Utility of 18F-fluorodeoxyglucose positron emission tomography in presurgical evaluation of patients with epilepsy: A multicenter study

Mirja Steinbrenner; John S Duncan; John Dickson; Chaturbhuj Rathore; Bettina Wächter; Nafi Aygun; Ramshekhar N Menon; Ashalatha Radhakrishnan; Martin Holtkamp; Maria Ilyas-Feldmann

doi:10.1111/epi.17194

Utility of 18F-fluorodeoxyglucose positron emission tomography in presurgical evaluation of patients with epilepsy: A multicenter study

Epilepsia. 2022 May;63(5):1238-1252. doi: 10.1111/epi.17194. Epub 2022 Feb 15.

Authors

Affiliations

¹ Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany.
² Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK.
³ Institute of Nuclear Medicine, University College London Hospitals, London, UK.
⁴ Department of Neurology, Smt. B. K. Shah (SBKS) Medical College, Sumandeep Vidyapeeth, Vadodara, India.
⁵ Epilepsy Center Berlin-Brandenburg, Evangelische Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
⁶ Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
⁷ Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

PMID: 35166379
DOI: 10.1111/epi.17194

Abstract

Objective: 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in presurgical assessment in patients with drug-resistant focal epilepsy (DRE) if magnetic resonance imaging (MRI) and scalp electroencephalography (EEG) do not localize the seizure onset zone or are discordant.

Methods: In this multicenter, retrospective observational cohort study, we included consecutive patients with DRE who had undergone FDG-PET as part of their presurgical workup. We assessed the utility of FDG-PET, which was defined as contributing to the decision-making process to refer for resection or intracranial EEG (iEEG) or to conclude surgery was not feasible.

Results: We included 951 patients in this study; 479 had temporal lobe epilepsy (TLE), 219 extratemporal epilepsy (ETLE), and 253 epilepsy of uncertain lobar origin. FDG-PET showed a distinct hypometabolism in 62% and was concordant with ictal EEG in 74% in TLE and in 56% in ETLE (p < .001). FDG-PET was useful in presurgical decision-making in 396 patients (47%) and most beneficial in TLE compared to ETLE (58% vs. 44%, p = .001). Overall, FDG-PET contributed to recommending resection in 78 cases (20%) and iEEG in 187 cases (47%); in 131 patients (33%), FDG-PET resulted in a conclusion that resection was not feasible. In TLE, seizure-freedom 1 year after surgery did not differ significantly (p = .48) between patients with negative MRI and EEG-PET concordance (n = 30, 65%) and those with positive MRI and concordant EEG (n = 46, 68%). In ETLE, half of patients with negative MRI and EEG-PET concordance and three quarters with positive MRI and concordant EEG were seizure-free postsurgery (n = 5 vs. n = 6, p = .28).

Significance: This is the largest reported cohort of patients with DRE who received presurgical FDG-PET, showing that FDG-PET is a useful diagnostic tool. MRI-negative and MRI-positive cases with concordant FDG-PET results (with either EEG or MRI) had a comparable outcome after surgery. These findings confirm the significance of FDG-PET in presurgical epilepsy diagnostics.

Keywords: 18F-fluorodeoxyglucose PET; drug-resistant epilepsy; epilepsy surgery; presurgical assessment.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Drug Resistant Epilepsy* / surgery
Electroencephalography
Epilepsies, Partial* / surgery
Epilepsy* / diagnostic imaging
Epilepsy* / surgery
Epilepsy, Temporal Lobe* / surgery
Fluorodeoxyglucose F18
Humans
Magnetic Resonance Imaging
Positron-Emission Tomography / methods
Retrospective Studies
Seizures

Substances

Fluorodeoxyglucose F18