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Czarnetzki C, Spinelli L, Huppertz HJ, Schaller K, Momjian S, Lobrinus J, Vargas MI, Garibotto V, Vulliemoz S, Seeck M. Yield of non-invasive imaging in MRI-negative focal epilepsy. J Neurol 2024; 271:995-1003. [PMID: 37907727 PMCID: PMC10827933 DOI: 10.1007/s00415-023-11987-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The absence of MRI-lesion reduces considerably the probability of having an excellent outcome (International League Against Epilepsies [ILAE] class I-II) after epilepsy surgery. Surgical success in magnetic-resonance imaging (MRI)-negative cases relies therefore mainly on non-invasive techniques such as positron-emission tomography (PET), subtraction ictal/inter-ictal single-photon-emission-computed-tomography co-registered to MRI (SISCOM), electric source imaging (ESI) and morphometric MRI analysis (MAP). We were interested in identifying the optimal imaging technique or combination to achieve post-operative class I-II in patients with MRI-negative focal epilepsy. METHODS We identified 168 epileptic patients without MRI lesion. Thirty-three (19.6%) were diagnosed with unifocal epilepsy, underwent surgical resection and follow-up ⩾ 2 years. Sensitivity, specificity, predictive values, and diagnostic odds ratio (OR) were calculated for each technique individually and in combination (after co-registration). RESULTS 23/33 (70%) were free of disabling seizures (75.0% with temporal and 61.5% extratemporal lobe epilepsy). None of the individual modalities presented an OR > 1.5, except ESI if only patients with interictal epileptiform discharges (IEDs) were considered (OR 3.2). On a dual combination, SISCOM with ESI presented the highest outcome (OR = 6). MAP contributed to detecting indistinguishable focal cortical dysplasia in particular in extratemporal epilepsies with a sensitivity of 75%. Concordance of PET, ESI on interictal epileptic discharges, and SISCOM was associated with the highest chance for post-operative seizure control (OR = 11). CONCLUSION If MRI is negative, the chances to benefit from epilepsy surgery are almost as high as in lesional epilepsy, provided that multiple established non-invasive imaging tools are rigorously applied and co-registered together.
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Affiliation(s)
- Christian Czarnetzki
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Laurent Spinelli
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | | | - Karl Schaller
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Shahan Momjian
- Department of Clinical Neurosciences, Neurosurgery Clinic, University Hospital of Geneva, Geneva, Switzerland
| | - Johannes Lobrinus
- Department of Clinical Pathology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Maria-Isabel Vargas
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Valentina Garibotto
- Department of Radiology, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Margitta Seeck
- EEG & Epilepsy Unit, Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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Giraudo C, Carraro S, Zucchetta P, Cecchin D. Pediatric Imaging Using PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:625-636. [PMID: 37741646 DOI: 10.1016/j.mric.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
PET/MR imaging is a one-stop shop technique for pediatric diseases allowing not only an accurate clinical assessment of tumors at staging and restaging but also the diagnosis of neurologic, inflammatory, and infectious diseases in complex cases. Moreover, applying PET kinetic analyses and sequences such as diffusion-weighted imaging as well as quantitative analysis investigating the relationship between disease metabolic activity and cellularity can be applied. Complex radiomics analysis can also be performed.
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Affiliation(s)
- Chiara Giraudo
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Silvia Carraro
- Unit of Pediatric Allergy and Respiratory Medicine, Women's and Children's Health Department, University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Pietro Zucchetta
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Diego Cecchin
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy.
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Pedersen C, Aboian M, Messina SA, Daldrup-Link H, Franceschi AM. PET/MRI Applications in Pediatric Epilepsy. World J Nucl Med 2023; 22:78-86. [PMID: 37223623 PMCID: PMC10202574 DOI: 10.1055/s-0043-1764303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Epilepsy neuroimaging assessment requires exceptional anatomic detail, physiologic and metabolic information. Magnetic resonance (MR) protocols are often time-consuming necessitating sedation and positron emission tomography (PET)/computed tomography (CT) comes with a significant radiation dose. Hybrid PET/MRI protocols allow for exquisite assessment of brain anatomy and structural abnormalities, in addition to metabolic information in a single, convenient imaging session, which limits radiation dose, sedation time, and sedation events. Brain PET/MRI has proven especially useful for accurate localization of epileptogenic zones in pediatric seizure cases, providing critical additional information and guiding surgical decision making in medically refractory cases. Accurate localization of seizure focus is necessary to limit the extent of the surgical resection, preserve healthy brain tissue, and achieve seizure control. This review provides a systematic overview with illustrative examples demonstrating the applications and diagnostic utility of PET/MRI in pediatric epilepsy.
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Affiliation(s)
- Christian Pedersen
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Mariam Aboian
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Steven A. Messina
- Neuroradiology Division, Department of Radiology, Mayo Clinic Radiology, Rochester, Minnesota, United States
| | - Heike Daldrup-Link
- Department of Radiology and Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Ana M. Franceschi
- Neuroradiology Division, Department of Radiology, Northwell Health/Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
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Kim SJ, Nam H, Lee SA, Koo YS. Accuracy of predicting surgical outcomes using interictal electrical source imaging in patients with MRI-negative intractable epilepsy. Clin Neurol Neurosurg 2023; 229:107740. [PMID: 37119657 DOI: 10.1016/j.clineuro.2023.107740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE We investigated the accuracy of interictal electrical source imaging (II-ESI) in localizing the epileptogenic zone in MRI-negative epilepsy patients who underwent epilepsy surgery. We also aimed to compare II-ESI's utility with other presurgical investigations and its role in guiding intracranial electroencephalography (iEEG) planning. METHODS We retrospectively reviewed the medical records of patients with operated MRI-negative intractable epilepsy at our center between 2010 and 2016. All patients underwent video electroencephalography (EEG) monitoring, high-resolution MRI, 18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans, ictal single-photon emission computed tomography (SPECT) and intracranial EEG (iEEG) monitoring. We computed II-ESI following the visual identification of interictal spikes, and outcomes were determined using Engel's classification at 6 months after surgery. RESULTS Among 21 operated MRI-negative intractable epilepsy patients, 15 had sufficient data for II-ESI analysis. Of these, nine patients (60%) showed favorable outcomes corresponding to Engle's classification I and II. The localization accuracy of II-ESI was 53%, which was not significantly different from those of FDG-PET and ictal SPECT (47% and 45%, respectively). Among the patients, iEEG did not cover the areas suggested by II-ESIs in seven cases (47%). In two of those patients (29%), the regions indicated by II-ESIs were not resected, resulting in poor surgical outcomes. CONCLUSION This study demonstrates that the localization accuracy of II-ESI was comparable to ictal SPECT and the brain FDG-PET scan. II-ESI is a simple, noninvasive method for evaluating the epileptogenic zone and guiding iEEG planning in patients with MRI-negative epilepsy.
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Affiliation(s)
- Soo Jeong Kim
- Department of Neurology, Konkuk University Medical Center, Konkuk University College of Medicine, Seoul, Republic of Korea
| | - Hyojin Nam
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Seo Koo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Wang K, Wen Q, Wu D, Hsu YC, Heo HY, Wang W, Sun Y, Ma Y, Wu D, Zhang Y. Lateralization of temporal lobe epileptic foci with automated chemical exchange saturation transfer measurements at 3 Tesla. EBioMedicine 2023; 89:104460. [PMID: 36773347 PMCID: PMC9945641 DOI: 10.1016/j.ebiom.2023.104460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/17/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) is an indispensable tool for the diagnosis of temporal lobe epilepsy (TLE). However, about 30% of TLE patients show no lesion on structural MRI (sMRI-negative), posing a significant challenge for presurgical evaluation. This study aimed to investigate whether chemical exchange saturation transfer (CEST) MRI at 3 Tesla can lateralize the epileptic focus of TLE and study the metabolic contributors to the CEST signal measured. METHODS Forty TLE subjects (16 males and 24 females) were included in this study. An automated data analysis pipeline was established, including segmentation of the hippocampus and amygdala (HA), calculation of four CEST metrics and quantitative relaxation times (T1 and T2), and construction of prediction models by logistic regression. Furthermore, a modified two-stage Bloch-McConnell fitting method was developed to investigate the molecular imaging mechanism of 3 T CEST in identifying epileptic foci of TLE. FINDINGS The mean CEST ratio (CESTR) metric within 2.25-3.25 ppm in the HA was the most powerful index in predicting seizure laterality, with an area under the receiver-operating characteristic curve (AUC) of 0.84. And, the combination of T2 and CESTR further increased the AUC to 0.92. Amine and guanidinium moieties were the two leading contributors to the CEST contrast between the epileptogenic HA and the normal HA. INTERPRETATION CEST at 3 Tesla is a powerful modality that can predict seizure laterality with high accuracy. This study can potentially facilitate the clinical translation of CEST MRI in identifying the epileptic foci of TLE or other localization-related epilepsies. FUNDING National Natural Science Foundation of China, Science Technology Department of Zhejiang Province, and Zhejiang University.
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Affiliation(s)
- Kang Wang
- Epilepsy Center, Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Qingqing Wen
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, 310027, China
| | - Dengchang Wu
- Epilepsy Center, Department of Neurology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Yi-Cheng Hsu
- MR Collaboration, Siemens Healthcare Ltd., Shanghai, 201318, China
| | - Hye-Young Heo
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wenqi Wang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, 310027, China
| | - Yi Sun
- MR Collaboration, Siemens Healthcare Ltd., Shanghai, 201318, China
| | - Yuehui Ma
- Epilepsy Center, Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, 310027, China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, 310027, China.
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Flaus A, Deddah T, Reilhac A, Leiris ND, Janier M, Merida I, Grenier T, McGinnity CJ, Hammers A, Lartizien C, Costes N. PET image enhancement using artificial intelligence for better characterization of epilepsy lesions. Front Med (Lausanne) 2022; 9:1042706. [PMID: 36465898 PMCID: PMC9708713 DOI: 10.3389/fmed.2022.1042706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION [18F]fluorodeoxyglucose ([18F]FDG) brain PET is used clinically to detect small areas of decreased uptake associated with epileptogenic lesions, e.g., Focal Cortical Dysplasias (FCD) but its performance is limited due to spatial resolution and low contrast. We aimed to develop a deep learning-based PET image enhancement method using simulated PET to improve lesion visualization. METHODS We created 210 numerical brain phantoms (MRI segmented into 9 regions) and assigned 10 different plausible activity values (e.g., GM/WM ratios) resulting in 2100 ground truth high quality (GT-HQ) PET phantoms. With a validated Monte-Carlo PET simulator, we then created 2100 simulated standard quality (S-SQ) [18F]FDG scans. We trained a ResNet on 80% of this dataset (10% used for validation) to learn the mapping between S-SQ and GT-HQ PET, outputting a predicted HQ (P-HQ) PET. For the remaining 10%, we assessed Peak Signal-to-Noise Ratio (PSNR), Structural Similarity Index Measure (SSIM), and Root Mean Squared Error (RMSE) against GT-HQ PET. For GM and WM, we computed recovery coefficients (RC) and coefficient of variation (COV). We also created lesioned GT-HQ phantoms, S-SQ PET and P-HQ PET with simulated small hypometabolic lesions characteristic of FCDs. We evaluated lesion detectability on S-SQ and P-HQ PET both visually and measuring the Relative Lesion Activity (RLA, measured activity in the reduced-activity ROI over the standard-activity ROI). Lastly, we applied our previously trained ResNet on 10 clinical epilepsy PETs to predict the corresponding HQ-PET and assessed image quality and confidence metrics. RESULTS Compared to S-SQ PET, P-HQ PET improved PNSR, SSIM and RMSE; significatively improved GM RCs (from 0.29 ± 0.03 to 0.79 ± 0.04) and WM RCs (from 0.49 ± 0.03 to 1 ± 0.05); mean COVs were not statistically different. Visual lesion detection improved from 38 to 75%, with average RLA decreasing from 0.83 ± 0.08 to 0.67 ± 0.14. Visual quality of P-HQ clinical PET improved as well as reader confidence. CONCLUSION P-HQ PET showed improved image quality compared to S-SQ PET across several objective quantitative metrics and increased detectability of simulated lesions. In addition, the model generalized to clinical data. Further evaluation is required to study generalization of our method and to assess clinical performance in larger cohorts.
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Affiliation(s)
- Anthime Flaus
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France
- CERMEP-Life Imaging, Lyon, France
| | | | - Anthonin Reilhac
- Brain Health Imaging Centre, Center for Addiction and Mental Health (CAHMS), Toronto, ON, Canada
| | - Nicolas De Leiris
- Departement of Nuclear Medicine, CHU Grenoble Alpes, University Grenoble Alpes, Grenoble, France
- Laboratoire Radiopharmaceutiques Biocliniques, University Grenoble Alpes, INSERM, CHU Grenoble Alpes, Grenoble, France
| | - Marc Janier
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Thomas Grenier
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
| | - Colm J. McGinnity
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
| | - Alexander Hammers
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Carole Lartizien
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, CNRS, INSERM, CREATIS UMR 5220, Lyon, France
| | - Nicolas Costes
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR5292, Lyon, France
- CERMEP-Life Imaging, Lyon, France
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Combined [ 18F]FDG-PET with MRI structural patterns in predicting post-surgical seizure outcomes in temporal lobe epilepsy patients. Eur Radiol 2022; 32:8423-8431. [PMID: 35713664 DOI: 10.1007/s00330-022-08912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To integrate the glucose metabolism measured using [18F]FDG PET/CT and anatomical features measured using MRI to forecast the post-surgical seizure outcomes of intractable temporal lobe epilepsy. METHODS This retrospective study enrolled 63 patients with drug-resistant temporal lobe epilepsy. Z-transform of the patients' PET images based on comparison with a database of healthy controls, cortical thickness, and quantitative anisotropy (QA) of the diffusion spectrum imaging concordant/non-concordant with cortical resection was adopted to quantify their predictive values for the post-surgical seizure outcomes. RESULTS The PET hypometabolism region was concordant with the surgical field in 47 of the 63 patients. Forty-two patients were seizure-free post-surgery. The sensitivity and specificity of PET in predicting seizure freedom were 89.4% and 68.8%, respectively. Complete resection of foci with overlapped PET, cortical thickness, and QA abnormalities resulted in Engel I in 27 patients, which was a good predictor of seizure freedom with an odds ratio (OR) of 19.57 (95% CI 2.38-161.25, p = 0.006). Hypometabolism involved in multiple lobes (OR = 7.18, 95% CI 1.02-50.75, p = 0.048) and foci of hypometabolism with QA/cortical thickness abnormalities outside surgical field (OR = 14.72, 95% CI 2.13-101.56, p = 0.006) were two major predictors of Engel III/IV outcomes. ORs of QA to predict Engel I and seizure recurrence were 14.64 (95% CI 2.90-73.80, p = 0.001) and 12.01 (95% CI 2.91-49.65, p = 0.001), respectively. CONCLUSION Combined PET and structural pattern is helpful to predict the post-surgical seizure outcomes and worse outcomes of Engel III/IV. This might decrease unnecessary surgical injuries to patients who are potentially not amenable to surgery. KEY POINTS • A combined metabolic and structural pattern is helpful to predict the post-surgical seizure outcomes. • Favorable post-surgical seizure outcome was most likely reached in patients whose hypometabolism overlapped with the structural changes. • Hypometabolism in multiple lobes and QA or cortical thickness abnormalities outside the surgical field were predictors of worse seizure outcomes of Engel III/IV.
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Haemels M, Van Weehaeghe D, Cleeren E, Dupont P, van Loon J, Theys T, Van Laere K, Van Paesschen W, Goffin K. Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy. Acta Neurol Belg 2022; 122:325-335. [PMID: 33544336 DOI: 10.1007/s13760-020-01569-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/08/2020] [Indexed: 01/30/2023]
Abstract
The value of functional molecular changes outside the seizure onset zone as independent predictive factors of surgical outcome has been scarcely evaluated. The aim of this retrospective study was to evaluate relative metabolic and perfusion changes outside the seizure onset zone as predictors of postoperative outcome in patients with unifocal refractory focal epilepsy. Eighty-six unifocal epilepsy patients who underwent 18F-FDG PET prior to surgery were included. Ictal and interictal perfusion SPECT was available in 65 patients. Good postoperative outcome was defined as the International League against Epilepsy class 1. Using univariate statistical analysis, the predictive ability of volume-of-interest based relative metabolism/perfusion for outcome classification was quantified by AUC ROC-curve, using composite, unilateral cortical (frontal, orbitofrontal, temporal, parietal, occipital) and central volumes-of-interest. The results were cross-validated, and a false discovery rate (FDR) correction was applied. As a secondary objective, a subgroup analysis was performed on temporal lobe epilepsy patients (N = 64). Increased relative ictal perfusion in the contralateral central volume-of-interest was significantly associated with the good surgical outcome both in the total population (AUC 0.79, pFDR = 0.009) and the temporal lobe epilepsy subgroup (AUC 0.80, pFDR = 0.028). No other significant associations between functional molecular changes and postoperative outcome were found. Increased relative ictal perfusion in the contralateral central region significantly predicted outcome after epilepsy surgery in patients with refractory focal epilepsy. We postulate that these relative perfusion changes could be an expression of better preoperative neuronal network integration and centralization in the contralateral central structures, which is suggested to be associated with better postoperative outcome.
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Steinbrenner M, Duncan JS, Dickson J, Rathore C, Wächter B, Aygun N, Menon RN, Radhakrishnan A, Holtkamp M, Ilyas-Feldmann M. Utility of 18F-fluorodeoxyglucose positron emission tomography in presurgical evaluation of patients with epilepsy: A multicenter study. Epilepsia 2022; 63:1238-1252. [PMID: 35166379 DOI: 10.1111/epi.17194] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in presurgical assessment in patients with drug-resistant focal epilepsy (DRE) if magnetic resonance imaging (MRI) and scalp electroencephalography (EEG) do not localize the seizure onset zone or are discordant. METHODS In this multicenter, retrospective observational cohort study, we included consecutive patients with DRE who had undergone FDG-PET as part of their presurgical workup. We assessed the utility of FDG-PET, which was defined as contributing to the decision-making process to refer for resection or intracranial EEG (iEEG) or to conclude surgery was not feasible. RESULTS We included 951 patients in this study; 479 had temporal lobe epilepsy (TLE), 219 extratemporal epilepsy (ETLE), and 253 epilepsy of uncertain lobar origin. FDG-PET showed a distinct hypometabolism in 62% and was concordant with ictal EEG in 74% in TLE and in 56% in ETLE (p < .001). FDG-PET was useful in presurgical decision-making in 396 patients (47%) and most beneficial in TLE compared to ETLE (58% vs. 44%, p = .001). Overall, FDG-PET contributed to recommending resection in 78 cases (20%) and iEEG in 187 cases (47%); in 131 patients (33%), FDG-PET resulted in a conclusion that resection was not feasible. In TLE, seizure-freedom 1 year after surgery did not differ significantly (p = .48) between patients with negative MRI and EEG-PET concordance (n = 30, 65%) and those with positive MRI and concordant EEG (n = 46, 68%). In ETLE, half of patients with negative MRI and EEG-PET concordance and three quarters with positive MRI and concordant EEG were seizure-free postsurgery (n = 5 vs. n = 6, p = .28). SIGNIFICANCE This is the largest reported cohort of patients with DRE who received presurgical FDG-PET, showing that FDG-PET is a useful diagnostic tool. MRI-negative and MRI-positive cases with concordant FDG-PET results (with either EEG or MRI) had a comparable outcome after surgery. These findings confirm the significance of FDG-PET in presurgical epilepsy diagnostics.
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Affiliation(s)
- Mirja Steinbrenner
- Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK
| | - John Dickson
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah (SBKS) Medical College, Sumandeep Vidyapeeth, Vadodara, India
| | - Bettina Wächter
- Epilepsy Center Berlin-Brandenburg, Evangelische Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Nafi Aygun
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Martin Holtkamp
- Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Epilepsy Center Berlin-Brandenburg, Evangelische Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Maria Ilyas-Feldmann
- Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
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10
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Wang ZM, Wei PH, Zhang M, Wu C, Shan Y, Yeh FC, Shan Y, Lu J. Diffusion spectrum imaging predicts hippocampal sclerosis in mesial temporal lobe epilepsy patients. Ann Clin Transl Neurol 2022; 9:242-252. [PMID: 35166461 PMCID: PMC8935311 DOI: 10.1002/acn3.51503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives Epileptic patients suffer from seizure recurrence after surgery due to the challenging localization. Improvement of the noninvasive imaging‐based approach for a better definition of the abnormalities would be helpful for a better outcome. Methods The quantitative anisotropy (QA) of diffusion spectrum imaging (DSI) is a quantitative scalar of evaluating the water diffusivity. Herein, we investigated the association between neuronal diameters or density acquired in literature and QA of DSI as well as the seizure localization in temporal lobe epilepsy. Thirty healthy controls (HCs) and 30 patients with hippocampal sclerosis (HS) were retrospectively analyzed. QA values were calculated and interactively compared between the areas with different neuronal diameter/density acquired from literature in the HCP‐1021 template. Diagnostic tests were performed on Z‐transformed asymmetry indices (AIs) of QA (which exclude physical asymmetry) among HS patients to evaluate its clinical value. Results The QA values in HCs conformed with different pyramidal cell distributions ranged from giant to small; corresponding groups were the motor‐sensory, associative, and limbic groups, respectively. Additionally, the QA value was correlated with the neuronal diameter/density in cortical layer IIIc (correlation coefficient with diameter: 0.529, p = 0.035; density: −0.678, p = 0.011). Decreases in cingulum hippocampal segments (Chs) were consistently observed on the sclerosed side in patients. The area under the curve of the Z‐transformed AI in Chs to the lateralization of HS was 0.957 (sensitivity: 0.909, specificity: 0.895). Interpretation QA based on DSI is likely to be useful to provide information to reflect the neuronal diameter/density and further facilitate localization of epileptic tissues.
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Affiliation(s)
- Zhen-Ming Wang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Peng-Hu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Miao Zhang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Chunxue Wu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yi Shan
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
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11
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Kumar A, Shandal V, Juhász C, Chugani HT. PET imaging in epilepsy. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Frazzini V, Cousyn L, Navarro V. Semiology, EEG, and neuroimaging findings in temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:489-518. [PMID: 35964989 DOI: 10.1016/b978-0-12-823493-8.00021-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy. First descriptions of TLE date back in time and detailed portraits of epileptic seizures of temporal origin can be found in early medical reports as well as in the works of various artists and dramatists. Depending on the seizure onset zone, several subtypes of TLE have been identified, each one associated with peculiar ictal semiology. TLE can result from multiple etiological causes, ranging from genetic to lesional ones. While the diagnosis of TLE relies on detailed analysis of clinical as well as electroencephalographic (EEG) features, the lesions responsible for seizure generation can be highlighted by multiple brain imaging modalities or, in selected cases, by genetic investigations. TLE is the most common cause of refractory epilepsy and despite the great advances in diagnostic tools, no lesion is found in around one-third of patients. Surgical treatment is a safe and effective option, requiring presurgical investigations to accurately identify the seizure onset zone (SOZ). In selected cases, presurgical investigations need intracerebral investigations (such as stereoelectroencephalography) or dedicated metabolic imaging techniques (interictal PET and ictal SPECT) to correctly identify the brain structures to be removed.
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Affiliation(s)
- Valerio Frazzini
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Louis Cousyn
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Vincent Navarro
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France.
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13
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Guedj E, Varrone A, Boellaard R, Albert NL, Barthel H, van Berckel B, Brendel M, Cecchin D, Ekmekcioglu O, Garibotto V, Lammertsma AA, Law I, Peñuelas I, Semah F, Traub-Weidinger T, van de Giessen E, Van Weehaeghe D, Morbelli S. EANM procedure guidelines for brain PET imaging using [ 18F]FDG, version 3. Eur J Nucl Med Mol Imaging 2021; 49:632-651. [PMID: 34882261 PMCID: PMC8803744 DOI: 10.1007/s00259-021-05603-w] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022]
Abstract
The present procedural guidelines summarize the current views of the EANM Neuro-Imaging Committee (NIC). The purpose of these guidelines is to assist nuclear medicine practitioners in making recommendations, performing, interpreting, and reporting results of [18F]FDG-PET imaging of the brain. The aim is to help achieve a high-quality standard of [18F]FDG brain imaging and to further increase the diagnostic impact of this technique in neurological, neurosurgical, and psychiatric practice. The present document replaces a former version of the guidelines that have been published in 2009. These new guidelines include an update in the light of advances in PET technology such as the introduction of digital PET and hybrid PET/MR systems, advances in individual PET semiquantitative analysis, and current broadening clinical indications (e.g., for encephalitis and brain lymphoma). Further insight has also become available about hyperglycemia effects in patients who undergo brain [18F]FDG-PET. Accordingly, the patient preparation procedure has been updated. Finally, most typical brain patterns of metabolic changes are summarized for neurodegenerative diseases. The present guidelines are specifically intended to present information related to the European practice. The information provided should be taken in the context of local conditions and regulations.
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Affiliation(s)
- Eric Guedj
- APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Aix Marseille Univ, Marseille, France. .,Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone, 264 rue Saint Pierre, 13005, Marseille, France.
| | - Andrea Varrone
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Healthcare Services, Stockholm, Sweden
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University, Leipzig, Germany
| | - Bart van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany.,German Centre of Neurodegenerative Diseases (DZNE), Site Munich, Bonn, Germany
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Ozgul Ekmekcioglu
- Sisli Hamidiye Etfal Education and Research Hospital, Nuclear Medicine Dept., University of Health Sciences, Istanbul, Turkey
| | - Valentina Garibotto
- NIMTLab, Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Iván Peñuelas
- Department of Nuclear Medicine, Clinica Universidad de Navarra, IdiSNA, University of Navarra, Pamplona, Spain
| | - Franck Semah
- Nuclear Medicine Department, University Hospital, Lille, France
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.,Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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14
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Bacon EJ, Jin C, He D, Hu S, Wang L, Li H, Qi S. Epileptogenic Zone Localization in Refractory Epilepsy by FDG-PET: The Comparison of SPM and SPM-CAT With Different Parameter Settings. Front Neurol 2021; 12:724680. [PMID: 34690915 PMCID: PMC8529991 DOI: 10.3389/fneur.2021.724680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Refractory epilepsy is a complex case of epileptic disease. The quantitative analysis of fluorodeoxyglucose positron emission tomography (FDG-PET) images complements visual assessment and helps localize the epileptogenic zone (EZ) for better curative treatment. Statistical parametric mapping (SPM) and its computational anatomy toolbox (SPM-CAT) are two commonly applied tools in neuroimaging analysis. This study compares SPM and SPM-CAT with different parameters to find the optimal approach for localizing EZ in refractory epilepsy. The current study enrolled 45 subjects, including 25 refractory epilepsy patients and 20 healthy controls. All of the 25 patients underwent surgical operations. Pathological results and the postoperative outcome evaluation by the Engel scale were likewise presented. SPM and SPM-CAT were used to assess FDG-PET images with three different uncorrected p-values and the corresponding cluster sizes (k), as in voxels in the cluster, namely p < 0.0002, k > 25; p < 0.001, k > 100; p < 0.005, and k > 200. When combining three settings, SPM and SPM-CAT yielded overall positive finding scores of 96.0% (24/25) and 100.0% (25/25) respectively. However, for the individual setting, SPM-CAT achieved the diverse positive finding scores of 96.0% (24/25), 96.0% (24/25), and 88.0% (22/24), which are higher than those of SPM [88.0% (22/25), 76.0% (19/25), and 72.0% (18/25)]. SPM and SPM-CAT localized EZ correctly with 28.0% (7/25) and 64.0% (16/25), respectively. SPM-CAT with parameter settings p < 0.0002 and k > 25 yielded a correct localization at 56.0% (14/25), which is slightly higher than that for the other two settings (48.0 and 20.0%). Moderate concordance was found between the confirmed and pre-surgical EZs, identified by SPM-CAT (kappa value = 0.5). Hence, SPM-CAT is more efficient than SPM in localizing EZ for refractory epilepsy by quantitative analysis of FDG-PET images. SPM-CAT with the setting of p < 0.0002 and k > 25 might perform as an objective complementary tool to the visual assessment for EZ localization.
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Affiliation(s)
- Eric Jacob Bacon
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.,Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
| | - Chaoyang Jin
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Dianning He
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Shuaishuai Hu
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lanbo Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Han Li
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.,Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
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15
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Sepehrizadeh T, Jong I, DeVeer M, Malhotra A. PET/MRI in paediatric disease. Eur J Radiol 2021; 144:109987. [PMID: 34649143 DOI: 10.1016/j.ejrad.2021.109987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
Nuclear medicine and molecular imaging have a small but growing role in the management of paediatric and neonatal diseases. During the past decade, combined PET/MRI has emerged as a clinically important hybrid imaging modality in paediatric medicine due to diagnostic advantages and reduced radiation exposure compared to alternative techniques. The applications for nuclear medicine, radiopharmaceuticals and combined PET/MRI in paediatric diagnosis is broadly similar to adults, however there are some key differences. There are a variety of clinical applications for PET/MRI imaging in children including, but not limited to, oncology, neurology, cardiovascular, infection and chronic inflammatory diseases, and in renal-urological disorders. In this article, we review the applications of PET/MRI in paediatric and neonatal imaging, its current role, advantages and disadvantages over other hybrid imaging techniques such as PET/CT, and its future applications. Overall, PET/MRI is a powerful imaging technology in diagnostic medicine and paediatric diseases. Higher soft tissue contrasts and lower radiation dose of the MRI makes it the superior technology compared to other conventional techniques such as PET/CT or scintigraphy. However, this relatively new hybrid imaging has also some limitations. MRI based attenuation correction remains a challenge and although methodologies have improved significantly in the last decades, most remain under development.
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Affiliation(s)
| | - Ian Jong
- Department of diagnostic imaging, Monash Health, Melbourne, Australia
| | - Michael DeVeer
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
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16
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Wu D, Yang L, Gong G, Zheng Y, Jin C, Qi L, Li Y, Wu D, Cui Z, He X, Ren L. Characterizing the hyper- and hypometabolism in temporal lobe epilepsy using multivariate machine learning. J Neurosci Res 2021; 99:3035-3046. [PMID: 34498762 DOI: 10.1002/jnr.24951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/21/2021] [Accepted: 08/07/2021] [Indexed: 11/08/2022]
Abstract
Mesial temporal lobe epilepsy (MTLE) is the most common type of focal epilepsy, presenting both structural and metabolic abnormalities in the ipsilateral mesial temporal lobe. While it has been demonstrated that the metabolic abnormalities in MTLE actually extend beyond the epileptogenic zone, how such multidimensional information is associated with the diagnosis of MTLE remains to be tested. Here, we explore the whole-brain metabolic patterns in 23 patients with MTLE and 24 healthy controls using [18 F]fluorodeoxyglucose PET imaging. Based on a multivariate machine learning approach, we demonstrate that the brain metabolic patterns can discriminate patients with MTLE from controls with a superior accuracy (>95%). Importantly, voxels showing the most extreme contributing weights to the classification (i.e., the most important regional predictors) distribute across both hemispheres, involving both ipsilateral negative weights over the anterior part of lateral and medial temporal lobe, posterior insula, and lateral orbital frontal gyrus, and contralateral positive weights over the anterior frontal lobe, temporal lobe, and lingual gyrus. Through region-of-interest analyses, we verify that in patients with MTLE, the negatively weighted regions are hypometabolic, and the positively weighted regions are hypermetabolic, compared to controls. Interestingly, despite that both hypo- and hypermetabolism have mutually contributed to our model, they may reflect different pathological and/or compensative responses. For instance, patients with earlier age at epilepsy onset present greater hypometabolism in the ipsilateral inferior temporal gyrus, while we find no evidence of such association with hypermetabolism. In summary, quantitative models utilizing multidimensional brain metabolic information may provide additional assistance to presurgical workups in TLE.
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Affiliation(s)
- Dongyan Wu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Liyuan Yang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Gaolang Gong
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yumin Zheng
- Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chaoling Jin
- Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Lei Qi
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanran Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Di Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zaixu Cui
- Chinese Institute for Brain Research, Beijing, China
| | - Xiaosong He
- Department of Psychology, University of Science and Technology of China, Hefei, China
| | - Liankun Ren
- Comprehensive Epilepsy Center of Beijing, The Beijing Key Laboratory of Neuromodulation, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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17
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Li Y, Zhu H, Chen Q, Yang L, Bao X, Chen F, Ma H, Xu H, Luo L, Zhang R. Evaluation of Brain Network Properties in Patients with MRI-Negative Temporal Lobe Epilepsy: An MEG Study. Brain Topogr 2021; 34:618-631. [PMID: 34173926 DOI: 10.1007/s10548-021-00856-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
Abnormal functional brain networks of temporal lobe epilepsy (TLE) patients with structural abnormalities may partially reflect structural lesions rather than either TLE per se or functional compensatory processes. In this study, we sought to investigate the brain-network properties of intractable TLE patients apart from the effects of structural abnormalities. The brain network properties of 20 left and 23 right MRI-negative TLE patients and 22 healthy controls were evaluated using magnetoencephalographic recordings in six main frequency bands. A slowing of oscillatory brain activity was observed for the left or right TLE group vs. healthy controls. The TLE groups presented significantly increased functional connectivity in the delta, theta, lower alpha and beta bands, and significantly greater values in the normalized clustering coefficient and path length, and significantly smaller values in the weighted small-world measure in the theta band when compared to healthy controls. Alterations in global and regional band powers can be attributed to spectral slowing in TLE patients. The brain networks of TLE patients displayed abnormally high synchronization in multi-frequency bands and shifted toward a more regular architecture with worse network efficiency in the theta band. Without the contamination of structural lesions, these significant findings can be helpful for better understanding of the pathophysiological mechanism of TLE. The theta band can be considered as a preferred frequency band for investigating the brain-network dysfunction of MRI-negative intractable TLE patients.
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Affiliation(s)
- Yuejun Li
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
- Department of Magnetoencephalography, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Haitao Zhu
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Qiqi Chen
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
- Department of Magnetoencephalography, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Lu Yang
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Xincai Bao
- Library of Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Fangqing Chen
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Haiyan Ma
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Honghao Xu
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Lei Luo
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Rui Zhang
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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18
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18 F-FDG-PET hypometabolic pattern reveals multifocal epileptic foci despite limited unique stereotyped seizures. Epilepsy Res 2021; 172:106589. [PMID: 33640665 DOI: 10.1016/j.eplepsyres.2021.106589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Interictal positron emission tomography (PET) with 18F-FDG has largely proved its utility in presurgical evaluation of drug-resistant epilepsies (DRE) and in the surgical outcomes. Interictal hypometabolism topography is related to the neuronal networks involved in the seizure onset zone (SOZ) and spread pathways. 18F-FDG PET has a good prognostic value for post-surgical outcome, especially in cases with unique focal ictal semiology and a limited extent of hypometabolism. Surprisingly few patients have similar limited ictal features but extended hypometabolism. The objective of this study is to show that stereoelectro encephalography (SEEG) provides an explanation for this large hypometabolism, which impacts the surgical strategy. METHODS A cohort of 248 patients underwent 18F-FDG PET and SEEG to explore for refractory epilepsy in two close tertiary epilepsy centers between January 2009 and December 2017. From this cohort, a subset of patients was selected with extended PET metabolism despite showing unique and limited ictal features in scalp EEG. The surgical outcome of this subset of patients has been analysed with respect to their FDG-PET and SEEG to understand the relationship between PET/SEEG/ presentation and surgical outcome. RESULTS We report a series of seven patients with DRE and unique stereotyped ictal semiology but extensive 18F-FDG-PET hypometabolism revealing unexpected multifocal SOZ using SEEG. All SOZ were encompassed by the hypometabolic area. CONCLUSION Our results demonstrate the necessity of accounting for the discrepancy between limited symptoms and widespread hypometabolism which can reveal multifocal SOZ. In those patients, surgical possibilities should be considered carefully.
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19
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Poirier SE, Kwan BYM, Jurkiewicz MT, Samargandy L, Iacobelli M, Steven DA, Lam Shin Cheung V, Moran G, Prato FS, Thompson RT, Burneo JG, Anazodo UC, Thiessen JD. An evaluation of the diagnostic equivalence of 18F-FDG-PET between hybrid PET/MRI and PET/CT in drug-resistant epilepsy: A pilot study. Epilepsy Res 2021; 172:106583. [PMID: 33636504 DOI: 10.1016/j.eplepsyres.2021.106583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Hybrid PET/MRI may improve detection of seizure-onset zone (SOZ) in drug-resistant epilepsy (DRE), however, concerns over PET bias from MRI-based attenuation correction (MRAC) have limited clinical adoption of PET/MRI. This study evaluated the diagnostic equivalency and potential clinical value of PET/MRI against PET/CT in DRE. MATERIALS AND METHODS MRI, FDG-PET and CT images (n = 18) were acquired using a hybrid PET/MRI and a CT scanner. To assess diagnostic equivalency, PET was reconstructed using MRAC (RESOLUTE) and CT-based attenuation correction (CTAC) to generate PET/MRI and PET/CT images, respectively. PET/MRI and PET/CT images were compared qualitatively through visual assessment and quantitatively through regional standardized uptake value (SUV) and z-score assessment. Diagnostic accuracy and sensitivity of PET/MRI and PET/CT for SOZ detection were calculated through comparison to reference standards (clinical hypothesis and histopathology, respectively). RESULTS Inter-reader agreement in visual assessment of PET/MRI and PET/CT images was 78 % and 81 %, respectively. PET/MRI and PET/CT were strongly correlated in mean SUV (r = 0.99, p < 0.001) and z-scores (r = 0.92, p < 0.001) across all brain regions. MRAC SUV bias was <5% in most brain regions except the inferior temporal gyrus, temporal pole, and cerebellum. Diagnostic accuracy and sensitivity were similar between PET/MRI and PET/CT (87 % vs. 85 % and 83 % vs. 83 %, respectively). CONCLUSION We demonstrate here that PET/MRI with optimal MRAC can yield similar diagnostic performance as PET/CT. Nevertheless, further exploration of the potential added value of PET/MRI is necessary before clinical adoption of PET/MRI for epilepsy imaging.
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Affiliation(s)
- Stefan E Poirier
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Benjamin Y M Kwan
- Department of Diagnostic Radiology, Queen's University, Kingston, ON, Canada
| | - Michael T Jurkiewicz
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lina Samargandy
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Maryssa Iacobelli
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada
| | - David A Steven
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Victor Lam Shin Cheung
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Frank S Prato
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - R Terry Thompson
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Udunna C Anazodo
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Research Centre for Studies in Aging, McGill University, Montréal, QC, Canada.
| | - Jonathan D Thiessen
- Lawson Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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20
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Pattern analysis of glucose metabolic brain data for lateralization of MRI-negative temporal lobe epilepsy. Epilepsy Res 2020; 167:106474. [PMID: 32992074 DOI: 10.1016/j.eplepsyres.2020.106474] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022]
Abstract
In this paper, we assessed the reliability of glucose metabolic brain data for identifying lateralization of magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE) patients. We designed and developed an efficacious and automatic metabolic-wise lateralization framework. The proposed lateralization framework comprises three main systematic levels. In the first stage of our investigation, we pre-processed interictal fluorodeoxyglucose positron emission tomography images to extract glucose metabolic brain data. In the second stage, we used a voxel selection method involving a feature-ranking strategy to select the most discriminative metabolic voxels. Finally, we used a support vector machine followed by a 10-fold cross-validation strategy to assess the proposed lateralization framework in 27 patients with right MRI-negative TLE and 29 patients with left MRI-negative TLE. The proposed lateralization framework achieved an excellent accuracy of 96.43 % concordance with experienced PET interpreter. Thus, we show that pattern analysis of glucose metabolic brain data can accurately lateralize MRI-negative TLE patients in the clinical setting.
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21
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Arifin MT, Bakhtiar Y, Andar EBPS, Kurnia B H, Priambada D, Risdianto A, Kusnarto G, Tsaniadi K, Bunyamin J, Hanaya R, Arita K, Bintoro AC, Iida K, Kurisu K, Askoro R, Briliantika SP, Muttaqin Z. Surgery for Radiologically Normal-Appearing Temporal Lobe Epilepsy in a Centre with Limited Resources. Sci Rep 2020; 10:8144. [PMID: 32424296 PMCID: PMC7235248 DOI: 10.1038/s41598-020-64968-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/27/2020] [Indexed: 11/08/2022] Open
Abstract
Approximately 26-30% of temporal lobe epilepsy (TLE) cases display a normal-appearing magnetic resonance image (MRI) leading to difficulty in determining the epileptogenic focus. This causes challenges in surgical management, especially in countries with limited resources. The medical records of 154 patients with normal-appearing MRI TLE who underwent epilepsy surgery between July 1999 and July 2019 in our epilepsy centre in Indonesia were examined. The primary outcome was the Engel classification of seizures. Anterior temporal lobectomy was performed in 85.1% of the 154 patients, followed by selective amygdalo-hippocampectomy and resection surgery. Of 82 patients (53.2%), Engel Class I result was reported in 69.5% and Class II in 25.6%. The median seizure-free period was 13 (95% CI,12.550-13.450) years, while the seizure-free rate at 5 and 12 years follow-up was 96.3% and 69.0%, respectively. Patients with a sensory aura had better seizure-free outcome 15 (11.575-18.425) years. Anterior temporal lobectomy and selective amygdala-hippocampectomy gave the same favourable outcome. Despite the challenges of surgical procedures for normal MRI TLE, our outcome has been favourable. This study suggests that epilepsy surgery in normal MRI TLE can be performed in centres with limited resources.
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Affiliation(s)
- Muhamad Thohar Arifin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia.
| | - Yuriz Bakhtiar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Erie B P S Andar
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Happy Kurnia B
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Dody Priambada
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Ajid Risdianto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Gunadi Kusnarto
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Krisna Tsaniadi
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Jacob Bunyamin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Aris Catur Bintoro
- Department of Neurology, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Rofat Askoro
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Surya P Briliantika
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
| | - Zainal Muttaqin
- Department of Neurosurgery, Faculty of Medicine, Diponegoro University, Jl Prof. Soedarto, Tembalang, Semarang, Jawa Tengah, Indonesia
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22
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Schäfer JF, Tsiflikas I, Esser M, Dittmann H, Bender B, Gatidis S. Kombinierte Positronenemissions-Magnetresonanztomographie (PET/MRT) bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00889-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Avendaño-Estrada A, Velasco F, Velasco AL, Cuellar-Herrera M, Saucedo-Alvarado PE, Marquez-Franco R, Rivera-Bravo B, Ávila-Rodríguez MA. Quantitative Analysis of [18F]FFMZ and [18F]FDG PET Studies in the Localization of Seizure Onset Zone in Drug-Resistant Temporal Lobe Epilepsy. Stereotact Funct Neurosurg 2019; 97:232-240. [PMID: 31722358 DOI: 10.1159/000503692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Positron emission tomography (PET) imaging in epilepsy is an in vivo technique that allows the localization of a possible seizure onset zone (SOZ) during the interictal period. Stereo-electro-encephalography (SEEG) is the gold standard to define the SOZ. The objective of this research was to evaluate the accuracy of PET imaging in localizing the site of SOZ compared with SEEG. METHODS Seven patients with refractory temporal lobe epilepsy (Ep) and 2 healthy controls (HC) underwent 2 PET scans, one with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) and another with 2'-[18F]fluoroflumazenil (FFMZ), acquired 1 day apart. FDG was acquired for 10 min (static scan) 1 h after administration. An FFMZ scan was acquired for 60 min from radiopharmaceutical administration in a dynamic mode. Each brain PET image was segmented using a standard template implemented in PMOD 3.8. The pons was used as the reference region for modeling of the nondisplaceable binding potential (BPND)for FFMZ, and to obtain uptake ratios for FDG. SEEG studies of patients were performed as a part of their surgical evaluation to define the SOZ. RESULTS Well-defined differences between HC and Ep were found with both radiopharmaceuticals, showing the utility to identify abnormal brain regions using quantitative PET imaging. Lateralization of the SOZ findings by PET (lower uptake/binding in a specific brain hemisphere) matched in 86% for FFMZ and 71% for FDG with SEEG data. CONCLUSION Quantitative PET imaging is an excellent complementary tool that matches reasonably well with SEEG to define SOZ in presurgical evaluation.
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Affiliation(s)
- Arturo Avendaño-Estrada
- Unidad Radiofarmacia-Ciclotrón, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Francisco Velasco
- Unit for Stereotactic and Functional Neurosurgery, Hospital General de México, Mexico City, Mexico
| | - Ana Luisa Velasco
- Unit for Stereotactic and Functional Neurosurgery, Hospital General de México, Mexico City, Mexico
| | - Manola Cuellar-Herrera
- Unit for Stereotactic and Functional Neurosurgery, Hospital General de México, Mexico City, Mexico
| | - Pablo E Saucedo-Alvarado
- Unit for Stereotactic and Functional Neurosurgery, Hospital General de México, Mexico City, Mexico
| | - Rene Marquez-Franco
- Unit for Stereotactic and Functional Neurosurgery, Hospital General de México, Mexico City, Mexico
| | - Belen Rivera-Bravo
- Unidad PET/CT, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Miguel A Ávila-Rodríguez
- Unidad Radiofarmacia-Ciclotrón, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico,
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24
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Baumgartner C, Koren JP, Britto-Arias M, Zoche L, Pirker S. Presurgical epilepsy evaluation and epilepsy surgery. F1000Res 2019; 8. [PMID: 31700611 PMCID: PMC6820825 DOI: 10.12688/f1000research.17714.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/21/2022] Open
Abstract
With a prevalence of 0.8 to 1.2%, epilepsy represents one of the most frequent chronic neurological disorders; 30 to 40% of patients suffer from drug-resistant epilepsy (that is, seizures cannot be controlled adequately with antiepileptic drugs). Epilepsy surgery represents a valuable treatment option for 10 to 50% of these patients. Epilepsy surgery aims to control seizures by resection of the epileptogenic tissue while avoiding neuropsychological and other neurological deficits by sparing essential brain areas. The most common histopathological findings in epilepsy surgery specimens are hippocampal sclerosis in adults and focal cortical dysplasia in children. Whereas presurgical evaluations and surgeries in patients with mesial temporal sclerosis and benign tumors recently decreased in most centers, non-lesional patients, patients requiring intracranial recordings, and neocortical resections increased. Recent developments in neurophysiological techniques (high-density electroencephalography [EEG], magnetoencephalography, electrical and magnetic source imaging, EEG-functional magnetic resonance imaging [EEG-fMRI], and recording of pathological high-frequency oscillations), structural magnetic resonance imaging (MRI) (ultra-high-field imaging at 7 Tesla, novel imaging acquisition protocols, and advanced image analysis [post-processing] techniques), functional imaging (positron emission tomography and single-photon emission computed tomography co-registered to MRI), and fMRI significantly improved non-invasive presurgical evaluation and have opened the option of epilepsy surgery to patients previously not considered surgical candidates. Technical improvements of resective surgery techniques facilitate successful and safe operations in highly delicate brain areas like the perisylvian area in operculoinsular epilepsy. Novel less-invasive surgical techniques include stereotactic radiosurgery, MR-guided laser interstitial thermal therapy, and stereotactic intracerebral EEG-guided radiofrequency thermocoagulation.
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Affiliation(s)
- Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Johannes P Koren
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Martha Britto-Arias
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Lea Zoche
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Susanne Pirker
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
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25
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Mayoral M, Niñerola-Baizán A, Marti-Fuster B, Donaire A, Perissinotti A, Rumià J, Bargalló N, Sala-Llonch R, Pavia J, Ros D, Carreño M, Pons F, Setoain X. Epileptogenic Zone Localization With 18FDG PET Using a New Dynamic Parametric Analysis. Front Neurol 2019; 10:380. [PMID: 31057476 PMCID: PMC6478660 DOI: 10.3389/fneur.2019.00380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/28/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: [18F]fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is part of the regular preoperative work-up in medically refractory epilepsy. As a complement to visual evaluation of PET, statistical parametric maps can help in the detection of the epileptogenic zone (EZ). However, software packages currently available are time-consuming and little intuitive for physicians. We develop a user-friendly software (referred as PET-analysis) for EZ localization in PET studies that allows dynamic real-time statistical parametric analysis. To evaluate its performance, the outcome of PET-analysis was compared with the results obtained by visual assessment and Statistical Parametric Mapping (SPM). Methods: Thirty patients with medically refractory epilepsy who underwent presurgical 18F-FDG PET with good post-operative outcomes were included. The 18F-FDG PET studies were evaluated by visual assessment, with SPM8 and PET-analysis. In SPM, parametric T-maps were thresholded at corrected p < 0.05 and cluster size k = 50 and at uncorrected p < 0.001 and k = 100 (the most used parameters in the literature). Since PET-analysis rapidly processes different threshold combinations, T-maps were thresholded with multiple p-value and different clusters sizes. The presurgical EZ identified by visual assessment, SPM and PET-analysis was compared to the confirmed EZ according to post-surgical follow-up. Results: PET-analysis obtained 66.7% (20/30) of correctly localizing studies, comparable to the 70.0% (21/30) achieved by visual assessment and significantly higher (p < 0.05) than that obtained with the SPM threshold p < 0.001/k = 100, of 36.7% (11/30). Only one study was positive, albeit non-localizing, with the SPM threshold corrected p < 0.05/k = 50. Concordance was substantial for PET-analysis (κ = 0.643) and visual interpretation (κ = 0.622), being fair for SPM (κ = 0.242). Conclusion: Compared to SPM with the fixed standard parameters, PET-analysis may be superior in EZ localization with its easy and rapid processing of different threshold combinations. The results of this initial proof-of-concept study validate the clinical use of PET-analysis as a robust objective complementary tool to visual assessment for EZ localization.
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Affiliation(s)
- Maria Mayoral
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| | - Aida Niñerola-Baizán
- Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,Biophysics and Bioengineering Unit, Biomedicine Department, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Berta Marti-Fuster
- Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,Biophysics and Bioengineering Unit, Biomedicine Department, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Antonio Donaire
- Neurology Department, Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Jordi Rumià
- Neurosurgery Department, Hospital Clínic, Barcelona, Spain
| | - Núria Bargalló
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Roser Sala-Llonch
- Biophysics and Bioengineering Unit, Biomedicine Department, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Javier Pavia
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain.,Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Domènec Ros
- Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,Biophysics and Bioengineering Unit, Biomedicine Department, School of Medicine, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Mar Carreño
- Neurology Department, Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Francesca Pons
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Xavier Setoain
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain.,Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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26
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18F-FDG in the presurgical evaluation of epilepsies: a pictorial essay. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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27
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Tsougos I, Kousi E, Georgoulias P, Kapsalaki E, Fountas KN. Neuroimaging methods in Epilepsy of Temporal Origin. Curr Med Imaging 2018; 15:39-51. [DOI: 10.2174/1573405613666170622114920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/04/2017] [Accepted: 05/11/2017] [Indexed: 11/22/2022]
Abstract
Background:
Temporal Lobe Epilepsy (TLE) comprises the most common form of
symptomatic refractory focal epilepsy in adults. Accurate lateralization and localization of the
epileptogenic focus are a significant prerequisite for determining surgical candidacy once the
patient has been deemed medically intractable. Structural MR imaging, clinical,
electrophysiological, and neurophysiological data have an established role in the localization of the
epileptogenic foci. Nevertheless, hippocampal sclerosis cannot be detected on MR images in more
than 30% of patients with TLE, and the presurgical assessment remains controversial.
</P><P>
Discussion: In the last years, advanced MR imaging techniques, such as 1H-MRS, DWI, DTI,
DSCI, and fMRI, may provide valuable additional information regarding the physiological and
metabolic characterization of brain tissue. MR imaging has shifted towards functional and
molecular imaging, thus, promising to improve the accuracy regarding the lateralization and the
localization of the epileptogenic focus. Additionally, nuclear medicine studies, such as SPECT and
PET imaging modalities, have become an asset for the decoding of brain function and activity, and
can be diagnostically helpful as well, since they provide valuable data regarding the altered
metabolic activity of the seizure foci.
Conclusion:
Overall, advanced MRI, SPECT, and PET imaging techniques are increasingly
becoming an essential part of TLE diagnostics, when the epileptogenic area is not identified on
structural MRI or when structural MRI, clinical, and electrophysiological findings are not in
concordance.
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Affiliation(s)
- Ioannis Tsougos
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Evanthia Kousi
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Panagiotis Georgoulias
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Eftychia Kapsalaki
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Kostas N. Fountas
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
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28
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Prognostic factors determining poor postsurgical outcomes of mesial temporal lobe epilepsy. PLoS One 2018; 13:e0206095. [PMID: 30339697 PMCID: PMC6195284 DOI: 10.1371/journal.pone.0206095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/06/2018] [Indexed: 01/12/2023] Open
Abstract
Objectives To investigate the long-term postoperative outcomes and predictive factors associated with poor surgical outcomes in mesial temporal lobe epilepsy (MTLE). Materials and methods We enrolled patients with MTLE who underwent resective surgery at single university-affiliated hospital. Surgical outcomes were determined using a modified Engel classification at the 2nd and 5th years after surgery and the last time of follow-up. Results The mean duration of follow-up after surgery was 7.6 ± 3.7 years (range, 5.0–21.0 years). 334 of 400 patients (83.5%) were seizure-free at the 5th postoperative year. Significant predictive factors of a poor outcome at the 5th year were a history of generalized tonic clonic (GTC) seizures (odds ratio, OR; 2.318), bi-temporal interictal epileptiform discharge (IED) (OR; 3.107), bilateral hippocampal sclerosis (HS) (OR; 5.471), unilateral HS and combined extra-hippocampal lesion (OR; 5.029), and bi-temporal hypometabolism (BTH) (OR; 4.438). Bi-temporal IED (hazard ratio, HR; 2.186), BTH (HR; 2.043), bilateral HS (HR; 2.541) and unilateral HS and combined extra-hippocampal lesion (HR; 2.75) were independently associated with seizure recurrence. We performed a subgroup analysis of 208 patients with unilateral HS, and their independent predictors of a poor outcome at the 5th year were BTH (OR; 5.838) and tailored hippocampal resection (OR; 11.053). Conclusion This study demonstrates that 16.5% of MTLE patients had poor long-term outcomes after surgery. Bilateral involvement in electrophysiological and imaging studies predicts poor surgical outcomes in MTLE patients.
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Verger A, Lagarde S, Maillard L, Bartolomei F, Guedj E. Brain molecular imaging in pharmacoresistant focal epilepsy: Current practice and perspectives. Rev Neurol (Paris) 2018; 174:16-27. [DOI: 10.1016/j.neurol.2017.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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30
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Bankstahl M, Bankstahl JP. Recent Advances in Radiotracer Imaging Hold Potential for Future Refined Evaluation of Epilepsy in Veterinary Neurology. Front Vet Sci 2017; 4:218. [PMID: 29326952 PMCID: PMC5733338 DOI: 10.3389/fvets.2017.00218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/30/2017] [Indexed: 12/26/2022] Open
Abstract
Non-invasive nuclear imaging by positron emission tomography and single photon emission computed tomography has significantly contributed to epileptic focus localization in human neurology for several decades now. Offering functional insight into brain alterations, it is also of particular relevance for epilepsy research. Access to these techniques for veterinary medicine is becoming more and more relevant and has already resulted in first studies in canine patients. In view of the substantial proportion of drug-refractory epileptic dogs and cats, image-guided epileptic focus localization will be a prerequisite for selection of patients for surgical focus resection. Moreover, radiotracer imaging holds potential for a better understanding of the pathophysiology of underlying epilepsy syndromes as well as to forecast disease risk after epileptogenic brain insults. Importantly, recent advances in epilepsy research demonstrate the suitability and value of several novel radiotracers for non-invasive assessment of neuroinflammation, blood–brain barrier alterations, and neurotransmitter systems. It is desirable that veterinary epilepsy patients will also benefit from these promising developments in the medium term. This paper reviews the current use of radiotracer imaging in the veterinary epilepsy patient and suggests possible future directions for the technique.
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Affiliation(s)
- Marion Bankstahl
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Center of Systems Neuroscience Hannover, Hannover, Germany
| | - Jens P Bankstahl
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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31
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Yang PF, Pei JS, Jia YZ, Lin Q, Xiao H, Zhang TT, Zhong ZH. Surgical Management and Long-Term Seizure Outcome After Surgery for Temporal Lobe Epilepsy Associated with Cerebral Cavernous Malformations. World Neurosurg 2017; 110:e659-e670. [PMID: 29175574 DOI: 10.1016/j.wneu.2017.11.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Operative strategies for cerebral cavernous malformation (CCM)-associated temporal lobe epilepsy and timing of surgical intervention continue to be debated. This study aimed to establish an algorithm to evaluate the efficacy of surgical intervention strategies, to maximize positive surgical outcomes and minimize postsurgical neurologic deficits. METHODS 47 patients having undergone operation for CCM-associated temporal lobe epilepsy were retrospectively reviewed. They had received a diagnostic series for seizure localization, including long-term video electroencephalography (vEEG), high-resolution magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT). In patients with mesial temporal lobe CCMs, the involved structures (amygdala, hippocampus, or parahippocampal gyrus) were resected in addition to the lesions. Patients with neocortical epileptogenic CCM underwent extended lesionectomy guided by intraoperative electrocorticography; further performance of amygdalohippocampectomy depended on the extent of hippocampal epileptogenicity. RESULTS The study cohort contained 28 patients with drug-resistant epilepsy (DRE), 12 with chronic epilepsy (CE), and 7 with sporadic seizure (SS). Normal temporal lobe metabolism was seen in 7/7 patients of the SS group. Hypometabolism was found in all patients with chronic disease except for those with posterior inferior and middle temporal gyrus cavernous malformations (CMs). Of the 31 patients with superficial neocortical CCM, 7 had normal PET without hippocampal sclerosis, 14 had ipsilateral temporal lobe hypometabolism without hippocampal sclerosis, and 10 had obvious hippocampal sclerosis and hypometabolism. Seizure freedom in DRE, CE, and SS was 82.1%, 75%, and 100%, respectively. A significant difference was found between lesion laterality and postoperative seizure control; the rate was lower in left-sided cases because of less aggressive resection. CONCLUSIONS Our study demonstrates that the data from the presurgical evaluation, particularly regarding CM location, responsiveness to antiepileptic drugs, and temporal lobe metabolism, are crucial parameters for choosing surgical approaches to CCM-associated temporal lobe epilepsy. By this operative strategy, patients may receive maximized seizure control and minimized postsurgical neurologic sequelae.
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Affiliation(s)
- Peng-Fan Yang
- Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China.
| | - Jia-Sheng Pei
- Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
| | - Yan-Zeng Jia
- Department of Epileptology, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
| | - Qiao Lin
- Department of Epileptology, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
| | - Hui Xiao
- Department of Medical Imaging, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
| | - Ting-Ting Zhang
- Department of Pathology, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
| | - Zhong-Hui Zhong
- Department of Epileptology, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
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Tan YL, Kim H, Lee S, Tihan T, Ver Hoef L, Mueller SG, Barkovich AJ, Xu D, Knowlton R. Quantitative surface analysis of combined MRI and PET enhances detection of focal cortical dysplasias. Neuroimage 2017; 166:10-18. [PMID: 29097316 DOI: 10.1016/j.neuroimage.2017.10.065] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/29/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Focal cortical dysplasias (FCDs) often cause pharmacoresistant epilepsy, and surgical resection can lead to seizure-freedom. Magnetic resonance imaging (MRI) and positron emission tomography (PET) play complementary roles in FCD identification/localization; nevertheless, many FCDs are small or subtle, and difficult to find on routine radiological inspection. We aimed to automatically detect subtle or visually-unidentifiable FCDs by building a classifier based on an optimized cortical surface sampling of combined MRI and PET features. METHODS Cortical surfaces of 28 patients with histopathologically-proven FCDs were extracted. Morphology and intensity-based features characterizing FCD lesions were calculated vertex-wise on each cortical surface, and fed to a 2-step (Support Vector Machine and patch-based) classifier. Classifier performance was assessed compared to manual lesion labels. RESULTS Our classifier using combined feature selections from MRI and PET outperformed both quantitative MRI and multimodal visual analysis in FCD detection (93% vs 82% vs 68%). No false positives were identified in the controls, whereas 3.4% of the vertices outside FCD lesions were also classified to be lesional ("extralesional clusters"). Patients with type I or IIa FCDs displayed a higher prevalence of extralesional clusters at an intermediate distance to the FCD lesions compared to type IIb FCDs (p < 0.05). The former had a correspondingly lower chance of positive surgical outcome (71% vs 91%). CONCLUSIONS Machine learning with multimodal feature sampling can improve FCD detection. The spread of extralesional clusters characterize different FCD subtypes, and may represent structurally or functionally abnormal tissue on a microscopic scale, with implications for surgical outcomes.
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Affiliation(s)
- Yee-Leng Tan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Neurology, National Neuroscience Institute, Singapore.
| | - Hosung Kim
- Laboratory of Neuro Imaging, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
| | - Seunghyun Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Tarik Tihan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Lawrence Ver Hoef
- Department of Neurology, University of Alabama, Birmingham, United Kingdom.
| | - Susanne G Mueller
- Department of Radiology, Seoul National University Hospital, Republic of Korea.
| | | | - Duan Xu
- Department of Radiology, Seoul National University Hospital, Republic of Korea.
| | - Robert Knowlton
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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PET/MRI in children. Eur J Radiol 2017; 94:A64-A70. [DOI: 10.1016/j.ejrad.2017.01.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 01/30/2023]
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Mendes Coelho VC, Morita ME, Amorim BJ, Ramos CD, Yasuda CL, Tedeschi H, Ghizoni E, Cendes F. Automated Online Quantification Method for 18F-FDG Positron Emission Tomography/CT Improves Detection of the Epileptogenic Zone in Patients with Pharmacoresistant Epilepsy. Front Neurol 2017; 8:453. [PMID: 28919879 PMCID: PMC5585153 DOI: 10.3389/fneur.2017.00453] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 08/15/2017] [Indexed: 12/02/2022] Open
Abstract
Aims To assess the validity of an online method to quantitatively evaluate cerebral hypometabolism in patients with pharmacoresistant focal epilepsy as a complement to the visual analysis of the 18F-FDG positron emission tomography (PET)/CT exam. Methods A total of 39 patients with pharmacoresistant epilepsy and probable focal cortical dysplasia [22 patients with frontal lobe epilepsy (FLE) and 17 with temporal lobe epilepsy (TLE)] underwent a presurgical evaluation including EEG, video-EEG, MRI, and 18F-FDG PET/CT. We conducted the automated quantification of their 18F-FDG PET/CT data and compared the results with those of the visual-PET analysis conducted by experienced nuclear medicine physicians. For each patient group, we calculated Cohen’s Kappa coefficient for the visual and quantitative analyses, as well as each method’s sensitivity, specificity, and positive and negative predictive values. Results For the TLE group, both the visual and quantitative analyses showed high agreement. Thus, although the quantitative analysis could be used as a complement, the visual analysis on its own was consistent and precise. For the FLE group, on the other hand, the visual analysis categorized almost half of the cases as normal, revealing very low agreement. For those patients, the quantitative analysis proved critical to identify the focal hypometabolism characteristic of the epileptogenic zone. Our results suggest that the quantitative analysis of 18F-FDG PET/CT data is critical for patients with extratemporal epilepsies, and especially those with subtle MRI findings. Furthermore, it can easily be used during the routine clinical evaluation of 18F-FDG PET/CT exams. Significance Our results show that quantification of 18F-FDG PET is an informative complementary method that can be added to the routine visual evaluation of patients with subtle lesions, particularly those in the frontal lobes.
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Affiliation(s)
| | - Marcia E Morita
- Neurology/Epilepsy, Unicamp - University of Campinas, Campinas, Brazil
| | - Barbara J Amorim
- Nuclear Medicine Department, Unicamp - University of Campinas, Campinas, Brazil
| | - Celso Darío Ramos
- Nuclear Medicine Department, Unicamp - University of Campinas, Campinas, Brazil
| | - Clarissa L Yasuda
- Neurology/Epilepsy, Unicamp - University of Campinas, Campinas, Brazil
| | - Helder Tedeschi
- Neurosurgery/Epilepsy, Unicamp - University of Campinas, Campinas, Brazil
| | - Enrico Ghizoni
- Neurosurgery/Epilepsy, Unicamp - University of Campinas, Campinas, Brazil
| | - Fernando Cendes
- Neurology/Epilepsy, Unicamp - University of Campinas, Campinas, Brazil
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Isler C, Ozkara C, Kucukyuruk B, Delil S, Oz B, Comunoglu N, Kizilkilic O, Kayhan A, Deniz K, Akkol S, Tanriverdi T, Uzan M. Seizure Outcome of Patients with Magnetic Resonance Imaging-Negative Epilepsies: Still An Ongoing Debate. World Neurosurg 2017; 106:638-644. [PMID: 28735141 DOI: 10.1016/j.wneu.2017.07.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/09/2017] [Accepted: 07/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical results regarding MRI-negative epilepsy were presented and related clinical and histopathological parameters were discussed. METHODS Thirty-six MRI-negative epilepsy patients were retrospectively analyzed. Histopathological specimens were re-reviewed by 2 blind neuropathologists and re-classified based on the current classifications. RESULTS The mean age at surgery and seizure onset was 24.5 years and 9.3 years, respectively. Eight patients were younger than 18 years. Mean duration of seizures was 15.3 years. All but 2 underwent invasive monitorization. Eighteen patients had hypometabolism on FDG-PET with temporal lobe involvement in majority (66.7%). Hypometabolism was found in all patients with hippocampal sclerosis (HS), which was present in 50% and 66.7% of focal cortical dysplasia (FCD) type I and II patients, respectively. The frontal lobe resection was the most frequent type of operation followed by resections in temporal, parietal and occipital lobes. In 7 patients, multilobar resection was performed. Histopathological diagnosis was FCD type I, II, III, HS, and gliosis in 14, 12, 2, 3 and 2 patients, respectively. The mean follow-up was 5.8 years. Seventeen patients were seizure free and favorable outcome (Engel's I and II) was found in 69.7%. FCD type I tend to have more favorable seizure outcome. Duration of epilepsy and hypometabolism on FDG-PET was significantly related to outcome, whereas involved lobe was not. CONCLUSIONS Our results suggest it is worth pursuing resective surgery in adults as well as in children with drug-resistant epilepsy with normal MRI.
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Affiliation(s)
- Cihan Isler
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cigdem Ozkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Kucukyuruk
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sakir Delil
- Department of Neurology, Bati Bahat Hospital, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Kayhan
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kaancan Deniz
- Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serdar Akkol
- Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Taner Tanriverdi
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Uzan
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Crocker CE, Pohlmann-Eden B, Schmidt MH. Role of neuroimaging in first seizure diagnosis. Seizure 2017; 49:74-78. [DOI: 10.1016/j.seizure.2016.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/17/2016] [Accepted: 05/25/2016] [Indexed: 11/16/2022] Open
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Abstract
PET/MR imaging benefits neurologic clinical care and research by providing spatially and temporally matched anatomic MR imaging, advanced MR physiologic imaging, and metabolic PET imaging. MR imaging sequences and PET tracers can be modified to target physiology specific to a neurologic disease process, with applications in neurooncology, epilepsy, dementia, cerebrovascular disease, and psychiatric and neurologic research. Simultaneous PET/MR imaging provides efficient acquisition of multiple temporally matched datasets, and opportunities for motion correction and improved anatomic assignment of PET data. Current challenges include optimizing MR imaging-based attenuation correction and necessity for dual expertise in PET and MR imaging.
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Affiliation(s)
- Michelle M Miller-Thomas
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, St Louis, MO 63110, USA.
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, St Louis, MO 63110, USA
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Muhlhofer W, Tan Y, Mueller SG, Knowlton R. MRI
‐negative temporal lobe epilepsy—What do we know? Epilepsia 2017; 58:727-742. [DOI: 10.1111/epi.13699] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Wolfgang Muhlhofer
- University of California San Francisco (UCSF) San Francisco California U.S.A
- University of Alabama Birmingham (UAB) Birmingham Alabama U.S.A
| | - Yee‐Leng Tan
- University of California San Francisco (UCSF) San Francisco California U.S.A
- National Neuroscience Institute Singapore Singapore
| | - Susanne G. Mueller
- University of California San Francisco (UCSF) San Francisco California U.S.A
- Center for Imaging of Neurodegenerative Diseases (CIND) San Francisco California U.S.A
- Department of Radiology UCSF San Francisco CaliforniaU.S.A
| | - Robert Knowlton
- University of California San Francisco (UCSF) San Francisco California U.S.A
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Mayoral M, Marti-Fuster B, Carreño M, Carrasco JL, Bargalló N, Donaire A, Rumià J, Perissinotti A, Lomeña F, Pintor L, Boget T, Setoain X. Seizure-onset zone localization by statistical parametric mapping in visually normal18F-FDG PET studies. Epilepsia 2016; 57:1236-44. [DOI: 10.1111/epi.13427] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Maria Mayoral
- Nuclear Medicine Department; Hospital Clinic; Barcelona Spain
| | - Berta Marti-Fuster
- Biomedical Imaging Group; Biomedical Research Networking Center in Bioengineering; Biomaterials and Nanomedicine (CIBER-BBN); Barcelona Spain
- Biophysics and Bioengineering Unit; Physiological Sciences Department I; School of Medicine; University of Barcelona; Spain
| | - Mar Carreño
- Neurology Department; Hospital Clinic; Barcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Barcelona Spain
| | - Josep L. Carrasco
- Biostatistics; Public Health Department; School of Medicine; University of Barcelona; Barcelona Spain
| | - Núria Bargalló
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Barcelona Spain
- Radiology Department; Hospital Clinic; Barcelona Spain
| | - Antonio Donaire
- Neurology Department; Hospital Clinic; Barcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Barcelona Spain
| | - Jordi Rumià
- Neurosurgery Department; Hospital Clinic; Barcelona Spain
| | | | - Francisco Lomeña
- Nuclear Medicine Department; Hospital Clinic; Barcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Barcelona Spain
| | - Luis Pintor
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Barcelona Spain
- Psychiatry and Psychology Department; Hospital Clinic; Barcelona Spain
| | - Teresa Boget
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Barcelona Spain
- Psychiatry and Psychology Department; Hospital Clinic; Barcelona Spain
| | - Xavier Setoain
- Nuclear Medicine Department; Hospital Clinic; Barcelona Spain
- Biomedical Imaging Group; Biomedical Research Networking Center in Bioengineering; Biomaterials and Nanomedicine (CIBER-BBN); Barcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Barcelona Spain
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Wang X, Zhang C, Wang Y, Hu W, Shao X, Zhang JG, Zhang K. Prognostic factors for seizure outcome in patients with MRI-negative temporal lobe epilepsy: A meta-analysis and systematic review. Seizure 2016; 38:54-62. [PMID: 27182689 DOI: 10.1016/j.seizure.2016.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis to identify predictors of postoperative seizure freedom in patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy. METHOD Publications were screened from electronic databases (MEDLINE, EMBASE), epilepsy archives, and bibliographies of relevant articles that were written in English. We recorded all possible risk factors that might predict seizure outcome after surgery. We calculated odds ratio (OR) with corresponding 95% confidence intervals (95% CI) of predictors for postoperative seizure freedom. Heterogeneity was assessed with I(2). All meta-analyses were performed using Review Manager. RESULTS Epilepsy duration (OR=2.57, 95% CI=1.21-5.47, p<0.05, I(2)=1%) and ictal or interictal electroencephalographic anomalies precisely localized in the ipsilateral temporal lobe (OR=3.89, 95% CI=1.66-9.08, p<0.01, I(2)=0 and OR=3.38, 95% CI=1.57-7.25, p<0.05, I(2)=0, respectively) were significantly associated with a higher rate of seizure freedom after surgery. However, the positron emission tomography (PET) results were not predictive of postoperative seizure freedom (OR=2.11, 95% CI=0.95-4.65, p=0.06, I(2)=0). No significant difference in seizure freedom was observed between the positive and negative pathology groups (OR=1.36, 95% CI=0.70-2.63, p=0.36, I(2)=0). CONCLUSIONS A shorter epilepsy duration and scalp electroencephalogram (EEG) signals localized precisely in the temporal lobe predicted a better seizure outcome in patients with MRI-negative temporal lobe epilepsy.
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Affiliation(s)
- Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Wenhan Hu
- Beijing Neurosurgical Institute, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Xiaoqiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan xili 6, Dongcheng, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Tiantan xili 6, Dongcheng, Beijing 100050, China.
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Abstract
Imaging is pivotal in the evaluation and management of patients with seizure disorders. Elegant structural neuroimaging with magnetic resonance imaging (MRI) may assist in determining the etiology of focal epilepsy and demonstrating the anatomical changes associated with seizure activity. The high diagnostic yield of MRI to identify the common pathological findings in individuals with focal seizures including mesial temporal sclerosis, vascular anomalies, low-grade glial neoplasms and malformations of cortical development has been demonstrated. Positron emission tomography (PET) is the most commonly performed interictal functional neuroimaging technique that may reveal a focal hypometabolic region concordant with seizure onset. Single photon emission computed tomography (SPECT) studies may assist performance of ictal neuroimaging in patients with pharmacoresistant focal epilepsy being considered for neurosurgical treatment. This chapter highlights neuroimaging developments and innovations, and provides a comprehensive overview of the imaging strategies used to improve the care and management of people with epilepsy.
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Does F-18 FDG-PET substantially alter the surgical decision-making in drug-resistant partial epilepsy? Epilepsy Behav 2015; 51:133-9. [PMID: 26276413 DOI: 10.1016/j.yebeh.2015.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE There is a dearth of information on the critical utility of positron emission tomography (PET) in choosing candidates for epilepsy surgery especially in resource-poor countries where it is not freely available. This study aimed to critically analyze the utility of FDG-PET in the presurgical evaluation and surgical selection of patients with DRE based on the results obtained through its use in our comprehensive epilepsy program. METHODS From 2008 to 2012, 117 patients with drug-resistant epilepsy underwent F-18 fluoro-deoxy-glucose (FDG) PET in our center. We utilized their data to audit the utility of PET in choosing/deferring patients for surgery. RESULTS Of the 117 patients (age: 5-42years) who underwent F-18 FDG-PET, 64 had normal MRI, and 53 had lesions. Electroclinical data favored temporal ictal onset in 48 (41%), extratemporal in 60 (51.3%), and uncertain lobar localization in 9 (7.7%). The topography of PET hypometabolism was localizing in 53 (45.3%), lateralizing in 12 (10.3%), and 52 (44.4%) had either normal or discordant results. In the nonlesional group, focal hypometabolism was concordant to the area of ictal onset in 27 (41.5%) versus 38 (58.5%) in the lesional group (p=0.002). Greater concordance was noted in temporal lobe epilepsy (TLE) (78.0%) as compared to extratemporal epilepsy (ETPE) (28.6%) (p<0.001). Positron emission tomography was more concordant in patients with mesial temporal sclerosis than in those with other lesions (82.8% versus 50%) (p=0.033). Positron emission tomography helped in surgical decision-making in 68.8% of TLE and 23.3% of ETPE cases. Overall, 37 patients (31.6%) were directly selected for resective surgery based on PET results. CONCLUSIONS Positron emission tomography, when utilized judiciously, remained an ancillary tool in the surgical selection of one-third of patients with drug-resistant partial epilepsy, although its utility as an independent tool is not very promising.
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Pustina D, Avants B, Sperling M, Gorniak R, He X, Doucet G, Barnett P, Mintzer S, Sharan A, Tracy J. Predicting the laterality of temporal lobe epilepsy from PET, MRI, and DTI: A multimodal study. Neuroimage Clin 2015; 9:20-31. [PMID: 26288753 PMCID: PMC4536304 DOI: 10.1016/j.nicl.2015.07.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/11/2015] [Accepted: 07/19/2015] [Indexed: 01/09/2023]
Abstract
Pre-surgical evaluation of patients with temporal lobe epilepsy (TLE) relies on information obtained from multiple neuroimaging modalities. The relationship between modalities and their combined power in predicting the seizure focus is currently unknown. We investigated asymmetries from three different modalities, PET (glucose metabolism), MRI (cortical thickness), and diffusion tensor imaging (DTI; white matter anisotropy) in 28 left and 30 right TLE patients (LTLE and RTLE). Stepwise logistic regression models were built from each modality separately and from all three combined, while bootstrapped methods and split-sample validation verified the robustness of predictions. Among all multimodal asymmetries, three PET asymmetries formed the best predictive model (100% success in full sample, >95% success in split-sample validation). The combinations of PET with other modalities did not perform better than PET alone. Probabilistic classifications were obtained for new clinical cases, which showed correct lateralization for 7/7 new TLE patients (100%) and for 4/5 operated patients with discordant or non-informative PET reports (80%). Metabolism showed closer relationship with white matter in LTLE and closer relationship with gray matter in RTLE. Our data suggest that metabolism is a powerful modality that can predict seizure laterality with high accuracy, and offers high value for automated predictive models. The side of epileptogenic focus can affect the relationship of metabolism with brain structure. The data and tools necessary to obtain classifications for new TLE patients are made publicly available.
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Affiliation(s)
- Dorian Pustina
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - Brian Avants
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Michael Sperling
- Department of Neurology, Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
| | - Richard Gorniak
- Department of Radiology, Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
| | - Xiaosong He
- Department of Neurology, Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
| | - Gaelle Doucet
- Department of Neurology, Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
| | - Paul Barnett
- Department of Neurology, Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
| | - Scott Mintzer
- Department of Neurology, Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, USA
| | - Joseph Tracy
- Department of Neurology, Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
- Department of Radiology, Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
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Capraz IY, Kurt G, Akdemir Ö, Hirfanoglu T, Oner Y, Sengezer T, Kapucu LOA, Serdaroglu A, Bilir E. Surgical outcome in patients with MRI-negative, PET-positive temporal lobe epilepsy. Seizure 2015; 29:63-8. [PMID: 26076845 DOI: 10.1016/j.seizure.2015.03.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 03/11/2015] [Accepted: 03/25/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the long-term surgical outcomes of magnetic resonance imaging (MRI)-negative, fluorodeoxyglucose positron emission tomography (FDG-PET)-positive patients with temporal lobe epilepsy (TLE) and compare them with those of patients with mesial temporal sclerosis (MTS). METHODS One hundred forty-one patients with TLE who underwent anterior temporal lobectomy were included in the study. The surgical outcomes of 24 patients with unilateral temporal hypometabolism on FDG-PET without an epileptogenic lesion on MRI were compared with that of patients with unilateral temporal hypometabolism on FDG-PET with MTS on MRI (n=117). The outcomes were compared using Engel's classification at 2 years after surgery. Clinical characteristics, unilateral interictal epileptiform discharges (IEDs), histopathological data and operation side were considered as probable prognostic factors. RESULTS Class I surgical outcomes were similar in MRI-negative patients and the patients with MTS on MRI (seizure-free rate at postoperative 2 years was 79.2% and 82% in the MRI-negative and MTS groups, respectively). In univariate analysis, history of febrile convulsions, presence of unilateral IEDs and left temporal localization were found to be significantly associated with seizure free outcome. Multivariate analysis revealed that independent predictors of a good outcome were history of febrile convulsions and presence of unilateral IEDs. CONCLUSION Our results suggest that epilepsy surgery outcomes of MRI-negative, PET positive patients are similar to those of patients with MTS. This finding may aid in the selection of best candidates for epilepsy surgery.
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Affiliation(s)
| | - Gökhan Kurt
- Gazi University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Özgür Akdemir
- Gazi University, Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Tugba Hirfanoglu
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Yusuf Oner
- Gazi University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Tugba Sengezer
- Guven Hospital, Department of Nuclear Medicine, Ankara, Turkey
| | | | - Ayse Serdaroglu
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Erhan Bilir
- Gazi University, Faculty of Medicine, Department of Neurology, Ankara, Turkey
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Werner P, Barthel H, Drzezga A, Sabri O. Current status and future role of brain PET/MRI in clinical and research settings. Eur J Nucl Med Mol Imaging 2015; 42:512-26. [PMID: 25573629 DOI: 10.1007/s00259-014-2970-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/03/2014] [Indexed: 12/11/2022]
Abstract
Hybrid PET/MRI systematically offers a complementary combination of two modalities that has often proven itself superior to the single modality approach in the diagnostic work-up of many neurological and psychiatric diseases. Emerging PET tracers, technical advances in multiparametric MRI and obvious workflow advantages may lead to a significant improvement in the diagnosis of dementia disorders, neurooncological diseases, epilepsy and neurovascular diseases using PET/MRI. Moreover, simultaneous PET/MRI is well suited to complex studies of brain function in which fast fluctuations of brain signals (e.g. related to task processing or in response to pharmacological interventions) need to be monitored on multiple levels. Initial simultaneous studies have already demonstrated that these complementary measures of brain function can provide new insights into the functional and structural organization of the brain.
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Affiliation(s)
- P Werner
- Department of Nuclear Medicine, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
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Williams LM, Morandi F, Osborne DR, Narak J, LeBlanc AK. Kinetic analysis of 2-([(18)F]fluoro)-2-deoxy-d-glucose uptake in brains of anesthetized healthy dogs. Am J Vet Res 2014; 75:588-94. [PMID: 24866515 DOI: 10.2460/ajvr.75.6.588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess kinetic 2-([(18)F]fluoro)-2-deoxy-d-glucose ((18)FDG) uptake in the brain of anesthetized healthy adult dogs by use of positron emission tomography (PET) and to determine whether (18)FDG uptake differs among anatomic regions of the brain. ANIMALS 5 healthy Beagles. PROCEDURES Each isoflurane-anesthetized dog was administered (18)FDG IV (dose range, 3.0 to 5.2 mCi), and PET data were acquired for 2 hours. A CT scan (without contrast agent administration) was performed to allow more precise neuroanatomic localization. Defined regions of interest within the brain were drawn on reconstructed image data. Standard uptake values (SUVs) for (18)FDG were calculated to generate time-activity curves and determine time to peak uptake. RESULTS Time-activity curve analysis identified 4 regional uptake patterns: olfactory, gray matter, white matter, and other (brainstem, cerebellum, and occipital and frontal regions). The highest maximum SUVs were identified in the olfactory bulbs and cerebral gray matter, and the lowest maximum SUV was identified in cerebral white matter. Mean time to peak uptake ranged from 37.8 minutes in white matter to 82.7 minutes in the olfactory bulbs. CONCLUSIONS AND CLINICAL RELEVANCE Kinetic analysis of (18)FDG uptake revealed differences in uptake values among anatomic areas of the brain in dogs. These data provide a baseline for further investigation of (18)FDG uptake in dogs with immune-mediated inflammatory brain disease and suggest that (18)FDG-PET scanning has potential use for antemortem diagnosis without histologic analysis and for monitoring response to treatment. In clinical cases, a 1-hour period of PET scanning should provide sufficient pertinent data.
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Affiliation(s)
- Lindsay M Williams
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996
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Can we increase the yield of FDG-PET in the preoperative work-up for epilepsy surgery? Epilepsy Res 2014; 108:1095-105. [PMID: 24893829 DOI: 10.1016/j.eplepsyres.2014.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/15/2014] [Accepted: 04/27/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE [(18)F] Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is a semi-invasive, interictal method of localization of hypometabolic epileptic foci. FDG-PET can be useful in the clinical work-up prior to epilepsy surgery, especially in equivocal cases. We investigated whether we could increase the yield of presurgical FDG-PET in patients with difficult epilepsy requiring chronic subdural electrocorticography (ECoG). METHODS We retrospectively studied patients with refractory focal epilepsy in whom there was uncertainty about the focus localization and who underwent FDG-PET and ECoG. Two experts (epileptologist and nuclear medicine radiologist) together systematically re-assessed the scans visually (PETRE), blinded to their initial reports. Scans were also re-analyzed by comparing them to a normal control dataset with Statistical Parametric Mapping (SPM), using a liberal (PETSPM1), and strict (PETSPM2) statistical threshold. Regions with hypometabolism and regions containing the seizure onset zone (SOZ) in ECoG were marked as positive anatomical regions (PARs). We compared the concordance of these PARs for the different PET re-assessments. We calculated the sensitivity, specificity and accuracy of the PET results for the SOZ. The added value of the re-assessments was evaluated with emphasis on scans initially reported as negative. RESULTS 41 Patients (63% extra-temporal) were included. PETRE identified the SOZ best, with a sensitivity of 62% and specificity of 93%. PETSPM1 had a sensitivity of 62% and specificity 69%, for PETSPM2 this was 35% and 85% respectively. The overlap between PETRE vs. PETSPM1 and vs. PETSPM2 was 71% and 37%. Visual re-assessment and PETSPM1 identified the SOZ in four out of five scans that were initially reported as negative. CONCLUSIONS Pre-surgical re-assessment of PET scans is worthwhile in epilepsy patients who undergo ECoG, especially when results were reported as negative before. Visual re-assessment itself has a higher combined specificity, sensitivity and accuracy than SPM analysis alone. SPM analysis could be used as a guide for visual (re-)assessment, because of its high sensitivity.
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Purz S, Sabri O, Viehweger A, Barthel H, Kluge R, Sorge I, Hirsch FW. Potential Pediatric Applications of PET/MR. J Nucl Med 2014; 55:32S-39S. [PMID: 24762622 DOI: 10.2967/jnumed.113.129304] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Medical imaging with multimodality and whole-body technologies has continuously improved in recent years. The advent of combined modalities such as PET/CT and PET/MR offers new tools with an exact fusion of molecular imaging and high-resolution anatomic imaging. For noninvasive pediatric diagnostics, molecular imaging and whole-body MR have become important, especially in pediatric oncology. Because it has a lower radiation exposure than PET/CT, combined PET/MR is expected to be of special use in pediatric diagnostics. This review focuses on possible pediatric applications of PET/MR hybrid imaging, particularly pediatric oncology and neurology but also the diagnosis of infectious or inflammatory diseases.
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Affiliation(s)
- Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Adrian Viehweger
- Department of Pediatric Radiology, University Hospital of Leipzig, Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Ina Sorge
- Department of Pediatric Radiology, University Hospital of Leipzig, Leipzig, Germany
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