High-resolution pediatric age–specific 18F-FDG PET template: a pilot study in epileptogenic focus localization

Abstract

Background PET imaging has been widely used in diagnosis of neurological disorders; however, its application to pediatric population is limited due to lacking pediatric age–specific PET template. This study aims to develop a pediatric age–specific PET template (PAPT) and conduct a pilot study of epileptogenic focus localization in pediatric epilepsy. Methods We recruited 130 pediatric patients with epilepsy and 102 age-matched controls who underwent 18F-FDG PET examination. High-resolution PAPT was developed by an iterative nonlinear registration-averaging optimization approach for two age ranges: 6–10 years (n = 17) and 11–18 years (n = 50), respectively. Spatial normalization to the PAPT was evaluated by registration similarities of 35 validation controls, followed by estimation of potential registration biases. In a pilot study, epileptogenic focus was localized by PAPT-based voxel-wise statistical analysis, compared with multi-disciplinary team (MDT) diagnosis, and validated by follow-up of patients who underwent epilepsy surgery. Furthermore, epileptogenic focus localization results were compared among three templates (PAPT, conventional adult template, and a previously reported pediatric linear template). Results Spatial normalization to the PAPT significantly improved registration similarities (P < 0.001), and nearly eliminated regions of potential biases (< 2% of whole brain volume). The PAPT-based epileptogenic focus localization achieved a substantial agreement with MDT diagnosis (Kappa = 0.757), significantly outperforming localization based on the adult template (Kappa = 0.496) and linear template (Kappa = 0.569) (P < 0.05). The PAPT-based localization achieved the highest detection rate (89.2%) and accuracy (80.0%). In postsurgical seizure-free patients (n = 40), the PAPT-based localization also achieved a substantial agreement with resection areas (Kappa = 0.743), and the highest detection rate (95%) and accuracy (80.0%). Conclusion The PAPT can significantly improve spatial normalization and epileptogenic focus localization in pediatric epilepsy. Future pediatric neuroimaging studies can also benefit from the unbiased spatial normalization by PAPT. Trial registration. NCT04725162: https://clinicaltrials.gov/ct2/show/NCT04725162

Processing speed dysfunction is associated with functional corticostriatal circuit alterations in childhood epilepsy with centrotemporal spikes: a PET and fMRI study

“…Most neuroimaging studies concentrated on cognitive impairments of language, attention, and working memory in ECTS patients [ 1 , 3 ]; however, only one study investigated processing speed [ 21 ]. Our study, together with the previous study, showed that processing speed could be impaired in patients with ECTS [ 28 ].…”

“…18 F-FDG PET images were preprocessed by Statistical Parametric Mapping (SPM8; https://www.fil.ion.ucl.ac.uk/spm ), FSL ( https://fsl.fmrib.ox.ac.uk/fsl/fslwiki ) [ 19 ], and FreeSurfer ( https://surfer.nmr.mgh.harvard.edu/ ) [ 20 ]. All 18 F-FDG PET images of ECTS patients and controls were spatially normalized to an in-house pediatric 18 F-FDG PET template, followed by Gaussian smoothing with 6-mm full-width half-maximum (FWHM) [ 21 ]. Standardized uptake value ratio (SUVR) was determined to normalize intensities by using cerebellum gray matter as the reference region [ 22 ].…”

“…edu/) [20]. All 18 F-FDG PET images of ECTS patients and controls were spatially normalized to an in-house pediatric 18 F-FDG PET template, followed by Gaussian smoothing with 6-mm fullwidth half-maximum (FWHM) [21]. Standardized uptake value ratio (SUVR) was determined to normalize intensities by using cerebellum gray matter as the reference region [22].…”

Nuclear imaging for localization and surgical outcome prediction in epilepsy: A review of latest discoveries and future perspectives

“…Functional deficit zone in pediatric epilepsy using in-house age-specific FDG-PET templates by linear registration between PET images and pediatric MRI template showed better agreement with the clinical diagnosis than using the in-built adult control dataset (99). A pediatric-age-specific FDG-PET template based on a nonlinear optimization method improved spatial normalization and showed better EZ localization than using the adult template and linear template (100). Three-dimensional stereotactic surface projection (3D-SSP; NEUROSTAT) software is another user-friendly voxel-based brain mapping software for FDG-PET, which was proven to improve EZ detection compared with visual assessment and MRI and its performance is comparable with SPM analysis (101).…”

Unsupervised generation of pseudo normal PET from MRI with diffusion model for epileptic focus localization

“…

18 F]fluorodeoxyglucose (FDG) positron emission tomography (PET) has emerged as a crucial tool in identifying the epileptic focus, especially in cases where magnetic resonance imaging (MRI) diagnosis yields indeterminate results. FDG PET can provide the metabolic information of glucose and help identify abnormal areas that are not easily found through MRI.

…”