PMID- 31753769 OWN - NLM STAT- MEDLINE DCOM- 20200805 LR - 20200805 IS - 1525-5069 (Electronic) IS - 1525-5050 (Linking) VI - 101 IP - Pt B DP - 2019 Dec TI - Usefulness of HMPAO-SPECT in the diagnosis of nonconvulsive status epilepticus. PG - 106544 LID - S1525-5050(19)30526-8 [pii] LID - 10.1016/j.yebeh.2019.106544 [doi] AB - BACKGROUND: The diagnosis of nonconvulsive status epilepticus (NCSE) can pose a challenge. Electroencephalogram (EEG) patterns can be difficult to interpret, and the absence of an EEG correlate does not rule out the diagnosis of NCSE. In this setting, neuroimaging tools to help in the diagnosis are crucial. Our aim was to evaluate the role of 99mTc-hexamethyl propyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) and quantitative HMPAO-SPECT (QtSPECT) in patients with clinical suspicion of NCSE, and to evaluate their value in the final diagnosis of NCSE. METHODS: We recruited consecutive patients admitted in our center with suspicion of NCSE, and selected those who underwent an HMPAO-SPECT. All patients were admitted to the neurology ward and underwent an EEG. We divided the patients into those who were finally with diagnosed NCSE (NCSE-p) and those who were not (non-NCSE) according to the Salzburg Diagnostic EEG criteria. Sensitivity and specificity of the diagnostic tools were calculated. The SPECTs were acquired in a Skylight SPECT (Philips Healthcare, Amsterdam). The injections were done during the clinical episode suspected of being an NCSE. The HMPAO-SPECT was analyzed by two experts and was also quantified. All data were normalized to the SPM SPECT template. We used an external healthy normal database to obtain a Z-score map for each individual versus the normal database. The Z-score maximum (Z(max)) was extracted from each region of the AAL atlas as was the percentage of voxels with a Z-score higher than 2.5 (N(%)). A logistic regression combining the Z(max), N(%), and the effect of patient age was fitted to predict the final NCSE diagnosis. A receiver operator characteristic (ROC) curve and the area under the curve (AUC) were obtained to evaluate the classification performance. RESULTS: We included 55 patients, 21 of them women (38.9%), with a median age of 62.1 years old (range 25-84). Thirty-six patients were with diagnosed NCSE (62.9%). Initial EEG had a sensitivity of 61.1% and a specificity of 89%. Most of the patients were critically ill with diagnostic difficulties, and it could be one of the main reasons to find low sensitivity of the Salzburg diagnostic EEG criteria. The Z(max) and N(%) were significantly higher in NCSE-p than in non-NCSE (p = 0.005 and p < 0.001, respectively). The HMPAO-SPECT qualitative analysis had a sensitivity of 80.5% and specificity of 89.5% while QtSPECT had a sensitivity of 82% and specificity of 81%. CONCLUSION: Both 99mTc-HMPAO-SPECT and QtSPECT can be useful in the diagnosis of NCSE. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures". CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Jaraba, Sonia AU - Jaraba S AD - Neurology Service, Epilepsy Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Neurology Department, Hospital de Viladecans, Viladecans, Barcelona, Spain. Electronic address: soniajaraba@gmail.com. FAU - Reynes-Llompart, Gabriel AU - Reynes-Llompart G AD - Image Diagnostic Institute (IDI), Nuclear Medicine Department, PET Unit, Hospital de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. FAU - Sala-Padro, Jacint AU - Sala-Padro J AD - Neurology Service, Epilepsy Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. FAU - Veciana, Misericordia AU - Veciana M AD - Neurology Service, Neurophysiology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. FAU - Miro, Julia AU - Miro J AD - Neurology Service, Epilepsy Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. FAU - Pedro, Jordi AU - Pedro J AD - Neurology Service, Neurophysiology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. FAU - Puig, Oriol AU - Puig O AD - Image Diagnostic Institute (IDI), Nuclear Medicine Department, SPECT Unit, Hospital Universitari de Bellvitge, Image Diagnostic Institute, L'Hospitalet de Llobregat, Barcelona, Spain. FAU - Mora, Jaume AU - Mora J AD - Image Diagnostic Institute (IDI), Nuclear Medicine Department, SPECT Unit, Hospital Universitari de Bellvitge, Image Diagnostic Institute, L'Hospitalet de Llobregat, Barcelona, Spain. FAU - Falip, Merce AU - Falip M AD - Neurology Service, Epilepsy Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. LA - eng PT - Journal Article DEP - 20191118 PL - United States TA - Epilepsy Behav JT - Epilepsy & behavior : E&B JID - 100892858 RN - 0 (Oximes) RN - 0 (Radiopharmaceuticals) RN - 0 (hexamethylpropyleneamine oxime) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Electroencephalography MH - Female MH - Humans MH - Image Processing, Computer-Assisted MH - Male MH - Middle Aged MH - Neuroimaging MH - *Oximes MH - ROC Curve MH - *Radiopharmaceuticals MH - Retrospective Studies MH - Seizures MH - Sensitivity and Specificity MH - Status Epilepticus/*diagnosis/*diagnostic imaging MH - Tomography, Emission-Computed, Single-Photon/*methods OTO - NOTNLM OT - Diagnosis OT - Nonconvulsive status epilepticus (NCSE) OT - Postprocessing techniques OT - Single photon emission computed tomography (SPECT) OT - Statistical parametric mapping (SPM) OT - Z-score EDAT- 2019/11/23 06:00 MHDA- 2020/08/06 06:00 CRDT- 2019/11/23 06:00 PHST- 2019/05/31 00:00 [received] PHST- 2019/09/03 00:00 [revised] PHST- 2019/09/03 00:00 [accepted] PHST- 2019/11/23 06:00 [pubmed] PHST- 2020/08/06 06:00 [medline] PHST- 2019/11/23 06:00 [entrez] AID - S1525-5050(19)30526-8 [pii] AID - 10.1016/j.yebeh.2019.106544 [doi] PST - ppublish SO - Epilepsy Behav. 2019 Dec;101(Pt B):106544. doi: 10.1016/j.yebeh.2019.106544. Epub 2019 Nov 18.