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Simultaneous high-resolution whole-brain MR spectroscopy and [18F]FDG PET for temporal lobe epilepsy

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

Abstract

Purpose

Precise lateralizing the epileptogenic zone in patients with drug-resistant mesial temporal lobe epilepsy (mTLE) remains challenging, particularly when routine MRI scans are inconclusive (MRI-negative). This study aimed to investigate the synergy of fast, high-resolution, whole-brain MRSI in conjunction with simultaneous [18F]FDG PET for the lateralization of mTLE.

Methods

Forty-eight drug-resistant mTLE patients (M/F 31/17, age 12–58) underwent MRSI and [18F]FDG PET on a hybrid PET/MR scanner. Lateralization of mTLE was evaluated by visual inspection and statistical classifiers of metabolic mappings against routine MRI. Additionally, this study explored how disease status influences the associations between altered N-acetyl aspartate (NAA) and FDG uptake using hierarchical moderated multiple regression.

Results

The high-resolution whole-brain MRSI data offers metabolite maps at comparable resolution to [18F]FDG PET. Visual examinations of combined MRSI and [18F]FDG PET showed an mTLE lateralization accuracy rate of 91.7% in a 48-patient cohort, surpassing routine MRI (52.1%). Notably, out of 23 MRI-negative mTLE, combined MRSI and [18F]FDG PET helped detect 19 cases. Logistical regression models combining hippocampal NAA level and FDG uptake improved lateralization performance (AUC=0.856), while further incorporating extrahippocampal regions such as amygdala, thalamus, and superior temporal gyrus increased the AUC to 0.939. Concurrent MRSI/PET revealed a moderating influence of disease duration and hippocampal atrophy on the association between hippocampal NAA and glucose uptake, providing significant new insights into the disease’s trajectory.

Conclusion

This paper reports the first metabolic imaging study using simultaneous high-resolution MRSI and [18F]FDG PET, which help visualize MRI-unidentifiable lesions and may thus advance diagnostic tools and management strategies for drug-resistant mTLE.

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Data Availability

The data that support the findings of this study are available upon request from the corresponding author, J.L.

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Funding

The study was partially supported by the National Natural Science Foundation of China (No. 62101321, and No. 82372073), Shanghai Municipal Health Commission (No. 202240031), and Shanghai Municipal Key Clinical Specialty (shslczdzk03403).

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Author notes

  1. Hui Huang and Miao Zhang contributed equally to this work.

Authors and Affiliations

  1. School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China

    Hui Huang, Bingyang Cai, Jiwei Li, Siyu Yuan & Jie Luo

  2. Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Miao Zhang, Xinyun Huang, Xiaozhu Lin & Biao Li

  3. Beckman Institute for Advanced Sciences and Technology, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA

    Yibo Zhao, Yudu Li, Wen Jin, Rong Guo & Zhi-Pei Liang

  4. Department of Electrical and Computer Engineering, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA

    Yibo Zhao, Wen Jin & Zhi-Pei Liang

  5. National Center for Supercomputing Applications, University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA

    Yudu Li

  6. Siemens Medical Solutions USA, Inc, Urbana, IL, 61801, USA

    Rong Guo

  7. Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Wei Liu

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  1. Hui Huang
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Correspondence to Biao Li or Jie Luo.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Ruijin hospital (Approved No. 2016-128).

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Huang, H., Zhang, M., Zhao, Y. et al. Simultaneous high-resolution whole-brain MR spectroscopy and [18F]FDG PET for temporal lobe epilepsy. Eur J Nucl Med Mol Imaging 51, 721–733 (2024). https://doi.org/10.1007/s00259-023-06465-0

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  • DOI: https://doi.org/10.1007/s00259-023-06465-0

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