados refletem o valor do SPECT intercrítico e RM na detecção e lateralização de anormalidades em epilepsia do lobo temporal. Por outro lado, em dois casos, o SPECT correlacionou-se mal com o EEG. Este método funcional não deve ser utilizado isoladamente na detecção de focos temporais. RM é mais útil do que a TC como recurso de neuroimagem na epilepsia do lobo temporal. Ela pode detectar pequenas lesões estruturais e esclerose mesial temporal, não facilmente identificáveis pela TC.

epilepsia; lobo temporal; TC; RM; EEG; SPECT

MRI and brain spect findings in patients with unilateral temporal lobe epilepsy and normal CT scan

Achados de ressonância magnética e SPECT cerebral em pacientes com epilepsia unilateral do lobo temporal e com TC de crânio normal

P.G. Carrilho; E.M.T. Yacubian; A. Cukiert; L.A. Fiore; C.A. Buchpiguel; C.L. Jorge; H.B. Scapolan; L.A. Bacheschi; R. Marino Jr

Departments of Neurology and Radiology, School of Medicine, University of São Paulo, São Paulo SP - Brazil

SUMMARY

26 patients with temporal lobe epilepsy clinically documented by several abnormal interictal surface EEGs with typical unitemporal epileptiform activity and a normal CT scan were studied. Interictal^99mTC HMPAO brain SPECT and MRI were performed in all subjects. Abnormalities were shown in 61.5% of MRI (n=16) and 65.4% of SPECT (n=17). Hippocampal atrophy associated to a high signal on T2-weighted MRI slices suggesting mesial temporal sclerosis was the main finding (n=12; 75% of abnormal MRI). MRI correlated well to surface EEG in 50% (n=13). There was also a good correlation between MRI and SPECT in 30.7% (n=8). SPECT and EEG were in agreement in 57.7% (n=l5). MRI, SPECT and EEG were congruent in 26.9% (n=7). These results support the usefulness of interictal brain SPECT and MRI in detecting lateralized abnormalities in temporal lobe epilepsy. On the other hand, in two cases, interictal SPECT correlated poorly with surface EEG. This functional method should not be used isolately in the detection of temporal lobe foci. MRI is more useful than CT as a neuroimaging technique in temporal lobe epilepsy. It may detect small structural lesions and mesial temporal lobe sclerosis which are not easily seen with traditional CT scanning.

Key words: epilepsy, temporal lobe, CT, MRI, EEG, SPECT.

RESUMO

Foram estudados 26 pacientes com epilepsia do lobo temporal clinicamente documentada por vários EEGs com atividade epileptiforme intercrítica e TC de crânio normal. SPECT com^99mTC HMPAO e ressonância magnética (RM) foram realizados em todos os casos. 61.5% (n=16) das RM e 65.4% (n=17) dos SPECTs revelaram algum tipo de anormalidade. Atrofia hipocampal, nas imagens enfatizadas em Tl e presença de hipersinal nas imagens enfatizadas em T2, sugerindo esclerose mesial temporal, foram o principal achado (n=12; 75% das RM anormais). RM correlacionou-se ao EEG em 50% (n=13). Concordância entre RM e SPECT ocorreu em 30.7% (n=8) e entre SPECTe EEG em 57.7% (n=15). RM, SPECT e EEG foram congruentes em 26.9% (n=7). Estes resultados refletem o valor do SPECT intercrítico e RM na detecção e lateralização de anormalidades em epilepsia do lobo temporal. Por outro lado, em dois casos, o SPECT correlacionou-se mal com o EEG. Este método funcional não deve ser utilizado isoladamente na detecção de focos temporais. RM é mais útil do que a TC como recurso de neuroimagem na epilepsia do lobo temporal. Ela pode detectar pequenas lesões estruturais e esclerose mesial temporal, não facilmente identificáveis pela TC.

Palavras-chave: epilepsia, lobo temporal, TC, RM, EEG, SPECT.

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Aceite: 4-outubro-1993.

Dr. Arthur Cukiert - Rua Baltazar da Veiga 367 apto 151 - 04510-001 São Paulo SP, Brasil. FAX (55.11) 533-7880.

1. Biersack, HJ, Reichman K, Winkler C. ^99mTC labelled hexamethylpropyleneamine oxime photon emission scans in epilepsy. Lancet 1985, 2:1436-1437.
2. Biersack HJ. Brain SPECT in epilepsy. Are interventional techniques necessary?. Proc Internat Symposium Focal Epilepsy: clinical use of the emission tomography. Paris, 1989.
3. Bonte FJ, Stokely EM, Devous MD, Homan RW. Single photon tomographic determination of rCBF. Am J Neuroradiol 1983, 4:544-546.
4. Duncan R, Patterson J, Hadley DM. Tc-99m HMPAO SPECT in temporal lobe epilepsy. Acta Neurol Scand 1990, 81:287-293.
5. Engel J, Kuhl DE, Phelps ME, Mazziotta JC. Interictal cerebral glucose metabolism in partial epilepsy and its relation to EEG changes. Ann Neurol 1982, 12:510-517.
6. Engel J. The use of PET in epilepsy. Ann Neurol 1984, 25:s86-sl04.
7. Jack CR, Cascino G. Temporal lobe volume measurement from MR images: accuracy and left-right asymmetry in normal persons. J Comp Assist Tomogr 1988, 12:21-29.
8. Lassen NA. ¹³³Xe, ^99mTC-HMPAO and other tracers for measurement of CBF by SPECT in temporal lobe epilepsy. Proc Internat Symposium Focal Epilepsy: clinical use of functional imaging by means of emission tomography. Paris, 1989.
9. Lassen NA. Concluding remarks. Proc Internat Symposium Focal Epilepsy: clinical use of emission tomography. Paris, 1989.
10. Mazziotta JC, Engel J. The use and impact of PET in epilepsy. Epilepsia 1984, 24:s86-s104.
11. Podreka I, Suess E, Goldemberg G. Initial experience with technetium ^99mHMPAO brain SPECT. J Nucl Med 1987, 28: 1657-1666.
12. Rowe C, Berkovic S, Austin M, Saling M, Kalnins R, McKay W, Bladin P. Visual and quantitative analysis of interictal SPECT with^99m TC HMPAO in temporal lobe epilepsy. J Nucl Med 1991, 32: 1688-1694.
13. Rowe C, Berkovic S, Austin M, McKay WJ, Bladin PR Postictal SPECT in epilepsy. Lancet 1989, 1: 389-390.
14. Shen W, Lee BI, Park HM, Siddiqui AR, Wellman HN, Markand ON. HIPDM SPECT brain imaging in evaluation of intractable epilepsy for temporal lobectomy. Neurology 1989, 39 (Suppl 1): 132.
15. Swartz BE, Tomiyasu U, Delgado-Escueta AV, Mandelkern M, Khonsari A. Neuroimaging in temporal lobe epilepsy. Test sensitivity and relationships to pathology and postoperative outcome. Epilepsia 1992, 33:624-634.
16. Theodore WH, Katz D, Kufta C, Sato S, Patronas N, Smothers P, Bromfield E. Pathology of temporal lobe foci: correlation with CT, MRI and PET. Neurology 1990, 40:797-803.

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
June 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Biersack, HJ, Reichman K, Winkler C. ^99mTC labelled hexamethylpropyleneamine oxime photon emission scans in epilepsy. Lancet 1985, 2:1436-1437.

[2] 2. Biersack HJ. Brain SPECT in epilepsy. Are interventional techniques necessary?. Proc Internat Symposium Focal Epilepsy: clinical use of the emission tomography. Paris, 1989.

[3] 3. Bonte FJ, Stokely EM, Devous MD, Homan RW. Single photon tomographic determination of rCBF. Am J Neuroradiol 1983, 4:544-546.

[4] 4. Duncan R, Patterson J, Hadley DM. Tc-99m HMPAO SPECT in temporal lobe epilepsy. Acta Neurol Scand 1990, 81:287-293.

[5] 5. Engel J, Kuhl DE, Phelps ME, Mazziotta JC. Interictal cerebral glucose metabolism in partial epilepsy and its relation to EEG changes. Ann Neurol 1982, 12:510-517.

[6] 6. Engel J. The use of PET in epilepsy. Ann Neurol 1984, 25:s86-sl04.

[7] 7. Jack CR, Cascino G. Temporal lobe volume measurement from MR images: accuracy and left-right asymmetry in normal persons. J Comp Assist Tomogr 1988, 12:21-29.

[8] 8. Lassen NA. ¹³³Xe, ^99mTC-HMPAO and other tracers for measurement of CBF by SPECT in temporal lobe epilepsy. Proc Internat Symposium Focal Epilepsy: clinical use of functional imaging by means of emission tomography. Paris, 1989.

[9] 9. Lassen NA. Concluding remarks. Proc Internat Symposium Focal Epilepsy: clinical use of emission tomography. Paris, 1989.

[10] 10. Mazziotta JC, Engel J. The use and impact of PET in epilepsy. Epilepsia 1984, 24:s86-s104.

[11] 11. Podreka I, Suess E, Goldemberg G. Initial experience with technetium ^99mHMPAO brain SPECT. J Nucl Med 1987, 28: 1657-1666.

[12] 12. Rowe C, Berkovic S, Austin M, Saling M, Kalnins R, McKay W, Bladin P. Visual and quantitative analysis of interictal SPECT with^99m TC HMPAO in temporal lobe epilepsy. J Nucl Med 1991, 32: 1688-1694.

[13] 13. Rowe C, Berkovic S, Austin M, McKay WJ, Bladin PR Postictal SPECT in epilepsy. Lancet 1989, 1: 389-390.

[14] 14. Shen W, Lee BI, Park HM, Siddiqui AR, Wellman HN, Markand ON. HIPDM SPECT brain imaging in evaluation of intractable epilepsy for temporal lobectomy. Neurology 1989, 39 (Suppl 1): 132.

[15] 15. Swartz BE, Tomiyasu U, Delgado-Escueta AV, Mandelkern M, Khonsari A. Neuroimaging in temporal lobe epilepsy. Test sensitivity and relationships to pathology and postoperative outcome. Epilepsia 1992, 33:624-634.

[16] 16. Theodore WH, Katz D, Kufta C, Sato S, Patronas N, Smothers P, Bromfield E. Pathology of temporal lobe foci: correlation with CT, MRI and PET. Neurology 1990, 40:797-803.