[F]FDG PET/MRI and Magnetoencephalography May Improve Presurgical Localization of Temporal Lobe Epilepsy

Overview

Journal Eur Radiol

Specialty Radiology

Date 2021 Oct 15

PMID 34651211

Citations 9

Authors

Kun Guo

Jingjuan Wang

Bixiao Cui

Yihe Wang

Yaqin Hou

Guoguang Zhao

Jie Lu

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate the clinical value of the combination of [F]FDG PET/MRI and magnetoencephalography (MEG) ([F]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 [F]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 [F]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 [F]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 [F]FDG PET/MRI/MEG. The results of PET/MRI/MEG concordance with surgical resection were significantly higher than that of PET/MRI or MEG (χ = 13.948, p < 0.001; χ = 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 (χ = 6.695, p = 0.012; χ = 16.991, p < 0.0001).

Conclusions: Presurgical evaluation by [F]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 [F]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.

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References

Thijs R, Surges R, OBrien T, Sander J . Epilepsy in adults. Lancet. 2019; 393(10172):689-701. DOI: 10.1016/S0140-6736(18)32596-0. View

Frauscher B . Localizing the epileptogenic zone. Curr Opin Neurol. 2020; 33(2):198-206. DOI: 10.1097/WCO.0000000000000790. View

Sidhu M, Duncan J, Sander J . Neuroimaging in epilepsy. Curr Opin Neurol. 2018; 31(4):371-378. DOI: 10.1097/WCO.0000000000000568. View

Engel Jr J . Evolution of concepts in epilepsy surgery. Epileptic Disord. 2019; 21(5):391-409. DOI: 10.1684/epd.2019.1091. View

Yuan J, Chen Y, Hirsch E . Intracranial electrodes in the presurgical evaluation of epilepsy. Neurol Sci. 2012; 33(4):723-9. DOI: 10.1007/s10072-012-1020-2. View

Trotta M, Cocjin J, Whitehead E, Damera S, Wittig Jr J, Saad Z . Surface based electrode localization and standardized regions of interest for intracranial EEG. Hum Brain Mapp. 2017; 39(2):709-721. PMC: 5764778. DOI: 10.1002/hbm.23876. View

Oldan J, Shin H, Khandani A, Zamora C, Benefield T, Jewells V . Subsequent experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy. Seizure. 2018; 61:128-134. DOI: 10.1016/j.seizure.2018.07.022. View

Guo K, Cui B, Shang K, Hou Y, Fan X, Yang H . Assessment of localization accuracy and postsurgical prediction of simultaneous F-FDG PET/MRI in refractory epilepsy patients. Eur Radiol. 2021; 31(9):6974-6982. DOI: 10.1007/s00330-021-07738-8. View

Plummer C, Vogrin S, Woods W, Murphy M, Cook M, Liley D . Interictal and ictal source localization for epilepsy surgery using high-density EEG with MEG: a prospective long-term study. Brain. 2019; 142(4):932-951. PMC: 6459284. DOI: 10.1093/brain/awz015. View

10.

van Klink N, Mooij A, Huiskamp G, Ferrier C, Braun K, Hillebrand A . Simultaneous MEG and EEG to detect ripples in people with focal epilepsy. Clin Neurophysiol. 2019; 130(7):1175-1183. DOI: 10.1016/j.clinph.2019.01.027. View

11.

Megevand P, Seeck M . Electroencephalography, magnetoencephalography and source localization: their value in epilepsy. Curr Opin Neurol. 2018; 31(2):176-183. DOI: 10.1097/WCO.0000000000000545. View

12.

Leijten F, Huiskamp G, Hilgersom I, van Huffelen A . High-resolution source imaging in mesiotemporal lobe epilepsy: a comparison between MEG and simultaneous EEG. J Clin Neurophysiol. 2003; 20(4):227-38. DOI: 10.1097/00004691-200307000-00001. View

13.

Englot D, Nagarajan S, Imber B, Raygor K, Honma S, Mizuiri D . Epileptogenic zone localization using magnetoencephalography predicts seizure freedom in epilepsy surgery. Epilepsia. 2015; 56(6):949-58. PMC: 4457690. DOI: 10.1111/epi.13002. View

14.

Kikuchi K, Togao O, Yamashita K, Momosaka D, Nakayama T, Kitamura Y . Diagnostic accuracy for the epileptogenic zone detection in focal epilepsy could be higher in FDG-PET/MRI than in FDG-PET/CT. Eur Radiol. 2020; 31(5):2915-2922. PMC: 8043950. DOI: 10.1007/s00330-020-07389-1. View

15.

Shang K, Wang J, Fan X, Cui B, Ma J, Yang H . 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. 2018; 39(10):1791-1798. PMC: 7410737. DOI: 10.3174/ajnr.A5814. View

16.

Ding Y, Zhu Y, Jiang B, Zhou Y, Jin B, Hou H . F-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(9):1567-1572. DOI: 10.1007/s00259-018-4017-0. View

17.

Niu N, Xing H, Wu M, Ma Y, Liu Y, Ba J . Performance of PET imaging for the localization of epileptogenic zone in patients with epilepsy: a meta-analysis. Eur Radiol. 2021; 31(8):6353-6366. DOI: 10.1007/s00330-020-07645-4. View

18.

Cahill V, Sinclair B, Malpas C, McIntosh A, Chen Z, Vivash L . Metabolic patterns and seizure outcomes following anterior temporal lobectomy. Ann Neurol. 2019; 85(2):241-250. DOI: 10.1002/ana.25405. View

19.

Stefan H, Hummel C, Scheler G, Genow A, Druschky K, Tilz C . Magnetic brain source imaging of focal epileptic activity: a synopsis of 455 cases. Brain. 2003; 126(Pt 11):2396-405. DOI: 10.1093/brain/awg239. View

20.

Widjaja E, Shammas A, Vali R, Otsubo H, Ochi A, Snead O . FDG-PET and magnetoencephalography in presurgical workup of children with localization-related nonlesional epilepsy. Epilepsia. 2013; 54(4):691-9. DOI: 10.1111/epi.12114. View