Skip to main content
SpringerLink
Log in

[18F]FDG PET/MRI and magnetoencephalography may improve presurgical localization of temporal lobe epilepsy

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

A Correction to this article was published on 21 March 2022

This article has been updated

Abstract

Objectives

To evaluate the clinical value of the combination of [18F]FDG PET/MRI and magnetoencephalography (MEG) ([18F]FDG PET/MRI/MEG) in localizing the epileptogenic zone (EZ) in temporal lobe epilepsy (TLE) patients.

Methods

Seventy-three patients with localization-related TLE who underwent [18F]FDG PET/MRI and MEG were enrolled retrospectively. PET/MRI images were interpreted by two radiologists; the focal hypometabolism on PET was identified using statistical parametric mapping (SPM). MEG spike sources were co-registered onto T1-weighted sequence and analyzed by Neuromag software. The clinical value of [18F]FDG PET/MRI, MEG, and PET/MRI/MEG in locating the EZ was assessed using cortical resection and surgical outcomes as criteria. The correlations between surgical outcomes and modalities concordant or non-concordant with cortical resection were analyzed.

Results

For 46.6% (34/73) of patients, MRI showed definitely structural abnormality concordant with surgical resection. SPM results of [18F]FDG PET showed focal temporal lobe hypometabolism concordant with surgical resection in 67.1% (49/73) of patients, while the concordant cases increased to 82.2% (60/73) patients with simultaneous MRI co-registration. MEG was concordant with surgical resection in 71.2% (52/73) of patients. The lobar localization was defined in 94.5% (69/73) of patients by the [18F]FDG PET/MRI/MEG. The results of PET/MRI/MEG concordance with surgical resection were significantly higher than that of PET/MRI or MEG (χ2 = 13.948, p < 0.001; χ2 = 5.393, p = 0.020). The results of PET/MRI/MEG cortical resection concordance with surgical outcome were shown to be better than PET/MRI or MEG (χ2 = 6.695, p = 0.012; χ2 = 16.991, p < 0.0001).

Conclusions

Presurgical evaluation by [18F]FDG PET/MRI/MEG could improve the identification of the EZ in TLE and may further guide surgical decision-making.

Key Points

• Lobar localization was defined in 94.5% of patients by the [18F]FDG PET/MRI/MEG.

• The results of PET/MRI/MEG concordance with surgical resection were significantly higher than that of PET/MRI or MEG alone.

• The results of PET/MRI/MEG cortical resection concordance with surgical outcome were shown to be better than that of PET/MRI or MEG alone.

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
Fig. 5

Similar content being viewed by others

Change history

Abbreviations

[18F]FDG:

18F-Fluorodeoxyglucose

EZ:

Epileptogenic zone

FCD:

Focal cortical dysplasia

HS:

Hippocampal sclerosis

MEG:

Magnetoencephalography

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

SPM:

Statistical parametric mapping

TLE:

Temporal lobe epilepsy

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

    Article  PubMed  Google Scholar 

  2. Frauscher B (2020) Localizing the epileptogenic zone. Curr Opin Neurol 33:198–206. https://doi.org/10.1097/WCO.0000000000000790

    Article  PubMed  Google Scholar 

  3. Sidhu MK, Duncan JS, Sander JW (2018) Neuroimaging in epilepsy. Curr Opin Neurol 31:371–378. https://doi.org/10.1097/WCO.0000000000000568

    Article  PubMed  Google Scholar 

  4. Engel J Jr (2019) Evolution of concepts in epilepsy surgery. Epileptic Disord 21:391–409. https://doi.org/10.1684/epd.2019.1091

    Article  PubMed  Google Scholar 

  5. Yuan J, Chen Y, Hirsch E (2012) Intracranial electrodes in the presurgical evaluation of epilepsy. Neurol Sci 33:723–729. https://doi.org/10.1007/s10072-012-1020-2

    Article  PubMed  Google Scholar 

  6. Trotta MS, Cocjin J, Whitehead E et al (2018) Surface based electrode localization and standardized regions of interest for intracranial EEG. Hum Brain Mapp 39:709–721. https://doi.org/10.1002/hbm.23876

    Article  PubMed  Google Scholar 

  7. 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 

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

    Article  PubMed  Google Scholar 

  9. Plummer C, Vogrin SJ, Woods WP et al (2019) Interictal and ictal source localization for epilepsy surgery using high-density EEG with MEG: a prospective long-term study. Brain 142:932–951. https://doi.org/10.1093/brain/awz015

    Article  PubMed  PubMed Central  Google Scholar 

  10. van Klink N, Mooij A, Huiskamp G (2019) Simultaneous MEG and EEG to detect ripples in people with focal epilepsy. Clin Neurophysiol 130:1175–1183. https://doi.org/10.1016/j.clinph.2019.01.027

    Article  PubMed  Google Scholar 

  11. Mégevand P, Seeck M (2018) Electroencephalography, magnetoencephalography and source localization: their value in epilepsy. Curr Opin Neurol 31:176–183. https://doi.org/10.1097/WCO.0000000000000545

    Article  PubMed  Google Scholar 

  12. Leijten FS, Huiskamp GJ, Hilgersom I et al (2003) High-resolution source imaging in mesiotemporal lobe epilepsy: a comparison between MEG and simultaneous EEG. J Clin Neurophysiol 20:227–238. https://doi.org/10.1097/00004691-200307000-00001

    Article  PubMed  Google Scholar 

  13. Englot DJ, Nagarajan SS, Imber BS et al (2015) Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery. Epilepsia 56:949–958. https://doi.org/10.1111/epi.13002

    Article  PubMed  PubMed Central  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. Kikuchi K, Togao O, Yamashita K et al (2021) Diagnostic accuracy for the epileptogenic zone detection in focal epilepsy could be higher in FDG-PET/MRI than in FDG-PET/CT. Eur Radiol 31:2915–2922. https://doi.org/10.1007/s00330-020-07389-1

    Article  PubMed  Google Scholar 

  16. Shang K, Wang J, Fan X et al (2018) Clinical value of hybrid TOF-PET/MR imaging-based multiparametric imaging in localizing seizure focus in patients with MRI-negative temporal lobe epilepsy. AJNR Am J Neuroradiol 39:1791–1798. https://doi.org/10.3174/ajnr.A5814

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Ding Y, Zhu Y, Jiang B et al (2018) [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 45:1567–1572. https://doi.org/10.1007/s00259-018-4017-0

    Article  PubMed  Google Scholar 

  18. Niu N, Xing H, Wu M et al (2021) Performance of PET imaging for the localization of epileptogenic zone in patients with epilepsy: a meta-analysis. Eur Radiol 31:6353–6366. https://doi.org/10.1007/s00330-020-07645-4

    Article  PubMed  Google Scholar 

  19. Cahill V, Sinclair B, Malpas CB et al (2019) Metabolic patterns and seizure outcomes following anterior temporal lobectomy. Ann Neurol 85:241–250. https://doi.org/10.1002/ana.25405

    Article  PubMed  Google Scholar 

  20. Yicong L, Yu-Hua Dean F, Guiyun W et al (2018) Quantitative positron emission tomography-guided magnetic resonance imaging postprocessing in magnetic resonance imaging-negative epilepsies. Epilepsia 59:1583–1594. https://doi.org/10.1111/epi.14474

    Article  Google Scholar 

  21. Stefan H, Hummel C, Scheler G et al (2003) Magnetic brain source imaging of focal epileptic activity: a synopsis of 455 cases. Brain 126:2396–2405. https://doi.org/10.1093/brain/awg239

    Article  CAS  PubMed  Google Scholar 

  22. Widjaja E, Shammas A, Vali R et al (2013) FDG-PET and magnetoencephalography in presurgical workup of children with localization-related non-lesional epilepsy. Epilepsia 54:691–699. https://doi.org/10.1111/epi.12114

    Article  PubMed  Google Scholar 

  23. 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 co-registration 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 

Download references

Acknowledgements

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

Author information

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, Bixiao Cui, Yaqin Hou & 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

Authors
  1. Kun Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jingjuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bixiao Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yihe Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yaqin Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guoguang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. 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.

The original online version of this article was revised: In the 'Statistical Analysis' section, the phrase "imaging results non-concordant with surgical resection in patients with ongoing seizures (Engel II–IV) were classified as false positive (FP)" was corrected to "imaging results concordant with surgical resection in patients with ongoing seizures (Engel II–IV) were classified as false positive (FP)" and the phrase "False negative (FN) was defined as imaging results concordant with the actual surgical resection in seizure-freedom patients." was corrected to "False negative (FN) was defined as imaging results non-concordant with the actual surgical resection in seizure-freedom patients."

Additionally, in the caption text for Figure 3, “right hippocampus” was corrected to “left hippocampus”. The corrected caption text should read: “A 30-year-old woman with refractory focal epilepsy with impaired consciousness for 15 years. MR imaging axial TIWI sequence (a), axial T2WI sequence (b), and T2-FLAIR (c) showed a reduction in volume and hyperintensity on T2 in the left hippocampus. [18F]FDG PET (d) and SPM image (f) showed bilateral temporal lobe hypometabolism. PET/MRI (e) localized the EZ in the left hippocampus. Surgery was performed (g) and pathology was HS. Post-surgical follow-up 2 years later, the patient was classified as having an Engel class I outcome”. The original article has been corrected.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 27 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guo, K., Wang, J., Cui, B. et al. [18F]FDG PET/MRI and magnetoencephalography may improve presurgical localization of temporal lobe epilepsy. Eur Radiol 32, 3024–3034 (2022). https://doi.org/10.1007/s00330-021-08336-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-08336-4

Keywords

Search

Navigation