All issues > Volume 52(7); 2009

Original Article

Korean J Pediatr. 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 YJ Hur¹, Joon Soo JS Lee², Hoon Chul HC Kang², Hye Jung HJ Park³, Mi Jin MJ Yun³, Heung Dong HD 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

Correspondence Heung Dong HD 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.

Keywords :Infantile spasms, Computed tomography, Single-photon emission