Impact of radiotracer injection latency and seizure duration on subtraction ictal SPECT co-registered to MRI (SISCOM) performance in children

Localization of the epileptogenic zone (EZ) in patients with drug-resistant epilepsy undergoing presurgical evaluation is crucial for successful outcome and usually requires multiple investigations. It has been described that seizure activity is associated with transient focal increased cerebral blood flow in the involved cortical region (Horsley, 1892, Penfield, 1939). Subtraction ictal single-photon emission computed tomography (SPECT) co-registered to magnetic resonance imaging (SISCOM), which demonstrates regional differences in cerebral blood flow based on a differential between ictal and interictal perfusion imaging, has been shown to help improve the accuracy of epileptic focus localization, particularly in adult population (O'Brien et al., 1998b, O'Brien et al., 1999, Spanaki et al., 1999b, Kaiboriboon et al., 2002, O'Brien et al., 2004).

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