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Quantitative Analysis of Cerebral Blood Flow Patterns in Mesial Temporal Lobe Epilepsy Using Composite SISCOM

¹ Department of Neurology, University of California, San Francisco, California
² Department of Neurology, Saint Louis University School of Medicine, St. Louis, Missouri
³ Division of Nuclear Medicine, Saint Louis University School of Medicine, St. Louis, Missouri

View larger version (66K): [in a new window]   FIGURE 1. Axial images (from left to right, MRI, composite SISCOM, and composite subtraction SPECT) and rainbow color scales for left MTLE group (top) and right MTLE group (bottom). At far right is composite subtraction SPECT image of MTS subgroup, matched to same MRI plane as left MTLE group. Based on highest-intensity values in image (highest-intensity value being highest value in color scale), intensities were 0–15 for left MTLE group, 0–14 for right MTLE group, and 0–10 for MTS subgroup. Transition from yellow to green represents an intensity of 6 in both right and left MTLE group color scales and an intensity of 5 for MTS subgroup. All groups show similar patterns of hyperperfusion. Entire anterior temporal lobe shows pronounced hyperperfusion in this view. Also present are distant regions of hyperperfusion in orbitofrontal and contralateral temporal lobes, likely representing patterns of seizure propagation.

View larger version (55K): [in a new window]   FIGURE 2. Coronal images (from left to right, MRI, composite SISCOM, and composite subtraction SPECT) and rainbow color scale for anterior (top) and posterior temporal (bottom) regions of left MTLE group. At far right is composite subtraction SPECT image of MTS subgroup, matched to same MRI plane as left MTLE group. Anterior section shows that all temporal lobe gyri are significantly hyperperfused, with extension into basal ganglia and insula. Much of anterior temporal lobe of left MTLE group shows composite intensity value of 15 (represented by purple, P < 0.0001). Contralateral temporal lobe and basal ganglia are significantly hyperperfused in anterior section. Posterior temporal region shows significant regions of hyperperfusion, but with most of temporal lobe showing perfusion changes near the cutoff value for significance. Contralateral mesial temporal region also shows significant hyperperfusion.

View larger version (26K): [in a new window]   FIGURE 3. Sagittal images (from left to right, MRI, composite SISCOM, and composite subtraction SPECT) and rainbow color scale for left MTLE group. At far right is composite subtraction SPECT image of MTS subgroup, matched to same MRI plane as left MTLE group. Sagittal view serves to highlight predominance of anterior temporal hyperperfusion, as well as extension of hyperperfusion into insula. This view shows sharp demarcation between regions of hyperperfusion in insula and adjacent frontal lobe.