Skip to main content
SpringerLink
Log in

Assessment of localization accuracy and postsurgical prediction of simultaneous 18F-FDG PET/MRI in refractory epilepsy patients

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the accuracies of simultaneous 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([18F]-FDG PET/MRI) in preoperative localization and the postsurgical prediction.

Methods

This retrospective study was performed on ninety-eight patients diagnosed with refractory epilepsy whose presurgical evaluation included [18F]-FDG PET/MRI, with 1-year post-surgery follow-up between August 2016 and December 2018. PET/MRI images were interpreted by two radiologists and a nuclear medicine physician to localize the EOZ using standard visual analysis and asymmetry index based on standard uptake value (SUV). The localization accuracy and predictive performance of simultaneous 18F-FDG PET/MRI based on the surgial pathology and postsurgical outcome were evaluated.

Results

A total of 41.8% (41/98) patients were found to have a definitely structural abnormality on the MR portion of PET/MRI; 93.9% (92/98) were shown hypometabolism on the PET portion of the hybrid PET/MRI. PET/MRI identified 18 cases with subtle structural abnormalities on MRI re-read. Six percent (6/98) of patients PET/MRI were negative. A total of 65.3% (64/98) patients showed seizure-free at 1-year follow-up after epilepsy surgery. The sensitivity, specificity, and accuracy of [18F]-FDG PET/MRI was 95.3%, 8.8%, and 65.3% for seizure onset localization based on surgical pathology and postsurgical outcome, respectively. Multivariate regression analysis indicated that concordant of EOZ localization between PET/MRI and surgical resection range, which was a good positive predictor of seizure freedom (Engel I) (OR = 14.741, 95% CI 3.934–55.033, p < 0.001).

Conclusions

[18F]-FDG PET/MRI used as two combined modalities providing additional sensitivity when detecting possible epileptic foci and will probably improve the surgical outcome.

Key Points

• Sensitivity, specificity, and accuracy of [18F]-FDG PET/MRI were 95.3%, 8.8%, and 65.3% for seizure onset localization based on surgical pathology and postsurgical outcome, respectively.

• Concordance of EOZ localization between PET/MRI and surgical resection range was a good positive predictor of seizure freedom; presurgical [ 18 F] -FDG PET/MRI will probably improve the surgical outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

[18F]-FDG PET/MRI:

18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging

AI:

Asymmetry index

CD:

Cortical dysplasia

CI:

Confidence interval

EOZ:

Epileptogenic onset zone

FCD:

Focal cortical dysplasia

HS:

Hippocampus sclerosis

OR:

Odds ratio

SVA:

Standard visual analysis

TSC:

Tuberous sclerosis complex

References

  1. Thijs RD, Surges R, O'Brien TJ, Sander JW (2019) Epilepsy in adults. Lancet 393:689–701. https://doi.org/10.1016/S0140-6736(18)32596-0

  2. Duncan JS, Sander JW, Sisodiya SM, Walker MC (2006) Adult epilepsy. Lancet 367:1087–1100. https://doi.org/10.1016/S0140-6736(06)68477-8

    Article  PubMed  Google Scholar 

  3. Widjaja E, Jain P, Demoe L, Guttmann A, Tomlinson G, Sander B (2020) Seizure outcome of pediatric epilepsy surgery: systematic review and meta-analyses. Neurology 94:311–321. https://doi.org/10.1212/WNL.0000000000008966

    Article  PubMed  Google Scholar 

  4. Spencer S, Huh L (2008) Outcomes of epilepsy surgery in adults and children. Lancet Neurol 7:525–537. https://doi.org/10.1016/S1474-4422(08)70109-1

    Article  PubMed  Google Scholar 

  5. Oldan JD, Shin HW, Khandani AH, Zamora C, Benefield T, Jewells V (2018) Subsequent experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy. Seizure 61:128–134. https://doi.org/10.1016/j.seizure.2018.07.022

    Article  PubMed  Google Scholar 

  6. Tellez-Zenteno JF, Hernandez RL, Moien-Afshari F, Wiebe S (2010) Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta analysis. https://doi.org/10.1016/j.eplepsyres.2010.02.007

  7. Rathore C, Dickson JC, Teotónio R, Ell P, Duncan JS (2014) The utility of 18F-fluorodeoxyglucose PET (FDG PET) in epilepsy surgery. Epilepsy Res 108:1306–1314. https://doi.org/10.1016/j.eplepsyres.2014.06.012

    Article  PubMed  Google Scholar 

  8. Shaikh Z, Torres A, Takeoka M (2019) Neuroimaging in pediatric epilepsy. Brain Sci 9:190. https://doi.org/10.3390/brainsci9080190

    Article  CAS  PubMed Central  Google Scholar 

  9. Tomás J, Pittau F, Hammers A et al (2019) The predictive value of hypometabolism in focal epilepsy: a prospective study in surgical candidates. Eur J Nucl Med Mol Imaging 46:1806–1816. https://doi.org/10.1007/s00259-019-04356-x

    Article  CAS  PubMed  Google Scholar 

  10. LoPinto-Khoury C, Sperling MR, Skidmore C et al (2012) Surgical outcome in PET-positive, MRI-negative patients with temporal lobe epilepsy. Epilepsia 53:342–348. https://doi.org/10.1111/j.1528-1167.2011.03359.x

    Article  PubMed  Google Scholar 

  11. Carne RP, O'Brien TJ, Kilpatrick CJ et al (2004) MRI-negative PET-positive temporal lobe epilepsy: a distinct surgically remediable syndrome. Brain 127(Pt 10):2276–2285. https://doi.org/10.1093/brain/awh257

    Article  CAS  PubMed  Google Scholar 

  12. Chassoux F, Rodrigo S, Semah F et al (2010) FDG-PET improves surgical outcome in negative MRI Taylor-type focal cortical dysplasias. Neurology 75:2168–2175. https://doi.org/10.1212/WNL.0b013e31820203a9

    Article  CAS  PubMed  Google Scholar 

  13. Werner P, Barthel H, Drzezga A, Sabri O (2015) Current status and future role of brain PET/MRI in clinical and research settings. Eur J Nucl Med Mol Imaging 42:512–526. https://doi.org/10.1007/s00259-014-2970-9

    Article  CAS  PubMed  Google Scholar 

  14. Wieser HG, Blume WT, Fish D et al (2001) ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia 2:282–286

    Google Scholar 

  15. von Oertzen J, Urbach H, Jungbluth S et al (2002) Standard MRI is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry 73:643–647. https://doi.org/10.1136/jnnp.73.6.643

    Article  Google Scholar 

  16. Bien CG, Szinay M, Wagner J, Clusmann H, Becker AJ, Urbach H (2009) Characteristics and surgical outcomes of patients with refractory magnetic resonance imaging-negative epilepsies. Arch Neurol 66:1491–1499. https://doi.org/10.1001/archneurol.2009.283

    Article  PubMed  Google Scholar 

  17. S Fernández, A. Donaire , E Serès et al (2015) PET/MRI and PET/MRI/SISCOM coregistration in the pre-surgical evaluation of refractory focal epilepsy. Epilepsy Res 111: 1-9. https://doi.org/10.1016/j.eplepsyres.2014.12.011

  18. Desarnaud S, Mellerio C, Semah F et al (2018) 18F-FDG PET in drug-resistant epilepsy due to focal cortical dysplasia type 2: additional value of electroclinical data and coregistration with MRI. Eur J Nucl Med Mol Imaging 45:1449–1460. https://doi.org/10.1007/s00259-018-3994-3

    Article  CAS  PubMed  Google Scholar 

  19. Garibotto V, Heinzer S, Vulliemoz S et al (2013) Clinical applications of hybrid PET/MRI in neuroimaging. Clin Nucl Med 38:e13–e18. https://doi.org/10.1097/RLU.0b013e3182638ea6

    Article  PubMed  Google Scholar 

  20. Yerys BE, Jankowski KF, Shook D, Rosenberger LR, Barnes KA, Berl MM (2009) The fMRI success rate of children and adolescents: typical development, epilepsy, attention deficit/hyperactivity disorder, and autism spectrum disorders. Hum Brain Mapp 30:3426–3435. https://doi.org/10.1002/hbm.20767

    Article  PubMed  PubMed Central  Google Scholar 

  21. Grouiller F, Delattre B, Pittau F et al (2015) All-in one interictal presurgical imaging in patients with epilepsy: single –session EEG/PET/(f)MRI. Eur J Nucl Med Mol Imaging 42:1133–1143. https://doi.org/10.1007/s00259-015-3045-2

    Article  PubMed  Google Scholar 

  22. Ormond DR, Clusmann H, Sassen R et al (2019) Pediatric temporal lobe epilepsy surgery in bonn and review of the literature. Neurosurgery 2019(84):844–856. https://doi.org/10.1093/neuros/nyy125

    Article  Google Scholar 

  23. Bonini F, McGonigal A, Scavarda D et al (2018) Predictive factors of surgical outcome in frontal lobe epilepsy explored with stereoelectroencephalography. Neurosurgery 2018(83):217–225. https://doi.org/10.1093/neuros/nyx342

    Article  Google Scholar 

  24. Salamon N, Kung J, Shaw SJ et al (2008) FDG-PET co-registration improves detection of cortical dysplasia in patients with epilepsy. Neurology 71:1594–1601. https://doi.org/10.1212/01.wnl.0000334752.41807.2f

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Chassoux F, Rodrigo S, Semah F et al (2010) FDG-PET improves surgical outcome in negative MRI Taylor-type focal cortical dysplasias. Neurology 75:2168–2175. https://doi.org/10.1212/WNL.0b013e31820203a9

    Article  CAS  PubMed  Google Scholar 

  26. Kikuchi K, Togao O, Yamashita K et al (2020) Diagnostic accuracy for the epileptogenic zone detection in focal epilepsy could be higher in FDG-PET/MRI than in FDG-PET/CT. Eur Radiol. https://doi.org/10.1007/s00330-020-07389-1

Download references

Funding

This study was supported by the Project of Beijing Municipal Administration of Hospital’s Ascent Plan, Code:DFL 20180802.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China

    Kun Guo, Bixiao Cui, Kun Shang, Yaqin Hou, Hongwei Yang & Jie Lu

  2. Department of Neurosurgery, China INI, Xuanwu Hospital, Capital Medical University, Beijing, China

    Xiaotong Fan & Guoguang Zhao

  3. Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China

    Jie Lu

  4. Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China

    Jie Lu

Authors
  1. Kun Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bixiao Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kun Shang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yaqin Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaotong Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hongwei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guoguang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jie Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jie Lu.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Jie Lu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

  • retrospective

  • diagnostic or prognostic study

  • performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guo, K., Cui, B., Shang, K. et al. Assessment of localization accuracy and postsurgical prediction of simultaneous 18F-FDG PET/MRI in refractory epilepsy patients. Eur Radiol 31, 6974–6982 (2021). https://doi.org/10.1007/s00330-021-07738-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-07738-8

Keywords

Search

Navigation