Klinische Anwendung der Bildfusion in der prächirurgischen Epilepsiediagnostik

Zusammenfassung

Bei manchen Patienten mit medikamentös nur unzureichend behandelbaren fokalen Epilepsien kann eine epilepsiechirurgische Behandlung helfen, wenn es gelingt, den Anfallsursprung zu entfernen. Ziel der prächirurgischen Epilepsiediagnostik ist die genaue Lokalisation des epileptogenen Fokus sowie seine Abgrenzung von gesundem Hirnparenchym. Die Bildfusion ermöglicht die Kombination komplementärer Informationen verschiedener bildgebender Verfahren, insbesondere eine genaue anatomische Lokalisation funktioneller Untersuchungsergebnisse.
Dieser Beitrag beschreibt die Einsatzmöglichkeiten der Bildfusion im Rahmen der prächirurgischen Epilepsiediagnostik, wo sie die diagnostische Wertigkeit einzelner Modalitäten wie PET oder SPECT deutlich erhöhen kann. Eine besondere Bedeutung hat die Bildfusion im Rahmen der anatomisch detaillierten Operationsplanung anhand dreidimensional visualisierter Bildfusionen. Hier kann das konkrete operative Vorgehen durch die Integration multimodaler Befunde am Kortexmodell geplant werden.

Abstract

Some patients with medically intractable focal epilepsies will benefit from epilepsy surgery if the epileptogenic zone can be resected. The aim of presurgical evaluation is the exact localization of the the epileptogenic zone and its relation to eloquent cortex. Image registration allows the integration of complementary information from different imaging modalities, which can improve the diagnostic significance of imaging techniques such as SPECT or PET. The most important advantadge of image registration techniques is the possibility to integrate multimodal imaging results in one 3D-reconstruction of the brain that allows anatomically detailled planning of resective surgery.

Schlüsselwörter

Bildfusion - Epilepsie - Resektion - MRT - SPECT - PET

Key words

Image registration - epilepsy - resection - MRI - SPECT - PET

Literatur

• 1 Benbadis S R, So N K, Antar M A, Barnett G H, Morris H H. The value of PET scan (and MRI and Wada test) in patients with bitemporal epileptiform abnormalities.  Arch Neurol. 1995;  52 1062-1068
• 2 Blume W T. Diagnosis and management of epilepsy.  Cmaj. 2003;  168 441-448
• 3 Engel J. Surgery for seizures.  N Engl J Med. 1996;  334 647-652
• 4 Gubermann A, Bruni J. Essentials of Clinical Epilepsy. Butterworth Heinemann, Boston 1999
• 5 Hamer H M, Morris H H, Mascha E J. et al . Complications of invasive video-EEG monitoring with subdural grid electrodes.  Neurology. 2002;  58 97-103
• 6 Henry T R, Van Heertum R L. Positron emission tomography and single photon emission computed tomography in epilepsy care.  Semin Nucl Med. 2003;  33 88-104
• 7 Horsley V. Brain- surgery.  BMJ. 1886;  2 670-675
• 8 Jannin P, Fleig O J, Seigneuret E, Grova C, Morandi X, Scarabin J M. A data fusion environment for multimodal and multi-informational neuronavigation.  Comput Aided Surg. 2000;  5 1-10
• 9 Kwan P, Brodie M J. Early identification of refractory epilepsy.  N Engl J Med. 2000;  342 314-319
• 10 Levin D N, Pelizzari C A, Chen G T, Chen C T, Cooper M D. Retrospective geometric correlation of MR, CT, and PET images.  Radiology. 1988;  169 817-823
• 11 Lüders H, Acharya J, Baumgartner C. et al . Semiological seizure classification.  Epilepsia. 1998;  39 1006-1013
• 12 Lüders H, Awad I, Burgess R, Wyllie E, Van Ness P. Subdural electrodes in the presurgical evaluation for surgery of epilepsy.  Epilepsy Res Suppl. 1992;  5 147-156
• 13 Marusic P, Najm I M, Ying Z. et al . Focal cortical dysplasias in eloquent cortex: functional characteristics and correlation with MRI and histopathologic changes.  Epilepsia. 2002;  43 27-32
• 14 Noachtar S, Arnold S, Yousry T A, Bartenstein P, Werhahn K J, Tatsch K. Ictal technetium-99m ethyl cysteinate dimer single-photon emission tomographic findings and propagation of epileptic seizure activity in patients with extratemporal epilepsies.  Eur J Nucl Med. 1998;  25 166-172
• 15 Noachtar S, Winkler P A, Lüders H O. Surgical therapy of epilepsy. In: Neurological Disorders: Course and Treatment. Brandt T, Caplan C, Dichgans J, Diener J, Kennard C (eds). 2nd edition. Academic Press, San Diego 2003
• 16 O'Brien T J, O'Connor M K, Mullan B P. et al . Subtraction ictal SPET co-registered to MRI in partial epilepsy: description and technical validation of the method with phantom and patient studies.  Nucl Med Commun. 1998;  19 31-45
• 17 O'Brien T J, So E L, Mullan B P. et al . Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome.  Neurology. 2000;  55 1668-1677
• 18 Pfluger T, Vollmar C, Wismuller A. et al . Quantitative comparison of automatic and interactive methods for MRI-SPECT image registration of the brain based on 3-dimensional calculation of error.  J Nucl Med. 2000;  41 1823-1829
• 19 Pietrzyk U, Herholz K, Fink G. et al . An interactive technique for three-dimensional image registration: validation for PET, SPECT, MRI and CT brain studies.  J Nucl Med. 1994;  35 2011-2018
• 20 Rowe C C, Berkovic S F, Austin M C. et al . Visual and quantitative analysis of interictal SPECT with technetium-99m-HMPAO in temporal lobe epilepsy.  J Nucl Med. 1991;  32 1688-1694
• 21 Ryvlin P, Bouvard S, Le Bars D. et al . Clinical utility of flumazenil-PET versus [¹⁸F]fluorodeoxyglucose-PET and MRI in refractory partial epilepsy. A prospective study in 100 patients.  Brain. 1998;  121 2067-2081
• 22 Spanaki M V, Spencer S S, Corsi M, MacMullan J, Seibyl J, Zubal I G. Sensitivity and specificity of quantitative difference SPECT analysis in seizure localization.  J Nucl Med. 1999;  40 730-736
• 23 Uren R F, Magistretti P L, Royal H D. et al . Single-photon emission computed tomography. A method of measuring cerebral blood flow in three dimensions (preliminary results of studies in patients with epilepsy and stroke).  Med J Aust. 1983;  1 411-413
• 24 West J, Fitzpatrick J M, Wang M Y. et al . Comparison and evaluation of retrospective intermodality brain image registration techniques.  J Comput Assist Tomogr. 1997;  21 554-566
• 25 Wiebe S, Blume W T, Girvin J P, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy.  N Engl J Med. 2001;  345 311-318
• 26 Winkler P A, Vollmar C, Krishnan K G, Pfluger T, Bruckmann H, Noachtar S. Usefulness of 3D-reconstructed images of the human cerebral cortex for localization of subdural electrodes in epilepsy surgery.  Epilepsy Res. 2000;  41 169-178
• 27 Wong S TC, Knowlton R C, Hawkins R A, Laxer K D. Multimodal Image Fusion for Noninvasive Epilepsy Surgery Planning.  IEEE Computer Graphics and Applications. 1996;  16 30-38
• 28 Zubal I G, Avery R A, Stokking R. et al . Ratio-images calculated from interictal positron emission tomography and single-photon emission computed tomography for quantification of the uncoupling of brainÂ’metabolism and perfusion in epilepsy.  Epilepsia. 2000;  41 1560-1566