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All-in-one interictal presurgical imaging in patients with epilepsy: single-session EEG/PET/(f)MRI

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

Abstract

Purpose

In patients with pharmacoresistant focal epilepsy, resection of the epileptic focus can lead to freedom from seizures or significant improvement in well-selected candidates. Localization of the epileptic focus with multimodal concordance is crucial for a good postoperative outcome. Beyond the detection of epileptogenic lesions on structural MRI and focal hypometabolism on FDG PET, EEG-based Electric Source Imaging (ESI) and simultaneous EEG and functional MRI (EEG-fMRI) are increasingly applied for mapping epileptic activity. We here report presurgical multimodal interictal imaging using a hybrid PET/MR scanner for single-session FDG PET, MRI, EEG-fMRI and ESI.

Methods

This quadrimodal imaging procedure was performed in a single session in 12 patients using a high-density (256 electrodes) MR-compatible EEG system and a hybrid PET/MR scanner. EEG was used to exclude subclinical seizures during uptake of the PET tracer, to compute ESI on interictal epileptiform discharges and to guide fMRI analysis for mapping haemodynamic changes correlated with interictal epileptiform activity.

Results

The whole multimodal recording was performed in less than 2 hours with good patient comfort and data quality. Clinically contributory examinations with at least two modalities were obtained in nine patients and with all modalities in five patients.

Conclusion

This single-session quadrimodal imaging procedure provided reliable and contributory interictal clinical data. This procedure avoids multiple scanning sessions and is associated with less radiation exposure than PET-CT. Moreover, it guarantees the same medication level and medical condition for all modalities. The procedure improves workflow and could reduce the duration and cost of presurgical epilepsy evaluations.

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Acknowledgments

This work was supported by the Swiss National Science Foundation for Scientific Research (grant nos. 33CM30-140332 and 320030-141165 and 146633), the Gertrude von Meissner Foundation and by the Centre for Biomedical Imaging (CIBM) of the Universities and Hospitals of Geneva and Lausanne, and the EPFL.

Conflicts of interest

S.H. and B.D. are Philips clinical scientists hired to run the scanner together with the hospital staff. They provided valuable technical assistance and are included in the authors’ list. However, the data analysis and interpretation were performed by the authors with pure academic affiliations with complete independence and without any conflicts of interest with respect to Philips Healthcare. The industrial company had no influence on the writing of this paper. The remaining authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiology and Medical Informatics, Geneva University Hospital, 1211, Geneva 14, Switzerland

    Frédéric Grouiller, Bénédicte M. A. Delattre, François Lazeyras, Osman Ratib, Maria I. Vargas & Valentina Garibotto

  2. EEG and Epilepsy Unit, Department of Neurology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland

    Francesca Pittau, Laurent Spinelli, Margitta Seeck & Serge Vulliemoz

  3. Philips AG Healthcare, 8027, Zürich, Switzerland

    Susanne Heinzer

  4. Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, Geneva University Hospital, 1211, Geneva 14, Switzerland

    Giannina R. Iannotti

Authors
  1. Frédéric Grouiller
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  2. Bénédicte M. A. Delattre
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  3. Francesca Pittau
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  4. Susanne Heinzer
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  6. Laurent Spinelli
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  7. Giannina R. Iannotti
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  8. Margitta Seeck
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  9. Osman Ratib
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  10. Maria I. Vargas
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  11. Valentina Garibotto
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  12. Serge Vulliemoz
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Correspondence to Serge Vulliemoz.

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Grouiller, F., Delattre, B.M.A., Pittau, F. et al. 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 (2015). https://doi.org/10.1007/s00259-015-3045-2

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  • DOI: https://doi.org/10.1007/s00259-015-3045-2

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