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Intractable nonlesional epilepsy of temporal lobe origin

Lateralization by interictal SPECT versus MRI

Departments of Diagnostic Radiology, Mayo Clinic and Mayo Foundation, Rochester, MN. (Drs. Jack, Mullan, Hauser, Krecke, and Luetmer)
Departments of Neurology, Mayo Clinic and Mayo Foundation, Rochester, MN. (Drs. Sharbrough and Cascino)
Departments of Psychiatry and Psychology, Mayo Clinic and Mayo Foundation, Rochester, MN. (Dr. Trenerry)
Departments of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN. (Dr. O'Brien)
Departments of Medical Pathology, Mayo Clinic and Mayo Foundation, Rochester, MN. (Dr. Parisi)

Article abstract –We performed a retrospective study of 53 consecutive "nonlesional" temporal lobectomy patients to assess the relative utility of MRI versus interictal single-photon emission computed tomography (SPECT) in this patient population. We compared the seizure lateralizing properties of MRI and SPECT using multiple blinded expert reviewers for both SPECT and MRI with a test-retest reviewer paradigm and measurements of hippocampal volume from MRI. The criterion standard for seizure lateralization was satisfactory postoperative seizure control (n = 43). The rate of correct seizure lateralization was significantly greater for MRI than for SPECT (p 0.01), and the rate of incorrect lateralization was significantly less for MRI than for SPECT. The most accurate MRI measure was hippocampal volume measurements, which correctly lateralized the seizures in 86.0% of cases. The correct lateralization rate for SPECT was 45.4%. The MRI and SPECT studies tended to be noncomplementary with respect to seizure lateralization, and SPECT was likely to give an incorrect or indeterminate result in patients who were not lateralized by MRI. Concordant MRI-EEG lateralization was a strong predictor of satisfactory postoperative seizure control, while no relationship between postoperative seizure control and SPECT findings was present.

Address correspondence and reprint requests to Dr. Clifford R. Jack, Jr., Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Supported in part by PHS Grant RO1 NS28374.

Received August 9, 1993. Accepted for publication in final form October 26, 1993.

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