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- Title
The Role of FDG-PET in Patients with Epilepsy Related to Periventricular Nodular Heterotopias: Diagnostic Features and Long-Term Outcome.
- Authors
Popescu, Cristina Elena; Mai, Roberto; Sara, Roberto; Lizio, Domenico; Zanni, Daniela; Rossetti, Claudio; Caobelli, Federico
- Abstract
<bold>Background and Purpose: </bold>Periventricular nodular heterotopias (PNHs) are frequently associated with drug-resistant epilepsy (DRE). Although magnetic resonance imaging (MRI) can define the morphological features of PNHs, still there is a need to assess their metabolic activity in order to provide useful information on epileptogenicity and long-term outcome. To that end, we investigated the ability of 18 F-FDG PET to identify seizure onset zone in order to assess the metabolic activity of the ectopic neurons and to provide prognostic information on the postsurgical outcome.<bold>Methods: </bold>Sixteen patients (6 men and 10 women; ranging between 24 and 53 years of age) with PNHs-related DRE were evaluated. All patients underwent clinical evaluation, Stereo-electroencephalogram (SEEG), brain MRI, and 18 F-FDG brain PET/CT. PET images were superimposed on the patient-specific 3-dimensional-brain MRI. The metabolic activity of each nodule and of their cortex was visually and semiquantitatively assessed. The outcome after intervention was assessed in all patients using Engel classification.<bold>Results: </bold>Thirty-one heterotopic sites were identified. Twenty-one of 23 nodules with detectable electric activity on SEEG were identified by PET (91.3%), while 5 of 8 of nodules without electric activity showed no metabolism on PET (62.5%). Overall, the concordance between SEEG and FDG-PET was 26/31 (83.9%). Furthermore, cortical metabolic alterations were depicted, correlating with epileptogenic areas. A favorable postsurgical outcome was reported in 13 patients (81.3%). The presence of a hypometabolic nodule significantly correlated with a worse outcome after surgical therapy (P = .036).<bold>Conclusions: </bold>In PNHs-related epilepsy, FDG-PET more accurately identifies epileptogenic foci, which aids surgical planning and in postoperative seizure control.
- Subjects
PEOPLE with epilepsy; MAGNETIC resonance imaging; FLUORODEOXYGLUCOSE F18
- Publication
Journal of Neuroimaging, 2019, Vol 29, Issue 4, p512
- ISSN
1051-2284
- Publication type
journal article
- DOI
10.1111/jon.12620