Kun Guo1, Jingjuan Wang1, Bixiao Cui1, Yihe Wang2, Yaqin Hou1, Guoguang Zhao2, Jie Lu3,4. 1. Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China. 2. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. 3. Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China. imaginglu@hotmail.com. 4. Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China. imaginglu@hotmail.com.
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.
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.
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