Ictal single-photon emission computed tomography with slow dye
injection for determining primary epileptic foci in infantile spasms

Hur, Yun Jung; Lee, Joon Soo; Kang, Hoon Chul; Park, Hye Jung; Yun, Mi Jin; Kim, Heung Dong

Original Article

Korean Journal of Pediatrics 2009;52(7):804-810.
Published online July 15, 2009.

Ictal single-photon emission computed tomography with slow dye injection for determining primary epileptic foci in infantile spasms

Yun Jung Hur¹, Joon Soo Lee², Hoon Chul Kang², Hye Jung Park³, Mi Jin Yun³, Heung Dong Kim²

¹Department of Pediatrics, Pochon Cha University College of Medicine
²Department of Pediatrics, Handicapped Children`s Institute, Yonsei University College of Medicine, Seoul, Korea
³Department of Diagnostic Radiology Yonsei University College of Medicine, Seoul, Korea

영아연축에서 추적자의 느린 점적주사를 이용한 발작기 SPECT

허윤정^¹^, 이준수^²^, 강훈철^²^, 박해정^³^, 윤미진^³^, 김흥동^²

^¹포천중문대학교 의과대학 소아과학교실
^²연세대학교 의과대학 소아과학교실, 장애아동 연구소
^³연세대학교 의과대학 진단방사선과학교실

Correspondence:
Heung Dong Kim, Email: hdkimmd@yumc.yonsei.ac.kr

Abstract

Purpose
: We investigated whether ictal single-photon emission computed tomography (SPECT) with prolonged injection of technetium-99m (99mTc) ethyl cysteinate dimer during repeated spasms can localize the epileptogenic foci in children with infantile spasms.
Methods
: Fourteen children with infantile spasms (11 boys, 3 girls; mean age, 2.2¡¾1.3 years) were examined. When a cluster of spasms was detected during video electroencephalography (EEG) monitoring, 99mTc ethyl cysteinate dimer was slowly and continuously injected for 2 minutes to determine the presence of ictal SPECT. For 7 children, the ictal and interictal SPECT images were visually analyzed, while for the remaining 7 children, the SPECT images were analyzed using the subtraction ictal SPECT coregistered to magnetic resonance imaging (MRI) (SISCOM) technique. Subsequently, we analyzed the association between the ictal SPECT findings and those of other diagnostic modalities such as EEG, MRI, and positron emission tomography (PET).
Results
: Increase in cerebral blood flow on ictal SPECT involved the epileptogenic foci in 10 cases6 cases analyzed by visual assessment and 4 analyzed by the SISCOM technique. The ictal SPECT and video-EEG findings showed moderate agreement (Kappa=0.57; 95% confidence interval, 0.18-0.96).
Conclusion
: Ictal SPECT with prolonged injection of a tracer could provide supplementary information to localize the epileptogenic foci in infantile spasms.

Key Words: Infantile spasms, Computed tomography, Single-photon emission