J Nucl Med 1993 Apr;34(4):666-70
Ictal SPECT using technetium-99m-HMPAO: methods for rapid preparation and
optimal deployment of tracer during spontaneous seizures.
Newton MR, Austin MC, Chan JG, McKay WJ, Rowe CC, Berkovic SF.
Ictal SPECT provides unique information for the clinician treating patients with
refractory epilepsy and reveals insights into the pathophysiology of seizures.
We describe our methods for the routine attainment of ictal images using
99mTc-HMPAO. We have devised and implemented techniques for rapid reconstitution
of 99mTc-HMPAO adjacent to the video-EEG monitoring suite such that the tracer
can be rapidly injected into patients when spontaneous seizures occur. Our
quality assurance data show that this can be done safely outside a nuclear
medicine department. The clinical results in patients with temporal lobe
epilepsy show that ictal injections (97% correct lateralization of focus, 0%
incorrect) are more sensitive and accurate compared to interictal studies (48%
correct, 10% incorrect), demonstrating that the implementation of these
techniques is worthwhile.
