PET Manifestation in Different Types of Pathology in Epilepsy

Talanow, Roland; Ruggieri, Paul; Alexopoulos, Andreas V.; Lachhwani, Deepak; Wu, Guiyun

doi:10.1097/rlu.0b013e3181b534cf

Cited by 17 publications

(20 citation statements)

References 13 publications

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“…The presence of localized PET hypometabolism is correlated with a good seizure outcome after epilepsy surgery [24,27]. Interictal hypermetabolism on FDG-PET has been correlated with very frequent or continuous epileptiform discharges [24,[28][29][30][31][32][33][34][35][36]. Infrequent reports of interictal SPECT hyperperfusion also support these findings [19,37,38].…”

supporting

confidence: 58%

“…Despite being uncommon, one study used ictal PET-MRI coregistration to determine the EZ and to help with epilepsy surgery planning [33], while another ictal PET study showed that complex partial seizures are associated with bilaterally increased cerebral blood flow in the cortical areas, especially the temporal and frontal lobes and subcortical areas [50]. Interictal hypermetabolism on FDG-PET appears to be associated with very frequent or continuous epileptiform discharges [24,[28][29][30][31][32][33][34][35][36]. Infrequent reports of interictal SPECT hyperperfusion also support these findings [19,37,38].…”

Section: Discussionmentioning

confidence: 99%

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Significance of FDG-PET Hypermetabolism in Children with Intractable Focal Epilepsy

et al. 2018

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Background: Interictal ¹⁸F-fluorodeoxyglucose-positron emission topography (FDG-PET) hypometabolism is routinely used in the presurgical workup of children with medically intractable epilepsy (MIE). FDG-PET hypermetabolism, however, is rarely seen, and the significance of this finding in the epilepsy workup is not well established. Methods: We performed a retrospective study of patients who underwent FDG-PET during the presurgical workup of MIE over a 4-year period, between 1 January 2010 and 31 December 2013, at the Children’s Hospital Colorado, CO, USA. Results: Focal FDG-PET hypermetabolism was identified in 7 (2.2%) of 317 patients. The median age was 124 months, all cases with catastrophic epilepsy. Surface electroencephalography (EEG) performed concomitantly with FDG injections revealed ictal EEG discharges in 2 patients, frequent interictal epileptiform discharges (IEDs) in 3, occasional IEDs in 1, and no IEDs in 1. All 7 patients underwent functional hemispherectomies. Histopathology revealed type 1 focal cortical dysplasia in all patients. Six (86%) were completely seizure-free (Engel class I) and 1 had extremely infrequent seizures (Engel class II) (mean follow-up, 47.4 months). Conclusion: While a rare finding, interictal PET hypermetabolism does occur, may help identify epileptogenic zones, and assessment to reveal it should be made by concomitant use of surface EEG during PET scans.

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supporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Significance of FDG-PET Hypermetabolism in Children with Intractable Focal Epilepsy

et al. 2018

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“…Extra attention is especially required for diagnosis of gliomas. Mixed neuronal and glial tumors and gliomas which easily cause convulsions had decreased accumulation of FDG until now [26, 27]. In our case, accumulation of FDG was high in low-grade glioma which is frequently associated with convulsions.…”

Section: Discussionmentioning

confidence: 55%

Usefulness of FDG, MET and FLT-PET Studies for the Management of Human Gliomas

Miyake

Shinomiya²,

Okada³

et al. 2012

Journal of Biomedicine and Biotechnology

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The use of positron imaging agents such as FDG, MET, and FLT is expected to lead the way for novel applications toward efficient malignancy grading and treatment of gliomas. In this study, the usefulness of FDG, MET and FLT-PET images was retrospectively reviewed by comparing their histopathological findings. FDG, MET, and FLT-PET were performed in 27 patients with WHO grade IV, 15 patients with WHO grade III, and 12 patients with WHO grade II during 5.5 years. The resulting PET images were compared by measuring SUVs and T/N ratios (tumor to normal tissue ratios). Although there were no significant differences in FDG-PET, there were significant differences in the T/N ratios in the MET-PET between WHO grades II and IV and in the FLT-PET between the WHO grades III and IV. In glioblastoma patients, the SUVs of the areas depicted by MRI in the MET-PET were different from those SUVs in the FLT-PET. Importantly, the areas with high SUVs in both MET-PET and FLT-PET were also high in Ki-67 index and were histologically highly malignant. PET imaging is a noninvasive modality that is useful in determining a tumor area for removal as well as improving preoperative diagnosis for gliomas.

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“…PET images were assessed visually, and if a region of hypermetabolism was detected, a semiquantitative analysis was performed in the homologous regions with an asymmetry >10% difference considered significant. PET images were evaluated semiquantitatively by measuring maximum standardized uptake value (SUV) using advanced open‐source PACS station DICOM viewer OsiriX v. 4.1.2 in the region of interest from visual inspection …”

Section: Methodsmentioning

confidence: 99%

PET hypermetabolism in medically resistant childhood epilepsy: Incidence, associations, and surgical outcome

et al. 2016

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SUMMARYObjective: We observed several children with medically resistant epilepsy demonstrating focal positron emission tomography (PET) hypermetabolism, a finding rarely reported and of questionable significance. We therefore retrospectively reviewed the incidence of hypermetabolic PET, and its relationship to electroencephalography (EEG) and magnetic resonance imaging (MRI) findings, and to the outcome of epilepsy surgery. Methods: We retrospectively reviewed 498 PET brain studies in patients with medically resistant childhood epilepsy for evidence of hypermetabolism. In patients with PET hypermetabolism, we correlated metabolic abnormality with the scalp EEG and MRI findings. In a subset of patients who underwent surgical resection, we further correlated the PET findings with histopathologic and surgical outcomes. Results: Focal PET hypermetabolism was identified in 33 (6.6%) of 498 studies. The region of hypermetabolism correlated with a spike count of ≥10 per minute in 26 of 32 concomitant scalp EEG studies and 18 of 21 lesions evident on MRI. In 17 patients who underwent surgical resection, PET hypermetabolism further correlated with regions revealing almost continuous epileptiform discharges on the intracranial EEG and with histopathologically malformative tissue. At a minimum follow-up of 1 year postsurgery (median 33 months), 7 (50%) of 14 patients had Engel's class I outcome, 4 patients had class II, and 2 had class III outcome, whereas one patient was unchanged. At last follow-up, seizure freedom was noted in five of seven patients with focal PET hypermetabolism alone versus three of eight patients with PET hypometabolism. Significance: Focal PET hypermetabolism is associated with high spike frequency on scalp EEG and can occur in the absence of ictal events during the peri-injection period. Correlation with intracranial EEG usually corroborates the highly epileptogenic pathophysiologic state. Cortical malformations constitute the most common pathologic substrate, and resection of the hypermetabolic PET region may facilitate favorable outcomes. These observations indicate that focal PET hypermetabolism is an important marker of the epileptogenic zone and may represent its epicenter. KEY WORDS: Intractable childhood epilepsy, High spike count, Resection of hypermetabolic PET region, Epilepsy surgery outcome, Epicenter of epileptogenic zone.

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PET Manifestation in Different Types of Pathology in Epilepsy

Cited by 17 publications

References 13 publications

Significance of FDG-PET Hypermetabolism in Children with Intractable Focal Epilepsy

Significance of FDG-PET Hypermetabolism in Children with Intractable Focal Epilepsy

Usefulness of FDG, MET and FLT-PET Studies for the Management of Human Gliomas

PET hypermetabolism in medically resistant childhood epilepsy: Incidence, associations, and surgical outcome

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