Kun Guo1, Bixiao Cui1, Kun Shang1, Yaqin Hou1, Xiaotong Fan2, Hongwei Yang1, Guoguang Zhao2, Jie Lu3,4,5. 1. Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. 2. Department of Neurosurgery, China INI, Xuanwu Hospital, Capital Medical University, Beijing, China. 3. Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China. imaginglu@hotmail.com. 4. Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China. imaginglu@hotmail.com. 5. Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China. imaginglu@hotmail.com.
Abstract
OBJECTIVES: To evaluate the accuracies of simultaneous 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([18F]-FDG PET/MRI) in preoperative localization and the postsurgical prediction. METHODS: This retrospective study was performed on ninety-eight patients diagnosed with refractory epilepsy whose presurgical evaluation included [18F]-FDG PET/MRI, with 1-year post-surgery follow-up between August 2016 and December 2018. PET/MRI images were interpreted by two radiologists and a nuclear medicine physician to localize the EOZ using standard visual analysis and asymmetry index based on standard uptake value (SUV). The localization accuracy and predictive performance of simultaneous 18F-FDG PET/MRI based on the surgial pathology and postsurgical outcome were evaluated. RESULTS: A total of 41.8% (41/98) patients were found to have a definitely structural abnormality on the MR portion of PET/MRI; 93.9% (92/98) were shown hypometabolism on the PET portion of the hybrid PET/MRI. PET/MRI identified 18 cases with subtle structural abnormalities on MRI re-read. Six percent (6/98) of patients PET/MRI were negative. A total of 65.3% (64/98) patients showed seizure-free at 1-year follow-up after epilepsy surgery. The sensitivity, specificity, and accuracy of [18F]-FDG PET/MRI was 95.3%, 8.8%, and 65.3% for seizure onset localization based on surgical pathology and postsurgical outcome, respectively. Multivariate regression analysis indicated that concordant of EOZ localization between PET/MRI and surgical resection range, which was a good positive predictor of seizure freedom (Engel I) (OR = 14.741, 95% CI 3.934-55.033, p < 0.001). CONCLUSIONS: [18F]-FDG PET/MRI used as two combined modalities providing additional sensitivity when detecting possible epileptic foci and will probably improve the surgical outcome. KEY POINTS: • Sensitivity, specificity, and accuracy of [18F]-FDG PET/MRI were 95.3%, 8.8%, and 65.3% for seizure onset localization based on surgical pathology and postsurgical outcome, respectively. • Concordance of EOZ localization between PET/MRI and surgical resection range was a good positive predictor of seizure freedom; presurgical [18F]-FDG PET/MRI will probably improve the surgical outcome.
OBJECTIVES: To evaluate the accuracies of simultaneous 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([18F]-FDG PET/MRI) in preoperative localization and the postsurgical prediction. METHODS: This retrospective study was performed on ninety-eight patients diagnosed with refractory epilepsy whose presurgical evaluation included [18F]-FDG PET/MRI, with 1-year post-surgery follow-up between August 2016 and December 2018. PET/MRI images were interpreted by two radiologists and a nuclear medicine physician to localize the EOZ using standard visual analysis and asymmetry index based on standard uptake value (SUV). The localization accuracy and predictive performance of simultaneous 18F-FDG PET/MRI based on the surgial pathology and postsurgical outcome were evaluated. RESULTS: A total of 41.8% (41/98) patients were found to have a definitely structural abnormality on the MR portion of PET/MRI; 93.9% (92/98) were shown hypometabolism on the PET portion of the hybrid PET/MRI. PET/MRI identified 18 cases with subtle structural abnormalities on MRI re-read. Six percent (6/98) of patients PET/MRI were negative. A total of 65.3% (64/98) patients showed seizure-free at 1-year follow-up after epilepsy surgery. The sensitivity, specificity, and accuracy of [18F]-FDG PET/MRI was 95.3%, 8.8%, and 65.3% for seizure onset localization based on surgical pathology and postsurgical outcome, respectively. Multivariate regression analysis indicated that concordant of EOZ localization between PET/MRI and surgical resection range, which was a good positive predictor of seizure freedom (Engel I) (OR = 14.741, 95% CI 3.934-55.033, p < 0.001). CONCLUSIONS: [18F]-FDG PET/MRI used as two combined modalities providing additional sensitivity when detecting possible epileptic foci and will probably improve the surgical outcome. KEY POINTS: • Sensitivity, specificity, and accuracy of [18F]-FDG PET/MRI were 95.3%, 8.8%, and 65.3% for seizure onset localization based on surgical pathology and postsurgical outcome, respectively. • Concordance of EOZ localization between PET/MRI and surgical resection range was a good positive predictor of seizure freedom; presurgical [18F]-FDG PET/MRI will probably improve the surgical outcome.
Entities:
Keywords:
Epilepsy; Magnetic resonance imaging; Positron emission tomography; Prognosis; Surgery
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