Revisional Analysis of Electroencephalography and Magnetoencephalography Based on Comprehensive Epilepsy Conference

This chapter highlights the importance of the revised analysis of electroencephalography (EEG) and magnetoencephalography (MEG) spike source estimation based on comprehensive case conference discussion. It discusses two typical cases of localization-related epilepsy: case 1 as a simple situation and case 2 as a complicated situation. No “gold standard” for epileptic spike analysis in EEG or MEG has been established, so several methods must be adopted to achieve the most reasonable interpretation. However, such intense and revisional analyses may be too time-consuming in clinical settings and result in arbitrary conclusions. Therefore, the authors currently use a simple method first, that is, a single dipole model for the peak or preceding upward slope of unaveraged single spikes. In the following case conference, EEG and MEG data are reviewed with seizure semiology, anatomical magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). If all the findings almost agree, the clinical decision can be easily made. If not, revisional analysis of EEG/MEG is recommended using averaged spikes and principal component analysis models as well as distributed source models. In addition to EEG/MEG, the authors often order revisional analysis and additional MRI and FDG-PET studies after the conference. Even further history taking will be recommended if necessary.

Download Full-text

A Review on the Value of Imaging in Differentiating between Large Vessel Vasculitis and Atherosclerosis

Journal of Personalized Medicine ◽

10.3390/jpm11030236 ◽

2021 ◽

Vol 11 (3) ◽

pp. 236

Author(s):

Pieter H. Nienhuis ◽

Gijs D. van Praagh ◽

Andor W. J. M. Glaudemans ◽

Elisabeth Brouwer ◽

Riemer H. J. A. Slart

Keyword(s):

Fdg Pet ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Current Evidence ◽

Future Directions ◽

Inflammatory Conditions ◽

Positron Emission ◽

Magnetic Resonance Imaging Mri ◽

Review Reports ◽

Ct Studies

Imaging is becoming increasingly important for the diagnosis of large vessel vasculitis (LVV). Atherosclerosis may be difficult to distinguish from LVV on imaging as both are inflammatory conditions of the arterial wall. Differentiating atherosclerosis from LVV is important to enable optimal diagnosis, risk assessment, and tailored treatment at a patient level. This paper reviews the current evidence of ultrasound (US), 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET), computed tomography (CT), and magnetic resonance imaging (MRI) to distinguish LVV from atherosclerosis. In this review, we identified a total of eight studies comparing LVV patients to atherosclerosis patients using imaging—four US studies, two FDG-PET studies, and two CT studies. The included studies mostly applied different methodologies and outcome parameters to investigate vessel wall inflammation. This review reports the currently available evidence and provides recommendations on further methodological standardization methods and future directions for research.

Download Full-text

Clinical and Pathological Evidence of Anti-GD2 Immunotherapy Induced Differentiation in Relapsed/Refractory High-Risk Neuroblastoma

Cancers ◽

10.3390/cancers13061264 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1264

Author(s):

Jaume Mora ◽

Alicia Castañeda ◽

Maria Cecilia Colombo ◽

Maite Gorostegui ◽

Fernando Gomez ◽

...

Keyword(s):

High Risk ◽

Fdg Pet ◽

Current Therapy ◽

Bone Lesions ◽

Functional Magnetic Resonance ◽

Positron Emission ◽

Apparent Diffusion ◽

Neuroblastic Tumors ◽

Direct Cell ◽

Magnetic Resonance Imaging Mri

Background: Neuroblastic tumors (NBTs) originate from a block in the process of differentiation. Histologically, NBTs are classified in neuroblastoma (NB), ganglioneuroblastoma (GNB), and ganglioneuroma (GN). Current therapy for high-risk (HR) NB includes chemotherapy, surgery, radiotherapy, and anti-GD2 monoclonal antibodies (mAbs). Anti-GD2 mAbs induce immunological cytoxicity but also direct cell death. Methods: We report on patients treated with naxitamab for chemorefractory NB showing lesions with long periods of stable disease. Target lesions with persisting 123I-Metaiodobenzylguanidine (MIBG) uptake after 4 cycles of immunotherapy were further evaluated by functional Magnetic Resonance Imaging (MRI) and/or Fluorodeoxyglucose (FDG)-positron emission tomography (PET). MIBG avid lesions that became non-restrictive on MRI (apparent diffusion coefficient (ADC) > 1) and/or FDG-PET negative (SUV < 2) were biopsied. Results: Twenty-seven relapse/refractory (R/R) HR-NB patients were enrolled on protocol Ymabs 201. Two (7.5%) of the 27 showed persistent bone lesions on MIBG, ADC high, and/or FDG-PET negative. Forty-four R/R HR-NB patients received chemo-immunotherapy. Twelve (27%) of the 44 developed persistent MIBG+ but FDG-PET- and/or high ADC lesions. Twelve (86%) of the 14 cases identified were successfully biopsied producing 16 evaluable samples. Histology showed ganglioneuroma maturing subtype in 6 (37.5%); ganglioneuroma mature subtype with no neuroblastic component in 4 (25%); differentiating NB with no Schwannian stroma in 5 (31%); and undifferentiated NB without Schwannian stroma in one (6%). Overall, 10 (62.5%) of the 16 specimens were histopathologically fully mature NBTs. Conclusions: Our results disclose an undescribed mechanism of action for naxitamab and highlight the limitations of conventional imaging in the evaluation of anti-GD2 immunotherapy clinical efficacy for HR-NB.

Download Full-text

Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous 18F-FDG-PET/MRI

Contrast Media & Molecular Imaging ◽

10.1155/2018/5063285 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Hans-Jonas Meyer ◽

Sandra Purz ◽

Osama Sabri ◽

Alexey Surov

Keyword(s):

Cervical Cancer ◽

Fdg Pet ◽

Metabolic Tumor Volume ◽

Total Lesion Glycolysis ◽

Histogram Analysis ◽

Whole Body ◽

Standardized Uptake Values ◽

Positron Emission ◽

18F Fdg ◽

Magnetic Resonance Imaging Mri

Multimodal imaging has been increasingly used in oncology, especially in cervical cancer. By using a simultaneous positron emission (PET) and magnetic resonance imaging (MRI, PET/MRI) approach, PET and MRI can be obtained at the same time which minimizes motion artefacts and allows an exact imaging fusion, which is especially important in anatomically complex regions like the pelvis. The associations between functional parameters from MRI and 18F-FDG-PET reflecting different tumor aspects are complex with inconclusive results in cervical cancer. The present study correlates histogram analysis and 18F-FDG-PET parameters derived from simultaneous FDG-PET/MRI in cervical cancer. Overall, 18 female patients (age range: 32–79 years) with histopathologically confirmed squamous cell cervical carcinoma were retrospectively enrolled. All 18 patients underwent a whole-body simultaneous 18F-FDG-PET/MRI, including diffusion-weighted imaging (DWI) using b-values 0 and 1000 s/mm2. Apparent diffusion coefficient (ADC) histogram parameters included several percentiles, mean, min, max, mode, median, skewness, kurtosis, and entropy. Furthermore, mean and maximum standardized uptake values (SUVmean and SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were estimated. No statistically significant correlations were observed between SUVmax or SUVmean and ADC histogram parameters. TLG correlated inversely with p25 (r=−0.486,P=0.041), p75 (r=−0.490,P=0.039), p90 (r=−0.513,P=0.029), ADC median (r=−0.497,P=0.036), and ADC mode (r=−0.546,P=0.019). MTV also showed significant correlations with several ADC parameters: mean (r=−0.546,P=0.019), p10 (r=−0.473,P=0.047), p25 (r=−0.569,P=0.014), p75 (r=−0.576,P=0.012), p90 (r=−0.585,P=0.011), ADC median (r=−0.577,P=0.012), and ADC mode (r=−0.597,P=0.009). ADC histogram analysis and volume-based metabolic 18F-FDG-PET parameters are related to each other in cervical cancer.

Download Full-text

Einsatz der FDG-PET bei der Diagnostik des zentralnervösen Lupus erythematodes und Vergleich mit CT und MRI

Nuklearmedizin ◽

10.1055/s-0038-1629490 ◽

1989 ◽

Vol 28 (05) ◽

pp. 187-192 ◽

Cited By ~ 5

Author(s):

Gabriele Stoppe ◽

K. Wildhagen ◽

G. J. Meyer ◽

O. Schober

Keyword(s):

Lupus Erythematosus ◽

Fdg Pet ◽

Central Nervous System Involvement ◽

Special Problem ◽

Emission Tomography ◽

Cranial Computed Tomography ◽

Resonance Imaging ◽

Positron Emission ◽

Neuropsychiatric Sle ◽

Magnetic Resonance Imaging Mri

Central nervous system involvement has been found in 30-75% of all cases of systemic lupus erythematosus (SLE). Up to now, clinical diagnosis is difficult and there are no markers for disease activity. We have compared cranial computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) using fluorodesoxyglucose (FDG) in two cases. FDG-PET is shown to be the most sensitive method demonstrating even reversible deficits and a better correlation with other neurological findings. MRI seems to be more sensitive than CT. A survey of the literature concerning imaging methods in neuropsychiatric SLE is given. The special problem of neuronal desactivation by antineuronal activity is discussed.

Download Full-text

The Additional Value of 18F-FDG PET and MRI in Patients with Glioma: A Review of the Literature from 2015 to 2020

Diagnostics ◽

10.3390/diagnostics10060357 ◽

2020 ◽

Vol 10 (6) ◽

pp. 357

Author(s):

Natale Quartuccio ◽

Riccardo Laudicella ◽

Antonio Vento ◽

Salvatore Pignata ◽

Maria Vittoria Mattoli ◽

...

Keyword(s):

Functional Data ◽

Fdg Pet ◽

Diagnostic Value ◽

Complementary Information ◽

Positron Emission ◽

Combined Use ◽

18F Fdg ◽

Magnetic Resonance Imaging Mri ◽

Additional Value ◽

Fluorine 18 Fluorodeoxyglucose

Aim: Beyond brain computed tomography (CT) scan, Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) hold paramount importance in neuro-oncology. The aim of this narrative review is to discuss the literature from 2015 to 2020, showing advantages or complementary information of fluorine-18 fluorodeoxyglucose (18F-FDG) PET imaging to the anatomical and functional data offered by MRI in patients with glioma. Methods: A comprehensive Pubmed/MEDLINE literature search was performed to retrieve original studies, with a minimum of 10 glioma patients, published from 2015 until the end of April 2020, on the use of 18F-FDG PET in conjunction with MRI. Results: Twenty-two articles were selected. Combined use of the two modalities improves the accuracy in predicting prognosis, planning treatments, and evaluating recurrence. Conclusion: According to the recent literature, 18F-FDG PET provides different and complementary information to MRI and may enhance performance in the whole management of gliomas. Therefore, integrated PET/MRI may be particularly useful in gliomas, since it could provide accurate morphological and metabolic information in one-shoot examination and improve the diagnostic value compared to each of procedures.

Download Full-text

2-18fluoro-deoxy-D-glucose Positron Emission Tomography Is a Reliable Predictor for Viable Tumor in Postchemotherapy Seminoma: An Update of the Prospective Multicentric SEMPET Trial

Journal of Clinical Oncology ◽

10.1200/jco.2004.07.188 ◽

2004 ◽

Vol 22 (6) ◽

pp. 1034-1039 ◽

Cited By ~ 296

Author(s):

Maria De Santis ◽

Alexander Becherer ◽

Carsten Bokemeyer ◽

Franz Stoiber ◽

Karin Oechsle ◽

...

Keyword(s):

Positron Emission Tomography ◽

Predictive Value ◽

Fdg Pet ◽

Clinical Decision Making ◽

Residual Tumor ◽

Clinical Decision ◽

Emission Tomography ◽

Clinical Value ◽

Positron Emission ◽

Residual Lesions

Purpose To define the clinical value of 2-18fluoro-deoxy-D-glucose positron emission tomography (FDG PET) as a predictor for viable residual tumor in postchemotherapy seminoma residuals in a prospective multicentric trial. Patients and Methods FDG PET studies in patients with metastatic pure seminoma who had radiographically defined postchemotherapy residual masses were correlated with either the histology of the resected lesion or the clinical outcome documented by computer tomography (CT), tumor markers, and/or physical examination during follow-up. The size of the residual lesions on CT, either > 3 cm or ≤ 3 cm, was correlated with the presence or absence of viable residual tumor. Results Fifty-six FDG PET scans of 51 patients were assessable. All 19 cases with residual lesions > 3 cm and 35 (95%) of 37 with residual lesions ≤ 3 cm were correctly predicted by FDG PET. The specificity, sensitivity, positive predictive value, and negative predictive value of FDG PET were 100% (95% CI, 92% to 100%), 80% (95% CI, 44% to 95%), 100%, and 96%, respectively, versus 74% (95% CI, 58% to 85%), 70% (95% CI, 34% to 90%), 37%, and 92%, respectively, for CT discrimination of the residual tumor by size (> 3 cm/≤ 3 cm). Conclusion This investigation confirms that FDG PET is the best predictor of viable residual tumor in postchemotherapy seminoma residuals and should be used as a standard tool for clinical decision making in this patient group.

Download Full-text

Simultaneous 18F-FDG PET/MRI in tuberculous spondylitis: an independent method for assessing therapeutic response - case series

BMC Infectious Diseases ◽

10.1186/s12879-019-4469-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Ikchan Jeon ◽

Eunjung Kong ◽

Sang Woo Kim

Keyword(s):

Fdg Pet ◽

Therapeutic Response ◽

Case Series ◽

Standardized Uptake Value ◽

Tuberculous Spondylitis ◽

Medication Therapy ◽

Positron Emission ◽

18F Fdg ◽

Magnetic Resonance Imaging Mri ◽

One Year

Abstract Background 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) shows great potential for diagnosis and assessing therapeutic response of tuberculous spondylitis. Tuberculous spondylitis required long-term anti-tuberculosis (TB) medication therapy, and the optimal duration of therapy is controversial. There is still no clear way to tell when the anti-TB therapy can safely be discontinued. Case presentation Three patients with tuberculous spondylitis were evaluated for therapeutic response using 18F-FDG PET/magnetic resonance imaging (MRI). Clinical and hematological improvements were achieved after about 12 months of anti-TB medication therapy, and we considered whether to discontinue the therapy. There was no relapse during one year of follow-up after discontinuation of 12 months anti-TB medication based on the low maximum standardized uptake value (SUVmax) of 1.83 in one patient. However, the other two patients continued further anti-TB medication therapy based on the high SUVmax of 4.14 and 7.02, which were suspected to indicate active residual lesions in the abscess or granulation tissues. Continuous TB was confirmed by the bacterial and histological examinations. Conclusions 18F-FDG PET/MRI has metabolic and anatomical advantages for assessing therapeutic response in TB spondylitis, and can be considered as a helpful independent and alternative method for determining the appropriate time to discontinue anti-TB medication.

Download Full-text

PET/MRI Imaging in High-Risk Sarcoma: First Findings and Solving Clinical Problems

Case Reports in Oncological Medicine ◽

10.1155/2013/793927 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Markus K. Schuler ◽

Stephan Richter ◽

Bettina Beuthien-Baumann ◽

Ivan Platzek ◽

Jörg Kotzerke ◽

...

Keyword(s):

Clinical Decision Making ◽

Imaging Technique ◽

Clinical Decision ◽

Whole Body ◽

Mri Imaging ◽

Cross Sectional ◽

Positron Emission ◽

Magnetic Resonance Imaging Mri ◽

Sarcoma Treatment ◽

Clinical Problems

Simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) is a new whole-body hybrid PET/MR imaging technique that combines metabolic and cross-sectional diagnostic imaging. Since the use of MRI in imaging of soft-tissue sarcoma is extremely beneficial, investigation of the combined PET/MRI is of great interest. In this paper, we present three cases and first data. Combined PET/MRI technique can support the process of clinical decision-making and give answers to some meaningful questions when treating patients with STS. Therefore, the combined modality of simultaneous PET/MRI offers new pieces to the puzzle of sarcoma treatment.

Download Full-text

The impact of FDG PET in the staging of breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.530 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 530-530 ◽

Cited By ~ 7

Author(s):

C. E. Carr ◽

E. F. Conant ◽

M. A. Rosen ◽

M. D. Schnall ◽

R. Davidson

Keyword(s):

Breast Cancer ◽

Clinical Judgment ◽

Fdg Pet ◽

Whole Body ◽

Neoplastic Disease ◽

Additional Information ◽

Positron Emission ◽

Magnetic Resonance Imaging Mri ◽

The Impact ◽

Work Up

530 Background: To evaluate the impact of whole-body fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in staging breast cancer beyond the breast and axilla. Methods: 200 women, mean age 51 yrs (range 28–81) with breast cancer were enrolled in an IRB approved multi-modality imaging trial from 3/02 to 5/05. After imaging with film screen mammography ± ultrasound (US), patients underwent digital mammography, whole breast US, magnetic resonance imaging (MRI), and whole body FDG PET. Imaging reports and patient charts were reviewed and distant lesions were classified: 1 = no uptake; 2 = physiologic uptake; 3 = non-suspicious uptake; 4 = suspicious uptake without work-up; 5 = suspicious uptake with work-up. Decisions to forego work-up in class 4 lesions were clinical. Class 5 PET lesions were evaluated by confirmatory studies, including computed tomography (CT), MRI, x-ray (XR), bone scan (BS), or pathology. Patients also underwent standard staging with chest XR and BS per clinical judgment. Results: 189/200 (95%) women received PET scans. PET identified 71 distant areas of increased uptake in 42/189 (22%) women. 59/71 (83%) lesions were considered suspicious in 33/42 (79%) women: 50/59 (85%) lesions were class 5 and 9/59 (15%) class 4. Of the 50 class 5 lesions, 19 (38%) were true positive (TP) for neoplastic disease, 2 (4%) were TP for non-neoplastic disease, and 29 (58%) were false positive (FP). The positive predictive value (PPV) for class 5 lesions was 40%. The 19 TP distant sites of malignancy occurred in 6/189 (3%) patients; 4 of these patients (67%) also had TP distant sites identified by standard staging procedures. PET alone identified TP distant disease in 2/189 (1%) women. PET identified 29 FP findings in 22/189 (12%) patients. FP findings prompted 17 CTs, 8 XRs, 2 MRIs, and 1 BS. MRI revealed 2 additional neoplasms that had been false negatives (FN) by PET in 2/189 (1%) women. Conclusions: Whole-body FDG-PET added little additional information in staging our patients with known primary breast cancer, based on low PPV and equivalent TP and FN rates. Additionally, the high FP rate of PET in these patients may prompt unnecessary, costly, and invasive follow-up studies. No significant financial relationships to disclose.

Download Full-text

The utility of FDG-PET for detecting multiple primary cancers in hypopharyngeal cancer patients

Onkologische Welt ◽

10.1055/s-0038-1631581 ◽

2010 ◽

Vol 01 (02) ◽

pp. 60-65

Author(s):

H. Kaida ◽

M. Ishibashi ◽

S. Kurata ◽

Y. Uchiyama ◽

N. Tanaka ◽

...

Keyword(s):

Oesophageal Cancer ◽

Fdg Pet ◽

Hypopharyngeal Cancer ◽

Multiple Primary Cancers ◽

Predictive Values ◽

Positron Emission ◽

Multiple Primary ◽

Magnetic Resonance Imaging Mri ◽

Superficial Type ◽

Sensitivity Specificity

SummaryAim: To examine the utility of 2’-[18F]-fluoro-2’-deoxy-D-glucose positron emission tomography (FDG-PET) for detecting multiple primary cancers (MPC) in patients with hypopharyngeal cancer (HPC). Patients, methods: Seventy patients with HPC underwent FDG-PET to determine the staging. Routine clinical examinations were carried out, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), and oesophagealgastroduodenoscopy (EGDS). The detection rate of synchronous and metachronous cancer was calculated based on FDG-PET alone or FDG-PET combined with clinical routine examination. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and accuracy were used to diagnose oesophageal cancer using FDG-PET. Results: Of the 70 patients, 12 (17.1%) had 15 synchronous tumours, and 2 of the 58 remaining patients (3.4%) had metachronous tumours. Oesophageal cancer was discovered most frequently: superficial type (n=6), advanced type (n=4). On a per-patient basis, 11 of 12 patients (91.6%) were diagnosed with synchronous tumours, and on a per-lesion basis, 12 of 15 lesions (80.0%) were detected by FDG-PET.The sensitivity, specificity, accuracy, PPV, and NPV of FDG-PET regarding oesophageal cancer were 70%, 100%, 95.7%, 100%, and 95.2% respectively. Three of the six superficial types were positive on FDG-PET. Both of the metachronous tumour lesions were detected by FDG-PET. Conclusion: FDG-PET is useful for estimating the MPC in HPC patients. Since 3 of 10 synchronous oesophageal cancer were missed with PET alone, a combination with EGDS should be considered to exclude synchronous oesophageal cancer.

Download Full-text