Triple-Technique (MR Imaging, Single-Photon Emission CT, and CT) Coregistration for Image-Guided Surgical Evaluation of Patients with Intractable Epilepsy
R. Edward Hogan
,a,
Val J. Lowea and
Richard D. Bucholza
a From the Department of Neurology (R.E.H.) and the Divisions of Nuclear Medicine (V.J.L.) and Neurosurgery (R.D.B.), Saint Louis University.
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FIG 1. A, CT scan shows segmentation to illustrate the external surface.
B, Same scan as A reformatted by thresholding to include only the upper 15% of gray-scale intensities to depict a representation of the subdural grid and strip electrodes.
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FIG 2. Triple-technique (MR imaging, ictal SPECT, and CT) coregistered image for patient 1. Subdural grid electrodes cover the area of ictal hyperperfusion in the triangular region of the left inferior frontal gyrus
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FIG 3. A, Interictal coregistered MR-SPECT scan with right temporal hypoperfusion.
B, Ictal coregistered MR-SPECT scan shows symmetrical bitemporal perfusion. This represents a relative increase in cerebral blood flow to the right temporal region during the seizure. There was ictal hyperperfusion in the right frontal region as well.
C, Triple-technique coregistration shows subdural strip electrodes over the right temporal and frontal regions in relation to the area of ictal hyperperfusion in the right frontal region. EEG recordings localized all seizures to the right temporal region.
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