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Etiologic classification of infantile spasms using positron emission/magnetic resonance imaging and the efficacy of adrenocorticotropic hormone therapy

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Abstract

Purpose

The aim of this study was to investigate if the etiologic classification of infantile spasm (IS) using positron emission tomography/magnetic resonance imaging (PET/MR) is feasible. Based on the classified etiologic groups, we further evaluated the efficacy of adrenocorticotropic hormone (ACTH) therapy in different IS groups.

Materials and methods

One hundred fifty-five children diagnosed with IS were included in this study. A qualitative assessment of the PET/MR images was performed. The abnormal lesions localized with both MR and PET images were considered to be epileptic foci, and the patients with these lesions were classified into the structural-metabolic group. For the remaining patients, quantitative analyses were further performed on whole-brain T1-weighted (T1WI) and PET images, based on the asymmetry index of bilateral volumes and metabolic quantifications. Patients with asymmetry indices above a certain threshold (15%) were classified into the structural-metabolic group. The patients without positive finding from either qualitative or quantitative analyses were assigned to the unknown etiology group. The efficacy of ACTH therapy was evaluated in the different IS groups.

Results

Among the 155 children with IS, 18 genetic cases were first diagnosed by the genetic testing. In the remaining 137 cases, 49 cases were identified with structural-metabolic etiology using qualitative PET/MR assessments. Fifty-two cases were newly diagnosed with quantitative analysis. The remaining 36 cases were classified into the unknown etiology group. The efficacy of ACTH therapy was statistically different for the different etiology groups (p < 0.001). The respective efficacy rates for the genetic, qualitative structural-metabolic, quantitative structural-metabolic, and unknown etiology groups were 27.8% (5/18), 30.61% (15/49), 34.62% (18/52), and 72.22% (26/36), respectively.

Conclusions

The combination of PET and MR provides additional diagnostic information for IS. Quantitative analysis can further improve patient etiologic classifications and the predication of therapy efficacies.

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Authors and Affiliations

  1. Department of Nuclear Medicine, The Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China

    Haodan Dang, Jiahe Tian, Jiajin Liu & Baixuan Xu

  2. Department of Pediatric, The Chinese PLA General Hospital, Beijing, 100853, China

    Liping Zou

  3. MR Scientific Marketing, Diagnostic Imaging, Siemens Healthcare Ltd., Beijing, 100102, People’s Republic of China

    Xiang Feng

  4. MR Collaboration, Diagnostic Imaging, Siemens Healthcare Ltd., Shanghai, 201318, People’s Republic of China

    Mu Lin

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Contributions

Conceptualization: Haodan Dang and Baixuan Xu

Methodology: Haodan Dang and Liping Zou

Formal analysis and investigation: Haodan Dang, Jiajin Liu, Xiang Feng, and Mu Lin

Writing (original draft preparation): Haodan Dang

Writing (review and editing): Haodan Dang, Xiang Feng, and Mu Lin

Writing (revision): Jiahe Tian, Haodan Dang, Xiang Feng, and Mu Lin

Resources: Liping Zou

Supervision: Baixuan Xu

Corresponding author

Correspondence to Baixuan Xu.

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Conflict of interest

Feng Xiang and Lin Mu are employed at Siemens Healthcare Ltd. All other authors of this manuscript declare no relationships with any company and no financial interests related to the subject matter of the article.

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Supplementary Materials 1

The overview of the asymmetry indices (AI) for the volume size and SUV mean in all the bilateral pairs of ROIs (ROI 1–-90) (DOCX 115 kb)

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Dang, H., Zou, L., Tian, J. et al. Etiologic classification of infantile spasms using positron emission/magnetic resonance imaging and the efficacy of adrenocorticotropic hormone therapy. Eur J Nucl Med Mol Imaging 47, 1585–1595 (2020). https://doi.org/10.1007/s00259-019-04665-1

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