Abstract
To assess the validity of an online method to quantitatively evaluate cerebral hypometabolism in patients with pharmacoresistant focal epilepsy as a complement to the visual analysis of the 18F-FDG positron emission tomography (PET)/CT exam. A total of 39 patients with pharmacoresistant epilepsy and probable focal cortical dysplasia [22 patients with frontal lobe epilepsy (FLE) and 17 with temporal lobe epilepsy (TLE)] underwent a presurgical evaluation including EEG, video-EEG, MRI, and 18F-FDG PET/CT. We conducted the automated quantification of their 18F-FDG PET/CT data and compared the results with those of the visual-PET analysis conducted by experienced nuclear medicine physicians. For each patient group, we calculated Cohen's Kappa coefficient for the visual and quantitative analyses, as well as each method's sensitivity, specificity, and positive and negative predictive values. For the TLE group, both the visual and quantitative analyses showed high agreement. Thus, although the quantitative analysis could be used as a complement, the visual analysis on its own was consistent and precise. For the FLE group, on the other hand, the visual analysis categorized almost half of the cases as normal, revealing very low agreement. For those patients, the quantitative analysis proved critical to identify the focal hypometabolism characteristic of the epileptogenic zone. Our results suggest that the quantitative analysis of 18F-FDG PET/CT data is critical for patients with extratemporal epilepsies, and especially those with subtle MRI findings. Furthermore, it can easily be used during the routine clinical evaluation of 18F-FDG PET/CT exams. Our results show that quantification of 18F-FDG PET is an informative complementary method that can be added to the routine visual evaluation of patients with subtle lesions, particularly those in the frontal lobes.
Highlights
Epilepsy is a brain disorder characterized by persistent unprovoked seizures [1]
After trying the 18F-FDG PET/CT quantification tool, we considered that it could be implemented during routine clinical analysis of patients with focal epilepsy, since it did not add a lot of processing time and effort
After quantification of the 18F-FDG PET/CT data, 52% of those patients with previously normal PET scans became “positive,” and hypometabolism was confirmed in the predetermined epileptogenic zone (EZ)
Summary
Epilepsy is a brain disorder characterized by persistent unprovoked seizures [1]. Most patients diagnosed with epilepsy respond well to pharmacological treatment [2]. How well a patient responds to treatment depends on the nature of the pathology as well as the complex interaction between genetic and environmental factors [3]. Surgical treatment yields positive results in some forms of pharmacoresistant focal epilepsy, and success depends on the degree to which the epileptogenic zone (EZ) can be resected while preserving essential functional areas [4]. In one recent study looking at focal cortical dysplasia (FCD), patients with Taylor-type dysplasia had more positive outcomes compared with patients with cytoarchitectural and architectural dysplasias (75 vs 50 and 43% seizure-free, respectively) [5]. Identifying the lesion responsible for seizure onset is critical for a better prognosis
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