scholarly journals Epileptogenic Zone Localization in Refractory Epilepsy by FDG-PET: The Comparison of SPM and SPM-CAT With Different Parameter Settings

2021 ◽  
Vol 12 ◽  
Author(s):  
Eric Jacob Bacon ◽  
Chaoyang Jin ◽  
Dianning He ◽  
Shuaishuai Hu ◽  
Lanbo Wang ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Fdg Pet ◽  
Refractory Epilepsy ◽  
Statistical Parametric Mapping ◽  
Postoperative Outcome ◽  
Visual Assessment ◽  
Outcome Evaluation ◽  
Complex Case ◽  
Epileptogenic Zone ◽  
Positive Finding

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.

Assessment of Bone Marrow Involvement by FDG-PET in Patients with Follicular Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 5108-5108
Author(s):  
Inas El- Najjar ◽  
Teresa Szyszko ◽  
Amy Mc Dowell ◽  
Janet Matthews ◽  
John G Gribben ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Quantitative Analysis ◽  
Follicular Lymphoma ◽  
Fdg Pet ◽  
Visual Analysis ◽  
Bone Marrow Involvement ◽  
High Specificity ◽  
Visual Assessment ◽  
Focal Lesions ◽  
Standardized Uptake Values

Abstract Abstract 5108 Background and Aims Several studies evaluating the role of FDG-PET in assessing bone marrow (BM) involvement in patients with lymphoma have been published. However, they have relied on visual analysis alone which has proved inadequate. The aim of this study was to assess the value of semi-quantitative assessment in identifying BM involvement in patients with follicular lymphoma (FL). Methods and statistical analysis This is a single centre retrospective analysis of 41 patients with grade 1–3a FL (female: 51%; median age: 64 years, range: 30 – 87) who underwent FDG -PET/CT and unilateral bone marrow biopsy (BMB) as part of the staging assessment. Thirty patients were newly diagnosed and 11 had their staging investigations at relapse. Amongst the latter, none of them had received any treatment in the previous 3 months. BM uptake was assessed both visually and with semi-quantitative analysis. On visual analysis, BM uptake was compared to the liver as the reference. Semi-quantitative analysis involved measuring the maximum standardized uptake values (SUVmax) at the sternum, both iliac blades and the T12 vertebra. An average of these 4 measurements was recorded as SUVav. The highest SUVmax recorded in any of the 4 bone sites, the SUVav, and the ratios SUVav/mediastinal blood pool (MBP) and SUVav/liver were compared by t-test according to whether patients had a positive or a negative BMB. Optimal SUVmax, SUVav, SUVav/liver and SUVav/MBP cutoffs were defined by receiver operating characteristic (ROC) curves. Results Sixteen patients (37%) had BM involvement on the BMB but 11 of them did not have increased uptake in the BM compartment on visual analysis of the FDG-PET. In contrast, 7 patients had BM involvement (focal lesions in 6, diffuse involvement in 1) on visual analysis of the FDG-PE but 2 had a negative BMB. All semi-quantitative measurements were significantly higher in patients with a positive BMB in comparison with those with a negative BMB (table). The optimal cutoff values were ≥2. 5 for SUVmax, ≥2 for SUVav, ≥0. 75 for SUVav/liver, and ≥1 for SUVav/MBP. The sensitivity and the specificity for the prediction of BM involvement utilising SUVmax ≥2. 5 at a single site was 56% and 84%. However, the SUVav ≥2 had a better sensitivity (63%) whilst maintaining a high specificity of 96%. The sensitivity was still further improved by normalizing these values as a ratio of the uptake: SUVav/liver ≥0. 75 had a sensitivity of 81% and a specificity of 80%, whereas the sensitivity and specificity of SUVav/MBP ≥1 were 88% and 80%, respectively. Conclusions Visual assessment of FDG-PET has a high specificity but a low sensitivity to detect BM involvement in FL patients. In contrast, semi-quantitative assessments can improve the sensitivity of FDG-PET to predict BM involvement from 31% to 88%. Were these results confirmed in further prospective studies, they may help to predict BM involvement in FL patients, which may result in sparing selected patients from having a BMB. Disclosures: Gribben: Celgene: Honoraria; Roche: Honoraria; Pharmacyclics: Honoraria; GSK: Honoraria; Mundipharma: Honoraria; Gilead: Honoraria.

18F-FDG-PET patterns of surgical success and failure in mesial temporal lobe epilepsy

Neurology ◽  
2017 ◽  
Vol 88 (11) ◽  
pp. 1045-1053 ◽  
Author(s):  
Francine Chassoux ◽  
Eric Artiges ◽  
Franck Semah ◽  
Agathe Laurent ◽  
Elisabeth Landré ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Fdg Pet ◽  
Hippocampal Sclerosis ◽  
Statistical Parametric Mapping ◽  
Mesial Temporal Lobe Epilepsy ◽  
Epileptogenic Zone ◽  
Metabolic Pattern ◽  
Suboptimal Outcome ◽  
Mesial Temporal Lobe

Objective:To search for [18F]-fluorodeoxyglucose (FDG)-PET patterns predictive of long-term prognosis in surgery for drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS).Methods:We analyzed metabolic data with [18F]-FDG-PET in 97 patients with MTLE (53 female participants; age range 15–56 years) with unilateral HS (50 left) and compared the metabolic patterns, electroclinical features, and structural atrophy on MRI in patients with the best outcome after anteromesial temporal resection (Engel class IA, completely seizure-free) to those with a non-IA outcome, including suboptimal outcome and failure. Imaging processing was performed with statistical parametric mapping (SPM5).Results:With a mean follow-up of >6 years (range 2–14 years), 85% of patients achieved a class I outcome, including 45% in class IA. Class IA outcome was associated with a focal anteromesial temporal hypometabolism, whereas non-IA outcome correlated with extratemporal metabolic changes that differed according to the lateralization: ipsilateral mesial frontal and perisylvian hypometabolism in right HS and contralateral fronto-insular hypometabolism and posterior white matter hypermetabolism in left HS. Suboptimal outcome presented a metabolic pattern similar to the best outcome but with a larger involvement of extratemporal areas, including the contralateral side in left HS. Failure was characterized by a mild temporal involvement sparing the hippocampus and relatively high extratemporal hypometabolism on both sides. These findings were concordant with electroclinical features reflecting the organization of the epileptogenic zone but were independent of the structural abnormalities detected on MRI.Conclusions:[18F]-FDG-PET patterns help refine the prognostic factors in MTLE and should be implemented in predictive models for epilepsy surgery.

scholarly journals Diagnostic performance of preoperative [18F]FDG-PET/CT for lymph node staging in vulvar cancer: a large single-centre study

2021 ◽  
Author(s):  
Vittoria Rufini ◽  
Giorgia Garganese ◽  
Francesco P. Ieria ◽  
Tina Pasciuto ◽  
Simona M. Fragomeni ◽  
...  
Keyword(s):  
Lymph Node ◽  
Quantitative Analysis ◽  
Fdg Pet ◽  
Diagnostic Performance ◽  
Vulvar Cancer ◽  
Visual Assessment ◽  
Single Centre ◽  
Pet Ct ◽  
Study Population ◽  
Fdg Pet Ct

Abstract Purpose This retrospective study aimed to assess the diagnostic performance of preoperative [18F]FDG-PET/CT in predicting the groin and pelvic lymph node (LN) status in a large single-centre series of vulvar cancer patients. Methods Between January 2013 and October 2018, among all consecutive women with proven vulvar cancer submitted to [18F]FDG-PET/CT, 160 patients were included. LNs were analysed by two qualitative methods assessing PET information (defined as visual assessment) and a combination of PET and low-dose CT information (defined as overall assessment), respectively, as well as semi-quantitative analysis (LN-SUVmax). Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) in predicting the groin and pelvic LN status were calculated in the overall study population; a subset analysis of groin parameters in clinically/ultrasonography negative patients was also performed. Histopathology was the reference standard. Results All patients underwent vulvar and inguinofemoral LN surgery, and 35 pelvic LN surgery. Overall, 338 LN sites (296 groins and 42 pelvic sites) were histologically examined with 30.4% prevalence of metastatic groins and 28.6% for metastatic pelvic sites. In the overall study population, sensitivity (95% confidence interval, CI), specificity (95% CI), accuracy (95% CI), PPV (95% CI) and NPV (95% CI) at the groin level were 85.6% (78.3–92.8), 65.5% (59.0–72.0), 71.6% (66.5–76.8), 52.0% (44.0–60.1) and 91.2% (86.7–95.8) for visual assessment; 78.9% (70.5–87.3), 78.2% (72.5–83.8), 78.4% (73.7–83.1), 61.2% (52.3–70.1) and 89.4% (85.0–93.9) for overall assessment; and 73.3% (64.2–82.5), 85.0% (80.1–89.8), 81.4% (77.0–85.8), 68.0% (58.8–77.3) and 87.9% (83.4–92.5) for semi-quantitative analysis (SUVmax cut-off value 1.89 achieved by ROC analysis). Similar results were observed in the pelvis-based analysis. Conclusion In this large single-centre series of vulvar cancer patients, [18F]FDG-PET/CT showed good values of sensitivity and NPV in discriminating metastatic from non-metastatic LNs. In routine clinical practice, qualitative analysis is a reliable interpretative criterion making unnecessary commonly used semi-quantitative methods such as SUVmax.

scholarly journals Localizing Epileptic Foci Before Surgery in Patients With MRI-Negative Refractory Epilepsy Using Statistical Parameter Mapping and Three-Dimensional Stereotactic Surface Projection Based on 18F-FDG PET

2022 ◽  
Vol 9 ◽  
Author(s):  
Hailing Zhou ◽  
Wei Zhang ◽  
Zhiqiang Tan ◽  
Ziqing Zhou ◽  
Ying Li ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Refractory Epilepsy ◽  
Comprehensive Evaluation ◽  
Three Dimensional ◽  
Statistical Parameter ◽  
Visual Assessment ◽  
Parameter Mapping ◽  
Positron Emission ◽  
Surface Projection ◽  
Magnetic Resonance Imaging Mri

Patients with refractory epilepsy are not only free of seizures after resecting epileptic foci, but also experience significantly improved quality of life. Fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG PET) is a promising avenue for detecting epileptic foci in patients with magnetic resonance imaging (MRI)-negative refractory epilepsy. However, the detection of epileptic foci by visual assessment based on 18F-FDG PET is often complicated by a variety of factors in clinical practice. Easy imaging methods based on 18F-FDG PET images, such as statistical parameter mapping (SPM) and three-dimensional stereotactic surface projection (3D-SSP), can objectively detect epileptic foci. In this study, the regions of surgical resection of patients with over 1 year follow-up and no seizures were defined as standard epileptic foci. We retrospectively analyzed the sensitivity of visual assessment, SPM and 3D-SSP based on 18F-FDG PET to detect epileptic foci in MRI-negative refractory epilepsy patients and obtained the sensitivities of visual assessment, SPM and 3D-SSP are 57, 70 and 60% respectively. Visual assessment combined with SPM or 3D-SSP can improve the sensitivity of detecting epileptic foci. The sensitivity was highest when the three methods were combined, but decreased consistency, in localizing epileptic foci. We conclude that SPM and 3D-SSP can be used as objective methods to detect epileptic foci before surgery in patients with MRI-negative refractory epilepsy. Visual assessment is the preferred method for PET image analysis in MRI-negative refractory epilepsy. When the visual assessment is inconsistent with the patient’s electroclinical information, SPM or 3D-SSP was further selected to assess the epileptic foci. If the combination of the two methods still fails to accurately locate the epileptic foci, comprehensive evaluation can be performed by combining the three methods.

scholarly journals Brain Metabolic Correlates of Persistent Olfactory Dysfunction after SARS-Cov2 Infection

Biomedicines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 287
Author(s):  
Maria Isabella Donegani ◽  
Alberto Miceli ◽  
Matteo Pardini ◽  
Matteo Bauckneht ◽  
Silvia Chiola ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Structural Connectivity ◽  
Statistical Parametric Mapping ◽  
Brain Regions ◽  
Olfactory Dysfunction ◽  
Whole Body ◽  
Mapping Software ◽  
18F Fdg ◽  
Left Insula

We aimed to evaluate the brain hypometabolic signature of persistent isolated olfactory dysfunction after SARS-CoV-2 infection. Twenty-two patients underwent whole-body [18F]-FDG PET, including a dedicated brain acquisition at our institution between May and December 2020 following their recovery after SARS-Cov2 infection. Fourteen of these patients presented isolated persistent hyposmia (smell diskettes olfaction test was used). A voxel-wise analysis (using Statistical Parametric Mapping software version 8 (SPM8)) was performed to identify brain regions of relative hypometabolism in patients with hyposmia with respect to controls. Structural connectivity of these regions was assessed (BCB toolkit). Relative hypometabolism was demonstrated in bilateral parahippocampal and fusiform gyri and in left insula in patients with respect to controls. Structural connectivity maps highlighted the involvement of bilateral longitudinal fasciculi. This study provides evidence of cortical hypometabolism in patients with isolated persistent hyposmia after SARS-Cov2 infection. [18F]-FDG PET may play a role in the identification of long-term brain functional sequelae of COVID-19.

scholarly journals The benefit of the diffusion kurtosis imaging in presurgical evaluation in patients with focal MR-negative epilepsy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michaela Bartoňová ◽  
Marek Bartoň ◽  
Pavel Říha ◽  
Lubomír Vojtíšek ◽  
Milan Brázdil ◽  
...  
Keyword(s):  
Refractory Epilepsy ◽  
Diffusion Kurtosis Imaging ◽  
Epileptogenic Zone ◽  
Diffusion Weighted Mri ◽  
Specific Detection ◽  
Presurgical Evaluation ◽  
Brain Areas ◽  
Specific Restriction ◽  
Diffusion Kurtosis ◽  
Selection Of

AbstractThe effectivity of diffusion-weighted MRI methods in detecting the epileptogenic zone (EZ) was tested. Patients with refractory epilepsy (N=25) who subsequently underwent resective surgery were recruited. First, the extent of white matter (WM) asymmetry from mean kurtosis (MK) was calculated in order to detect the lobe with the strongest impairment. Second, a newly developed metric was used, reflecting a selection of brain areas with concurrently increased mean Diffusivity, reduced fractional Anisotropy, and reduced mean Kurtosis (iDrArK). A two-step EZ detection was performed as (1) lobe-specific detection, (2) iDrArK voxel-wise detection (with a possible lobe-specific restriction if the result of the first step was significant in a given subject). The method results were compared with the surgery resection zones. From the whole cohort (N=25), the numbers of patients with significant results were: 10 patients in lobe detection and 9 patients in EZ detection. From these subsets of patients with significant results, the impaired lobe was successfully detected with 100% accuracy; the EZ was successfully detected with 89% accuracy. The detection of the EZ using iDrArK was substantially more successful when compared with solo diffusional parameters (or their pairwise combinations). For a subgroup with significant results from step one (N=10), iDrArK without lobe restriction achieved 37.5% accuracy; lobe-restricted iDrArK achieved 100% accuracy. The study shows the plausibility of MK for detecting widespread WM changes and the benefit of combining different diffusional voxel-wise parameters.

scholarly journals Quantitative [18]FDG PET asymmetry features predict long-term seizure recurrence in refractory epilepsy

2021 ◽  
pp. 107714
Author(s):  
Lohith G. Kini ◽  
Ashesh A. Thaker ◽  
Peter N. Hadar ◽  
Russell T. Shinohara ◽  
Mesha-Gay Brown ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Refractory Epilepsy ◽  
Seizure Recurrence
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