The Evaluation of Dynamic FDG-PET for Detecting Epileptic Foci and Analyzing Reduced Glucose Phosphorylation in Refractory Epilepsy

Tang, Yongxiang; Liow, Jeih‐San; Zhang, Zhimin; Li, Jian; Long, Tingting; Li, Yulai; Tang, Beisha; Hu, Shuo

doi:10.3389/fnins.2018.00993

Cited by 24 publications

(25 citation statements)

References 36 publications

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“…FDG-PET imaging plays an important role in the localization of epileptic foci. Tang et al performed an investigation on kinetic parameters for epileptic foci identification (24). They assessed the correlation of parameters asymmetry indexes (ASYM) between dynamic and static FDG-PET to understand the hypo metabolism pathophysiology within intractable epilepsy.…”

Section: Utility Of Fdg-pet In the Identification Of The Epileptogenic Zonementioning

confidence: 99%

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

Bacon

Jin

et al. 2021

Front. Neurol.

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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.

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Section: Utility Of Fdg-pet In the Identification Of The Epileptogenic Zonementioning

confidence: 99%

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

Bacon

Jin

et al. 2021

Front. Neurol.

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“…FDG was injected intravenously at a mean dose of 148 MBq. Images were acquired in three dimensions over a 60 min time period, following scanning protocol described by Tang et al (11). Image processing was performed using the SPM12 (Wellcome Department of Cognitive Neurology, London, UK).…”

Section: Fdg-pet Image Acquisition and Processingmentioning

confidence: 99%

“…While recurrent seizures following surgery suggested that some epileptogenic tissue distinct from the primary temporal lobe epileptogenic zone has not been resected, and those areas might reflect dual pathology beyond seizure onset zone, but usually negative in magnetic resonance imaging (MRI) or impossibility of whole brain electrocorticogram (ECoG) coverage (5,7), thus posing a difficult diagnostic challenge. Emerging evidence suggests that temporal lobe hypometabolism on fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) can provide relevant information on the epileptogenic zone extent and surgical outcome (9)(10)(11). The highest clinical benefit of FDG-PET can be achieved in patients with MRI-negative TLE (12).…”

Section: Introductionmentioning

confidence: 99%

FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy

Tang

Liao

et al. 2020

Front. Med.

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Objective: Metabolic abnormality in the extratemporal area on fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is not an uncommon finding in drug-resistant temporal lobe epilepsy (TLE), however the correlation between extratemporal metabolic abnormalities and surgical long-term prognosis has not been fully elucidated. We aim to investigate FDG-PET extratemporal metabolic profiles predictive of failure in surgery for TLE patients.Methods: Eighty-two patients with unilateral TLE (48 female, 34 male; 25.6 ± 10.6 years old; 37 left TLE, 45 right TLE) and 30 healthy age-matched controls were enrolled. Patients were classified either as experiencing seizure-recurrence (SZR, Engel class II through IV) or seizure-free (SZF, Engel class I) at least 1 year after surgery. Regional cerebral metabolism was evaluated by FDG-PET with statistical parametric mapping (SPM12). Abnormal metabolic profiles and patterns on FDG-PET in SZR group were evaluated and compared with those of healthy control and SZF subjects on SPM12. Volume and intensity as well as special brain areas of abnormal metabolism in temporal and extratemporal regions were quantified and visualized.Results: With a median follow-up of 1.5 years, 60% of patients achieved Engel class I (SZF). SZR was associated with left TLE and widespread hypometabolism in FDG-PET visual assessment (both p < 0.05). All patients had hypometabolism in the ipsilateral temporal lobe but SZR was not correlated with volume or intensity of temporal hypometabolism (median, 1,456 vs. 1,040 mm3; p > 0.05). SZR was correlated with extratemporal metabolic abnormalities that differed according to lateralization: in right TLE, SZR exhibited larger volume in extratemporal areas compared to SZF (median, 11,060 vs. 2,112 mm3; p < 0.05). Surgical failure was characterized by Cingulum_Ant_R/L, Frontal_Inf_Orb_R abnormal metabolism in extratemporal regions. In left TLE, SZR presented a larger involvement of extratemporal areas similar to right TLE but with no significant (median, 5,873 vs. 3,464 mm3; p > 0.05), Cingulum_Ant_ R/L, Parietal_Inf_L, Postcentral_L, and Precuneus_R involved metabolic abnormalities were correlated with SZR.Conclusions: Extratemporal metabolic profiles detected by FDG-PET may indicate a prominent cause of TLE surgery failure and should be considered in predictive models for epilepsy surgery. Seizure control after surgery might be improved by investigating extratemporal areas as candidates for resection or neuromodulation.

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“…However, some patients show no structural lesions on MRI or discordant findings between MRI and EEG. Thus, aberrant brain function needs to be assessed using other noninvasive imaging modalities such as MEG, Single Photon Emission Computed Tomography (SPECT), and PET [18,[21][22][23]. Interictal 18 F-FDG PET scans contribute to the functional deficit zone definition by Fig.…”

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

confidence: 99%

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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The Evaluation of Dynamic FDG-PET for Detecting Epileptic Foci and Analyzing Reduced Glucose Phosphorylation in Refractory Epilepsy

Cited by 24 publications

References 36 publications

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

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

FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy

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

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