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Ictal single-photon emission computed tomography (SPECT) is an imaging technique used to identify the seizure-onset zone (SOZ) in epilepsy patients. It visualizes increased cerebral blood flow near the SOZ through radiopharmaceuticals injected shortly after seizure onset. This chapter outlines the principles and methodology of ictal SPECT, including setup, tracer injection, image acquisition, and evaluation. Although ictal SPECT is resource-intensive and involves radiation exposure, it offers valuable insights for epilepsy surgery. Its validity varies by seizure-onset location, showing higher localization success in temporal lobe epilepsy compared to extratemporal cases. While some studies question its added value in presurgical evaluations, ictal SPECT remains clinically relevant for well-selected individuals, particularly those with inconclusive presurgical findings or MRI-negative results.

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Ictal SPECT and Its Value in the Localization of the Seizure-Onset Zone

  • 章节

  • 发表日期：

    2026年

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  • Felix Bitzer,
  • Freya L. Schulte,
  • Theodor Rüber

摘要

Ictal single-photon emission computed tomography (SPECT) is an imaging technique used to identify the seizure-onset zone (SOZ) in epilepsy patients. It visualizes increased cerebral blood flow near the SOZ through radiopharmaceuticals injected shortly after seizure onset. This chapter outlines the principles and methodology of ictal SPECT, including setup, tracer injection, image acquisition, and evaluation. Although ictal SPECT is resource-intensive and involves radiation exposure, it offers valuable insights for epilepsy surgery. Its validity varies by seizure-onset location, showing higher localization success in temporal lobe epilepsy compared to extratemporal cases. While some studies question its added value in presurgical evaluations, ictal SPECT remains clinically relevant for well-selected individuals, particularly those with inconclusive presurgical findings or MRI-negative results.