Subsequent experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy

Oldan, Jorge; Shin, Hae Won; Khandani, Amir H.; Zamora, Carlos; Benefield, Thad; Jewells, Valerie

doi:10.1016/j.seizure.2018.07.022

Cited by 36 publications

(36 citation statements)

References 13 publications

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“…for infantile epilepsy or infantile spasms and improves etiologic classifications and the predication of therapy efficacy [11,32]. Hybrid PET/MRIidentified 12 subtle hypometabolic areas (with fewer slices and slighter Z-score decreasing) that were overlooked by conventional visual PET analysis.…”

Section: Hybrid Pet/mri Showed Advantage In Soz Precise Localizationmentioning

confidence: 99%

“…With PET/MRI guidance, we were able to localize hypometabolic epileptic areas more precisely, and therefore could reduce the number of SEEG electrodes needed. The number of SEEG electrodes was reduced to 7.07 ± 1.85 (range, [6][7][8][9][10][11][12][13][14] electrodes for each patient, which had two main advantages: reduced brain injury and decreased patient financial burdens. Hybrid PET/MRI helped to navigate SEEG to localize the SOZ in 35 patients (83.33 %) and showed the same SOZ localization with SEEG in 27 patients (64.29 %), values that were defined as being concordant.…”

Section: Utility Of Hybrid Pet/mri In Navigating Seeg Electrode Implamentioning

confidence: 99%

“…Previous studies have shown increased accuracy of hybrid PET/MRI imaging compared to separate MRI imaging and PET/CT for SOZ localization with less radiation exposure [9][10][11]. However, until now, very few hybrid PET/MRI data have been available for navigating SEEG electrode implantation in MRI-negative refractory epilepsy.…”

Section: Introductionmentioning

confidence: 99%

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Utility of hybrid PET/MRI multiparametric imaging in navigating SEEG placement in refractory epilepsy

Zhang

Liu

Huang

et al. 2020

Seizure

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Stereo-electroencephalography (SEEG) implantation before epilepsy surgery is critical for precise localization and complete resection of the seizure onset zone (SOZ). Combined metabolic and morphological imaging using hybrid PET/MRI may provide supportive information for the optimization of the SEEG coverage of brain structures. In this study, we originally imported PET/MRI images into the SEEG positioning system to evaluate the application of PET/MRI in guiding SEEG implantation in refractory epilepsy patients. Materials: Forty-two patients undergoing simultaneous PET/MRI examinations were recruited. All the patients underwent SEEG implantation guided by hybrid PET/MRI and surgical resection or ablation of epileptic lesion. Surgery outcome was assessed using a modified Engel classification one year (13.60 ± 2.49 months) after surgery. Areas of SOZ were identified using hybrid PET/MRI and concordance with SEEG was evaluated. Logistic regression analysis was used to predict the presence of a favorable outcome with the coherence of concordance of PET/MRI and SEEG. Results: Hybrid PET/MRI (including visual PET, MRI, plus MI Neuro) identified SOZ lesions in 38 epilepsy patients (90.47 %). PET/MRI showed the same SOZ localization with SEEG in 29 patients (69.05 %), which was considered to be concordant. The concordance between the PET/MRI and SEEG findings was significantly predictive of a successful surgery outcome (odds ratio = 20.41; 95 % CI = 2.75-151.4, P = 0.003**). Conclusion: Hybrid PET/MRI combined visual PET, multiple sequences MRI and SPM PET helps identify epilepsy lesions particularly in subtle hypometabolic areas. Patients with concordant epileptic lesion localization on PET/ MRI and SEEG demonstrated a more favorable outcome than those with inconsistent localization between modalities.

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Section: Hybrid Pet/mri Showed Advantage In Soz Precise Localizationmentioning

confidence: 99%

Section: Utility Of Hybrid Pet/mri In Navigating Seeg Electrode Implamentioning

confidence: 99%

See 1 more Smart Citation

Utility of hybrid PET/MRI multiparametric imaging in navigating SEEG placement in refractory epilepsy

Zhang

Liu

Huang

et al. 2020

Seizure

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“…Retrospective studies by Oldan and colleagues and Shin et al evaluated the utility of hybrid PET-MRI in evaluation of refractory focal epilepsy, and they noted that PET-MRI fusion was able to identify additional lesions better than MRI alone, including lesions seen only retrospectively on MRI after detection on PET. 15,16 Their data suggest that PET-MR has the most utility in widening the range of possible targets rather than confirming a site of resection, and this may help predict areas of interest for invasive monitoring to guide surgical resection. With varied results on the predictive value of PET-CT and PET-MRI in postoperative patients, more studies are needed to help understand fully the role of this new imaging technology.…”

Section: Introductionmentioning

confidence: 99%

Refractory seizures: Prediction of outcome of surgical intervention based on results from PET-CT, PET-MRI and electroencephaolography

et al. 2019

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Purpose The purpose of this article is to evaluate the effectiveness of fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) and PET-magnetic resonance imaging (MRI) with scalp and intracranial electroencephalogram (EEG) in predicting surgical outcomes in patients with refractory seizures. Methods Patients who underwent PET-CT and MRI fusion, scalp and intracranial EEG, and subsequent surgical intervention were retrospectively included. PET-CT were fused with MRI and interpreted by an experienced blinded reader. An area of hypometabolism on PET was identified as the location of the epileptic focus. The site of seizure focus was correlated with scalp and intracranial EEG findings. Surgical outcomes were evaluated. Thirty-six patients were included; all had presurgical PET-CT, scalp EEG, and PET-MRI fusion, and 28 of these patients had intracranial EEGs. Results PET-CT showed concordance of epileptic foci with scalp EEG in 7/36 patients (19%) and with intracranial EEG in 9/28 patients (32%). PET-MRI was concordant with scalp EEG in 6/36 patients (17%) and with intracranial EEG in 8/28 patients (29%). All patients with concordance of epileptic foci between PET-CT and PET-MRI and scalp EEG had improvement or resolution of seizures postintervention, and 89% of patients had concordance between intracranial EEG and PET studies. However, 45% of patients with discordant PET-CT and scalp EEG, 37% with discordance PET-CT and intracranial EEG, 43% with discordant PET-MRI and scalp EEG, and 35% of patients with discordant PET-MRI and intracranial EEG did not improve postsurgically. Conclusion Concordance of epileptic foci localization between PET imaging and EEG yields favorable postoperative outcome in nearly all patients, whereas discordance has an equal probability of favorable vs unfavorable outcomes.

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“…Of note, hybrid PET/MRI relies on MR-based attenuation correction (MRAC) for PET reconstruction instead of CT-based AC used in PET/CT, which is the current clinical standard for FDG-PET imaging in epilepsy. While some studies show that traditional MRAC approaches can produce small bias in quantitative PET due to inadequate modeling of bone (Larsson et al 2013;Andersen et al 2014), recent reports have revealed that these MRAC biases do not significantly impact the clinical diagnosis of FDG-PET readings in epilepsy (Paldino et al 2017;Oldan et al 2018). Nevertheless, alternative MRAC methods have been proposed to reduce potential bias in reconstructed PET (Ladefoged et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET-guided diffusion tractography reveals white matter abnormalities around the epileptic focus in medically refractory epilepsy: implications for epilepsy surgical evaluation

Poirier

Kwan

Jurkiewicz

et al. 2020

European J Hybrid Imaging

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Background: Hybrid PET/MRI can non-invasively improve localization and delineation of the epileptic focus (EF) prior to surgical resection in medically refractory epilepsy (MRE), especially when MRI is negative or equivocal. In this study, we developed a PET-guided diffusion tractography (PET/DTI) approach combining 18 F-fluorodeoxyglucose PET (FDG-PET) and diffusion MRI to investigate white matter (WM) integrity in MRI-negative MRE patients and its potential impact on epilepsy surgical planning. Methods: FDG-PET and diffusion MRI of 14 MRI-negative or equivocal MRE patients were used to retrospectively pilot the PET/DTI approach. We used asymmetry index (AI) mapping of FDG-PET to detect the EF as brain areas showing the largest decrease in FDG uptake between hemispheres. Seed-based WM fiber tracking was performed on DTI images with a seed location in WM 3 mm from the EF. Fiber tractography was repeated in the contralateral brain region (opposite to EF), which served as a control for this study. WM fibers were quantified by calculating the fiber count, mean fractional anisotropy (FA), mean fiber length, and mean cross-section of each fiber bundle. WM integrity was assessed through fiber visualization and by normalizing ipsilateral fiber measurements to contralateral fiber measurements. The added value of PET/DTI in clinical decision-making was evaluated by a senior neurologist. Results: In over 60% of the patient cohort, AI mapping findings were concordant with clinical reports on seizure-onset localization and lateralization. Mean FA, fiber count, and mean fiber length were decreased in 14/14 (100%), 13/14 (93%), and 12/ 14 (86%) patients, respectively. PET/DTI improved diagnostic confidence in 10/14 (71%) patients and indicated that surgical candidacy be reassessed in 3/6 (50%) patients who had not undergone surgery.

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Subsequent experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy

Abstract: PET-MR provides additional sensitivity when used as two combined modalities for detecting possible epileptic foci.

Cited by 36 publications

References 13 publications

Utility of hybrid PET/MRI multiparametric imaging in navigating SEEG placement in refractory epilepsy

Utility of hybrid PET/MRI multiparametric imaging in navigating SEEG placement in refractory epilepsy

Refractory seizures: Prediction of outcome of surgical intervention based on results from PET-CT, PET-MRI and electroencephaolography

18F-FDG PET-guided diffusion tractography reveals white matter abnormalities around the epileptic focus in medically refractory epilepsy: implications for epilepsy surgical evaluation

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