Abstract
Purpose: To evaluate morphometric analysis program (MAP) and quantitative positron emission tomography (QPET) in epileptogenic zone (EZ) identification using a simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) system in MRI-negative epilepsies.Methods: Seventy-one localization-related MRI-negative epilepsies underwent preoperative simultaneous PET/MRI examination and surgical resection were enrolled retrospectively. MAP was performed on T1-weighted volumetric sequence and QPET was analyzed using statistical parametric mapping (SPM) with comparison to age-, and gender- matched normal controls. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MAP, QPET, MAP+ QPET and MAP/QPET in EZ localization were assessed. The correlations between surgical outcome and modalities concordant with cortical resection were analyzed.Results: Forty-five (63.4%) patients had Engel I seizure outcome. The sensitivity, specificity, PPV and NPV of MAP was 64.4%, 69.2%, 78.3% and 52.9%, respectively. The sensitivity, specificity, PPV, NPV of QPET was 73.3%, 65.4%, 78.6%, and 58.6%, respectively. MAP+QPET, defined as two tests concordant with cortical resection, had reduced sensitivity (53.3%) but increased specificity (88.5%) relative to individual tests. MAP/QPET, defined as one or both tests concordant with cortical resection, had increased sensitivity (86.7%) but reduced specificity (46.2%) relative to individual tests. The regions determined by MAP, QPET, MAP+QPET or MAP/QPET concordant with cortical resection was significantly associated with seizure-free outcome, MAP+QPET performed best. Conclusion: The combination of MAP and QPET imaging play a complementary role in EZ localization and this approach can be readily improved surgical outcome in MRI-negative epilepsies.
Morphometric analysis program and quantitative positron emission tomography in presurgical localization in MRI-negative epilepsies: a simultaneous PET/MRI study
