18f-fdg Pet/mr in Focal Epilepsy: a New Step for Improving the Detection of Epileptogenic Lesions

Abstract Purpose: Hybrid PET/MR is a promising tool in focal drug-resistant epilepsy, however the additional value for the detection of epileptogenic lesions and surgical decision-making remains to be established.Methods: We retrospectively compared 18F-FDG PET/MR images with those obtained by a previous 18F-FDG PET co-registered with MRI (PET+MR) in 25 consecutive patients (16 females, 13-60 year-old) investigated for focal drug-resistant epilepsy. Visual analysis was performed by two readers blinded from imaging modalities, asked to assess the technical characteristics (co-registration, quality of images), confidence in results, location of PET abnormalities and presence of a structural lesion on MRI. The clinical impact on surgical strategy and outcome was assessed independently.Results: The location of epilepsy was temporal in 9 patients and extra-temporal in 16 others. MRI was initially considered negative in 21 of them. PET alone demonstrated metabolic abnormalities in 19 cases (76%), and the co-registration with MRI allowed the detection of 4 additional structural lesions. PET/MR was considered better performing than PET+MR in 56% of patients. The increase in sensitivity was 13% and new structural lesions (mainly focal cortical dysplasias) were detected in 6 patients (24%). Change of surgical decision-making was substantial for 40% of patients, consisting in avoiding invasive monitoring in 6 patients and modifying the planning in 4 others. Seizure-free outcome was obtained in 13/14 patients who underwent a cortical resection.Conclusion: Hybrid PET/MR improves the detection of epileptogenic lesions, allowing to optimize the presurgical work-up and to increase the proportion of successful surgery even in the more complex cases.

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Does F-18 FDG-PET substantially alter the surgical decision-making in drug-resistant partial epilepsy?

Epilepsy & Behavior ◽

10.1016/j.yebeh.2015.07.004 ◽

2015 ◽

Vol 51 ◽

pp. 133-139 ◽

Cited By ~ 5

Author(s):

Ramshekhar N. Menon ◽

Ashalatha Radhakrishnan ◽

Ramanathapuram Parameswaran ◽

Bejoy Thomas ◽

Chandrashekharan Kesavadas ◽

...

Keyword(s):

Decision Making ◽

Fdg Pet ◽

Partial Epilepsy ◽

Drug Resistant ◽

Surgical Decision ◽

Surgical Decision Making

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Do sphenoidal electrodes aid in surgical decision making in drug resistant temporal lobe epilepsy?

Clinical Neurophysiology ◽

10.1016/j.clinph.2011.07.041 ◽

2012 ◽

Vol 123 (3) ◽

pp. 463-470 ◽

Cited By ~ 8

Author(s):

Ajith Cherian ◽

Ashalatha Radhakrishnan ◽

Sajeesh Parameswaran ◽

Raviprasad Varma ◽

Kurupath Radhakrishnan

Keyword(s):

Decision Making ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Drug Resistant ◽

Surgical Decision ◽

Surgical Decision Making

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Surgical decision making in temporal lobe epilepsy: A comparison of [18F]FDG-PET, MRI, and EEG

Epilepsy & Behavior ◽

10.1016/j.yebeh.2011.06.022 ◽

2011 ◽

Vol 22 (2) ◽

pp. 293-297 ◽

Cited By ~ 24

Author(s):

Aaron F. Struck ◽

Lance T. Hall ◽

John M. Floberg ◽

Scott B. Perlman ◽

Douglas A. Dulli

Keyword(s):

Decision Making ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Fdg Pet ◽

Surgical Decision ◽

18F Fdg ◽

Surgical Decision Making

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18F-FDG PET-CT after Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients to Optimize Surgical Decision Making

PLoS ONE ◽

10.1371/journal.pone.0133690 ◽

2015 ◽

Vol 10 (11) ◽

pp. e0133690 ◽

Cited By ~ 12

Author(s):

Maarten C. J. Anderegg ◽

Elisabeth J. de Groof ◽

Suzanne S. Gisbertz ◽

Roel J. Bennink ◽

Sjoerd M. Lagarde ◽

...

Keyword(s):

Decision Making ◽

Esophageal Cancer ◽

Cancer Patients ◽

Fdg Pet ◽

Neoadjuvant Chemoradiotherapy ◽

Surgical Decision ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Surgical Decision Making

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Correction to: 18F-FDG PET in drug-resistant epilepsy due to focal cortical dysplasia type 2: additional value of electroclinical data and coregistration with MRI

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-018-4022-3 ◽

2018 ◽

Vol 45 (8) ◽

pp. 1465-1465

Author(s):

Serge Desarnaud ◽

Charles Mellerio ◽

Franck Semah ◽

Agathe Laurent ◽

Elisabeth Landre ◽

...

Keyword(s):

Fdg Pet ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Drug Resistant ◽

18F Fdg ◽

Drug Resistant Epilepsy ◽

Additional Value

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Schizencephaly and intractable epilepsy: an FDG-PET study

Journal of the International Child Neurology Association ◽

10.17724/jicna.2016.117 ◽

2017 ◽

Author(s):

Tuhina Govil-Dalela ◽

Ajay Kumar ◽

Praneetha Konka ◽

Harry T Chugani

Keyword(s):

Decision Making ◽

Fdg Pet ◽

Intractable Epilepsy ◽

Infantile Spasms ◽

Contralateral Hemisphere ◽

Complex Partial Seizures ◽

Surgical Decision ◽

Unilateral Disease ◽

Surgical Decision Making

Background: To assess the role of 2-deoxy-2(18F)-fluoro-D-glucose positron emission tomography (FDG-PET) scans in the comprehensive evaluation and surgical decision-making in patients with schizencephaly. Methods: We evaluated 11 patients (8M) with schizencephaly (mean follow-up: 4.5 years), including detailed clinical, MRI, FDG-PET, EEG, surgical and neuropathology data. Results: Eight patients had unilateral and three had bilateral clefts on MRI. Mean age at seizure onset was 20 months, with seizure being frequent in 10 and rare in one. Multiple seizure types were noted, with complex partial seizures being the most common (n=8) followed by infantile spasms (n=6). FDG-PET showed larger area of involvement than MRI in all the patients which corresponded better with the electrophysiological changes. Five patients (with unilateral disease on MRI) underwent epilepsy surgery (4 hemispherectomy and 1 multilobar resection). Two patients with focal defect on MRI underwent hemispherectomy due to larger area of abnormality revealed by FDG-PET. One patient was excluded from the surgery due to bilateral abnormalities on FDG PET. Six patients (4 with surgery) were seizure-free at last follow-up (average seizure-free duration: 70 months). One patient who underwent hemispherectomy due to apparently unilateral disease on both video-EEG and MRI but having bilateral abnormality on PET continued to have seizures. ACTH treatment had only a brief (1 month to 1 year) or no response in the six infantile spasms patients. Conclusions: FDG-PET typically shows a much larger area of involvement than MRI thus supplementing MRI in defining the full extent of malformation and assessing the functional integrity of the contralateral hemisphere. FDG-PET may prove to be a useful tool to aid in surgical decision-making and predicting surgical outcome, as patients with contralateral abnormality on FDG-PET may have poor surgical outcomes. When the malformation is unilateral with an intact contralateral hemisphere, surgery (usually hemispherectomy) may be curative of the epilepsy.

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