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Morphometric analysis program and quantitative positron emission tomography in presurgical localization in MRI-negative epilepsies: a simultaneous PET/MRI study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To evaluate morphometric analysis program (MAP) and quantitative positron emission tomography (QPET) in epileptogenic zone (EZ) identification using a simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) system in MRI-negative epilepsies.

Methods

Seventy-one localization-related MRI-negative epilepsies who underwent preoperative simultaneous PET/MRI examination and surgical resection were enrolled retrospectively. MAP was performed on a T1-weighted volumetric sequence, and QPET was analyzed using statistical parametric mapping (SPM) with comparison to age- and gender-matched normal controls. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MAP, QPET, MAP + QPET, and MAP/QPET in EZ localization were assessed. The correlations between surgical outcome and modalities concordant with cortical resection were analyzed.

Results

Forty-five (63.4%) patients had Engel I seizure outcomes. The sensitivity, specificity, PPV, and NPV of MAP were 64.4%, 69.2%, 78.3%, and 52.9%, respectively. The sensitivity, specificity, PPV, NPV of QPET were 73.3%, 65.4%, 78.6%, and 58.6%, respectively. MAP + QPET, defined as two tests concordant with cortical resection, had reduced sensitivity (53.3%) but increased specificity (88.5%) relative to individual tests. MAP/QPET, defined as one or both tests concordant with cortical resection, had increased sensitivity (86.7%) but reduced specificity (46.2%) relative to individual tests. The regions determined by MAP, QPET, MAP + QPET, or MAP/QPET concordant with cortical resection were significantly associated with the seizure-free outcome.

Conclusion

QPET has a superior sensitivity than MAP, while the combined MAP + QPET obtained from a simultaneous PET/MRI scanner may improve the specificity of the diagnostic tests in EZ localization coupled with the preferable surgical outcome in MRI-negative epilepsies.

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Data availability

Data and materials are available from Jie Lu.

References

  1. Malmgren K, Krýsl D. Epilepsy: long-term outcomes in MRI-negative patients with epilepsy. Nat Rev Neurol. 2017;13:132–3.

    Article  PubMed  Google Scholar 

  2. Pellinen J, Kuzniecky R, Doyle W, Devinsky O, Dugan P. MRI-negative PET-negative epilepsy long-term surgical outcomes: a single-institution retrospective review. Epilepsy Res. 2020;67:106481.

    Article  Google Scholar 

  3. Wang ZI, Jones SE, Jaisani Z, Najm IM, Prayson RA, Burgess RC, et al. Voxel-based morphometric magnetic resonance imaging (MRI) postprocessing in MRI-negative epilepsies. Ann Neurol. 2015;77:1060–75.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sun K, Ren Z, Yang D, Wang X, Yu T, Ni D, et al. Voxel-based morphometric MRI post-processing and PET/MRI co-registration reveal subtle abnormalities in cingulate epilepsy. Epilepsy Res. 2021;171:106568.

    Article  CAS  PubMed  Google Scholar 

  5. Wagner J, Weber B, Urbach H, Elger CE, Huppertz HJ. Morphometric MRI analysis improves detection of focal cortical dysplasia type II. Brain. 2011;134:2844–54.

    Article  PubMed  Google Scholar 

  6. Kim YK, Lee DS, Lee SK, Kim SK, Chung CK, Chang KH, et al. Differential features of metabolic abnormalities between medial and lateral temporal lobe epilepsy: quantitative analysis of (18)F-FDG PET using SPM. J Nucl Med. 2003;44:1006–12.

    PubMed  Google Scholar 

  7. Liu F, Ruan W, Deng X, Song Y, Song W, Hu F, et al. Efficacy of delayed 18F-FDG hybrid PET/MRI for epileptic focus identification: a prospective cohort study. Eur J Nucl Med Mol Imaging. 2021;48:293–301.

    Article  CAS  PubMed  Google Scholar 

  8. Zhu Y, Feng J, Wu S, Hou H, Ji J, Zhang K, et al. Glucose metabolic profile by visual assessment combined with statistical parametric mapping analysis in pediatric patients with epilepsy. J Nucl Med. 2017;58:1293–9.

    Article  CAS  PubMed  Google Scholar 

  9. von Oertzen TJ. PET and ictal SPECT can be helpful for localizing epileptic foci. Curr Opin Neurol. 2018;31:184–91.

    Article  Google Scholar 

  10. Ponisio MR, Zempel JM, Day BK, Eisenman LN, Miller-Thomas MM, Smyth MD, et al. The role of SPECT and PET in epilepsy. AJR Am J Roentgenol. 2021;216:759–68.

    Article  PubMed  Google Scholar 

  11. Mayoral M, Marti-Fuster B, Carreño M, Carrasco JL, Bargalló N, Donaire A, et al. Seizure-onset zone localization by statistical parametric mapping in visually normal (18) F-FDG PET studies. Epilepsia. 2016;57:1236–44.

    Article  PubMed  Google Scholar 

  12. Peter J, Houshmand S, Werner TJ, Rubello D, Alavi A. Applications of global quantitative 18F-FDG-PET analysis in temporal lobe epilepsy. Nucl Med Commun. 2016;37:223–30.

    Article  CAS  PubMed  Google Scholar 

  13. Kumar A, Juhász C, Asano E, Sood S, Muzik O, Chugani HT. Objective detection of epileptic foci by 18F-FDG PET in children undergoing epilepsy surgery. J Nucl Med. 2010;51:1901–7.

    Article  PubMed  Google Scholar 

  14. Lin Y, Fang YD, Wu G, Jones SE, Prayson RA, Moosa ANV, et al. Quantitative positron emission tomography-guided magnetic resonance imaging postprocessing in magnetic resonance imaging-negative epilepsies. Epilepsia. 2018;59:1583–94.

    Article  PubMed  Google Scholar 

  15. Blümcke I, Thom M, Aronica E, Armstrong DD, Vinters HV, Palmini A, et al. The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia. 2011;52:158–74.

    Article  PubMed  Google Scholar 

  16. Engel JJ, Van Ness NP, Rasmussen TB, Ojemann LM. Outcome with respect to epileptic seizures. In: Engel JJ, editor. Surgical treatment of the epilepsies. 2nd ed. New York: Raven Press; 1993. p. 609–21.

    Google Scholar 

  17. Ryvlin P, Rheims S. Predicting epilepsy surgery outcome. Curr Opin Neurol. 2016;29:182–8.

    Article  CAS  PubMed  Google Scholar 

  18. Krucoff MO, Chan AY, Harward SC, Rahimpour S, Rolston JD, Muh C, et al. Rates and predictors of success and failure in repeat epilepsy surgery: a meta-analysis and systematic review. Epilepsia. 2017;58:2133–42.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Juhász C, John F. Utility of MRI, PET, and ictal SPECT in presurgical evaluation of non-lesional pediatric epilepsy. Seizure. 2020;77:15–28.

    Article  PubMed  Google Scholar 

  20. Tomás J, Pittau F, Hammers A, Bouvard S, Picard F, Vargas MI, et al. The predictive value of hypometabolism in focal epilepsy: a prospective study in surgical candidates. Eur J Nucl Med Mol Imaging. 2019;46:1806–16.

    Article  PubMed  Google Scholar 

  21. Widjaja E, Shammas A, Vali R, Otsubo H, Ochi A, Snead OC, et al. FDG-PET and magnetoencephalography in presurgical workup of children with localization-related non-lesional epilepsy. Epilepsia. 2013;54:691–9.

    Article  PubMed  Google Scholar 

  22. Ding Y, Zhu Y, Jiang B, Zhou Y, Jin B, Hou H, et al. 18F-FDG PET and high-resolution MRI co-registration for pre-surgical evaluation of patients with conventional MRI-negative refractory extra-temporal lobe epilepsy. Eur J Nucl Med Mol Imaging. 2018;45:1567–72.

    Article  PubMed  Google Scholar 

  23. Desarnaud S, Mellerio C, Semah F, Laurent A, Landre E, Devaux B, et al. 18F-FDG PET in drug-resistant epilepsy due to focal cortical dysplasia type 2: additional value of electroclinical data and co-registration with MRI. Eur J Nucl Med Mol Imaging. 2018;45:1449–60.

    Article  CAS  PubMed  Google Scholar 

  24. Mendes Coelho VC, Morita ME, Amorim BJ, Ramos CD, Yasuda CL, Tedeschi H, et al. Automated online quantification method for 18F-FDG positron emission tomography/CT improves detection of the epileptogenic zone in patients with pharmaco-resistant epilepsy. Front Neurol. 2017;8:453.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tan YL, Kim H, Lee S, Tihan T, Ver Hoef L, Mueller SG, et al. Quantitative surface analysis of combined MRI and PET enhances detection of focal cortical dysplasia. Neuroimage. 2018;166:10–8.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Yuchao Xu, Ph.D. and Yan Guo, MD from GE Healthcare for editing drafts and statistical suggestions for this manuscript.

Funding

This work was supported by the Beijing Municipal Administration of Hospitals Ascent Plan [grant number DFL20180802].

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Author notes

  1. Kun Guo and Jingjuan Wang contributed equally to this article

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China

    Kun Guo, Jingjuan Wang, Zhenming Wang, Bixiao Cui & Jie Lu

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

    Yihe Wang & Guoguang Zhao

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

    Jie Lu

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  1. Kun Guo
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  2. Jingjuan Wang
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Correspondence to Jie Lu.

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Research involving human participants and/or animals

The research involved human participants. This retrospective study was permitted by the Research Ethics Committee of the Capital Medical University of Xuanwu hospital.

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All patients gave written informed consent prior to enrollment in this study.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Neurology

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Guo, K., Wang, J., Wang, Z. et al. Morphometric analysis program and quantitative positron emission tomography in presurgical localization in MRI-negative epilepsies: a simultaneous PET/MRI study. Eur J Nucl Med Mol Imaging 49, 1930–1938 (2022). https://doi.org/10.1007/s00259-021-05657-w

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  • DOI: https://doi.org/10.1007/s00259-021-05657-w

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