{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:27:26Z","timestamp":1792801646175,"version":"4.5.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pharmacoresistant epilepsy affects around one-third of individuals with epilepsy, requiring precise diagnosis, particularly in cases where surgical resection of the epileptogenic zone (EZ) is an option. Functional imaging techniques, such as ictal-interictal subtraction SPECT coregistered to MRI (SISCOM), have proven useful in pre-surgical evaluation by improving EZ localization accuracy. However, the widespread use of SISCOM is limited by the high costs and technical complexity of commercial software. Statistical Parametric Mapping (SPM) has been demonstrated to be a viable alternative for SISCOM analysis, displaying the potential for cost-effective EZ localization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>In this retrospective study, we evaluated patients with pharmacoresistant temporal lobe epilepsy from two reference centers of epilepsy in Brazil, who underwent ictal and interictal SPECT imaging as part of their pre-surgical evaluation, achieving favorable outcomes (Engel I or II) after surgical resection. The EZ reference standard was determined according to anatomopathological findings and good clinical outcomes. SISCOM was performed using a semi-automated approach with Statistical Parametric Mapping (SPM) and a proprietary software \u2013 Analyze. Data from each method were compared to the EZ reference standard and classified as concordant, partially concordant, or discordant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 20 patients, 14 (70%) with left temporal lobe epilepsy and six (30%) with right temporal lobe epilepsy. Hippocampal sclerosis was the most common pathology (80%). Both SPM and Analyze were concordant with the EZ reference standard in 14 cases (70%), showing no difference in sensitivity between the methods. However, SPM generated smaller, more localized clusters, while Analyze produced larger clusters with broader spatial coverage. Concordance between the two methods was poor (Kappa\u202f=\u202f0.0179), reflecting methodological differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study evidences technical differences between SISCOM performed with SPM and Analyze, but with similar sensitivity (70%) for EZ localization. Further studies with larger sample sizes are required to confirm these findings. The data presented here suggest that SISCOM-SPM, due to its rapid and semi-automated workflow, may offer a practical and accessible alternative to proprietary software for epilepsy surgical planning.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1552774","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T04:12:07Z","timestamp":1744690327000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Quantitative SISCOM assessment for epileptogenic zone localization: insights from a multicenter study comparing two software platforms in temporal lobe epilepsy"],"prefix":"10.3389","volume":"16","author":[{"given":"Carla","family":"Oliveira Young","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brunno Machado","family":"de Campos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edna Marina","family":"de Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Querino","family":"Brunetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Julia de Oliveira Santos","family":"Gualberto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Alexandre-Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos Geraldo Merichelo","family":"de Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina Koutsodontis Machado","family":"Alvim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Cendes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elba","family":"Etchebehere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauro","family":"Wichert-Ana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e1rbara Juarez","family":"Amorim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2179","DOI":"10.1111\/epi.14596","article-title":"The epidemiology of drug-resistant epilepsy: a systematic review and meta-analysis","volume":"59","author":"Kalilani","year":"2018","journal-title":"Epilepsia"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1083775","DOI":"10.3389\/fneur.2022.1083775","article-title":"Nuclear imaging for localization and surgical outcome prediction in epilepsy: a review of latest discoveries and future perspectives","volume":"13","author":"Sukprakun","year":"2022","journal-title":"Front Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1038\/nrneurol.2010.131-c1","article-title":"Imaging epilepsy with SISCOM","volume":"7","author":"Bianchin","year":"2011","journal-title":"Nat Rev Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1002\/epi4.12373","article-title":"Subtraction ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy","volume":"5","author":"Foiadelli","year":"2020","journal-title":"Epilepsia Open"},{"key":"ref5","first-page":"285","article-title":"SPECT brain imaging in epilepsy: a meta-analysis","volume":"39","author":"Devous","year":"1998","journal-title":"J Nucl Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"14","DOI":"10.2967\/jnumed.112.114397","article-title":"The role of radionuclide imaging in epilepsy, part 1: sporadic temporal and Extratemporal lobe epilepsy","volume":"45","author":"Kumar","year":"2017","journal-title":"J Nucl Med Technol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.seizure.2016.06.024","article-title":"The role of SISCOM in preoperative evaluation for patients with epilepsy surgery: a meta-analysis","volume":"41","author":"Chen","year":"2016","journal-title":"Seizure"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1007\/s10278-021-00422-9","article-title":"MNI SISCOM: an open-source tool for computing subtraction ictal single-photon emission CT Coregistered to MRI","volume":"34","author":"Moreau","year":"2021","journal-title":"J Digit Imaging"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/j.remn.2015.05.002","article-title":"Perfusion SPECT, SISCOM and PET (18)F-FDG in the assessment of drug-refractory epilepsy patients candidates for epilepsy surgery","volume":"34","author":"Su\u00e1rez-Pi\u00f1era","year":"2015","journal-title":"Rev Esp Med Nucl Imagen Mol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s12149-009-0236-6","article-title":"Contribution of subtraction ictal SPECT coregistered to MRI to epilepsy surgery: a multicenter study","volume":"23","author":"Matsuda","year":"2009","journal-title":"Ann Nucl Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1668","DOI":"10.1212\/WNL.55.11.1668","article-title":"Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome","volume":"55","author":"O'brien","year":"2000","journal-title":"Neurology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.eplepsyres.2016.11.020","article-title":"The promise of subtraction ictal SPECT co-registered to MRI for improved seizure localization in pediatric epilepsies: affecting factors and relationship to the surgical outcome","volume":"129","author":"Stamoulis","year":"2017","journal-title":"Epilepsy Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1212\/WNL.50.2.445","article-title":"Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus","volume":"50","author":"O'Brien","year":"1998","journal-title":"Neurology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.3171\/2016.12.JNS161676","article-title":"A multimodal concept for invasive diagnostics and surgery based on neuronavigated voxel-based morphometric MRI postprocessing data in previously nonlesional epilepsy","volume":"128","author":"Delev","year":"2018","journal-title":"J Neurosurg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1111\/epi.12550","article-title":"ILAE official report: a practical clinical definition of epilepsy","volume":"55","author":"Fisher","year":"2014","journal-title":"Epilepsia"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1111\/epi.12910","article-title":"Correspondence between large-scale ictal and interictal epileptic networks revealed by single photon emission computed tomography (SPECT) and electroencephalography (EEG)-functional magnetic resonance imaging (fMRI)","volume":"56","author":"Tousseyn","year":"2015","journal-title":"Epilepsia"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1212\/WNL.0000000000000209","article-title":"Statistical SPECT processing in MRI-negative epilepsy surgery","volume":"82","author":"Sulc","year":"2014","journal-title":"Neurology"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1177\/1051228404268570","article-title":"Ictal single-photon emission computed tomography imaging in extra temporal lobe epilepsy using statistical parametric mapping","volume":"14","author":"Knowlton","year":"2004","journal-title":"J Neuroimaging"},{"key":"ref19","volume-title":"Statistical parametric mapping: the analysis of functional brain images","author":"Penny","year":"2011"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"467","DOI":"10.3389\/fneur.2020.00467","article-title":"Clinical usefulness of SISCOM-SPM compared to visual analysis to locate the epileptogenic zone","volume":"11","author":"Oliveira Young","year":"2020","journal-title":"Front Neurol"},{"key":"ref21","first-page":"258","article-title":"Multi-modal imaging in epilepsy: SPECT and PET","volume":"91","author":"Dupont","year":"2008","journal-title":"JBR-BTR"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s13550-018-0381-9","article-title":"On the optimal z-score threshold for SISCOM analysis to localize the ictal onset zone","volume":"8","author":"De Coster","year":"2018","journal-title":"EJNMMI"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1097\/01.rlu.0000249761.32486.5e","article-title":"Sphenoid sinus bleeding during generalized seizure: a rare SISCOM (subtraction ictal SPECT coregistered with MRI) finding mimicking skull base tumor","volume":"32","author":"Wichert-Ana","year":"2007","journal-title":"Clin Nucl Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1590\/s0004-282x2005000600014","article-title":"Statistical voxel-wise analysis of ictal SPECT reveals pattern of abnormal perfusion in patients with temporal lobe epilepsy","volume":"63","author":"Amorim","year":"2005","journal-title":"Arq Neuropsiquiatr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1590\/s0004-282x2010000200001","article-title":"Brain SPECT in mesial temporal lobe epilepsy: comparison between visual analysis and SPM","volume":"68","author":"Amorim","year":"2010","journal-title":"Arq Neuropsiquiatr"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1007\/s00259-007-0655-3","article-title":"Ictal technetium-99 m ethyl cysteinate dimer single-photon emission tomographic findings in epileptic patients with polymicrogyria syndromes: a subtraction of ictal-interictal SPECT coregistered to MRI study","volume":"35","author":"Wichert-Ana","year":"2008","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"167","DOI":"10.4103\/ijnm.IJNM_135_18","article-title":"The reperfusion of ischemic vasculitis in a patient with neuropsychiatric lupus: a serial single-photon emission computed tomography study","volume":"34","author":"Trevisan","year":"2019","journal-title":"Indian J Nucl Med"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1552774\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T04:12:09Z","timestamp":1744690329000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1552774\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,15]]},"references-count":27,"alternative-id":["10.3389\/fneur.2025.1552774"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1552774","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,15]]},"article-number":"1552774"}}