18F-FDG PET and high-resolution MRI co-registration for pre-surgical evaluation of patients with conventional MRI-negative refractory extra-temporal lobe epilepsy

Ding, Yao; Zhu, Yuankai; Jiang, Biao; Zhou, Yongji; Jin, Bo; Hou, Haifeng; Wu, Shuang; Wang, Irène; Wong, Chong; Zhang, Hong; Wang, Shuang; Tian, Mei

doi:10.1007/s00259-018-4017-0

Cited by 50 publications

(34 citation statements)

References 11 publications

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“…In a subsequent study of 48 children, FDG-PET showed a clear advantage over MRI in detecting mild malformations of cortical development, which were missed in about 2/3 of the cases but detected by PET in 77% [23]. While some previous studies utilized suboptimal MRI, 1.5 T scanners, and/or lower resolution scans, a recent study used 3 T MRI with high-resolution images (1 mm 3 isotropic voxels) combined with co-registered FDG-PET in patients with non-localizing conventional MRI [24]. This approach detected a previously missed MRI lesion in 46% and confirmed a suspicious subtle lesion in 12% of the cases, thus supporting the importance of high-resolution MRI combined with PET imaging; as a result, the rate of detected focal abnormalities increased to 94% by PET/ MRI fusion as compared to 68% by PET alone.…”

Section: Fdg-pet In Children With Non-localizing Mri and Mild Cortical Developmental Malformationsmentioning

confidence: 99%

Utility of MRI, PET, and ictal SPECT in presurgical evaluation of non-lesional pediatric epilepsy

Juhász

John

2020

Seizure

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Children with epilepsy and normal structural MRI pose a particular challenge in localization of epileptic foci for surgical resection. Many of these patients have subtle structural lesions such as mild cortical dysplasia that can be missed by conventional MRI but may become detectable by optimized and advanced MRI acquisitions and post-processing. Specificity of objective analytic techniques such as voxel-based morphometry remains an issue. Combination of MRI with functional imaging approaches can improve the accuracy of detecting epileptogenic brain regions. Analysis of glucose positron emission tomography (PET) combined with high-resolution MRI can optimize detection of hypometabolic cortex associated with subtle cortical malformations and can also enhance presurgical evaluation in children with epileptic spasms. Additional PET tracers may detect subtle epileptogenic lesions and cortex with enhanced specificity in carefully selected subgroups with various etiologies; e.g., increased tryptophan uptake can identify epileptogenic cortical dysplasia in the interictal state. Subtraction ictal SPECT can be also useful to delineate ictal foci in those with non-localizing PET or after failed surgical resection. Presurgical delineation of language and motor cortex and the corresponding white matter tracts is increasingly reliable by functional MRI and DTI techniques; with careful preparation, these can be useful even in young and sedated children. While evidence-based pediatric guidelines are still lacking, the data accumulated in the last decade strongly indicate that multimodal imaging with combined analysis of MRI, PET, and/or ictal SPECT data can optimize the detection of subtle epileptogenic lesions and facilitate seizure-free outcome while minimizing the postsurgical functional deficit in children with normal conventional MRI.

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Section: Fdg-pet In Children With Non-localizing Mri and Mild Cortical Developmental Malformationsmentioning

confidence: 99%

Utility of MRI, PET, and ictal SPECT in presurgical evaluation of non-lesional pediatric epilepsy

Juhász

John

2020

Seizure

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“…Importantly, we found that the PET/MR allowed the detection of structural lesions in a high proportion of patients (24 %) in whom the MRI was initially considered negative, despite optimal examination including the co-registration with the PET. This multimodal approach has been previously reported as increasing the detection of FCDs [8][9][10][11] and considered as the reference method that should be recommended as a standard procedure for MRI negative ETLE [12]. However, according to our data, the PET/MR reaches a new step for the detection of such epileptogenic lesions compared to the reference imaging.…”

Section: Discussionmentioning

confidence: 66%

“…Surgical resection of the dysplastic cortex allows a favorable outcome [2][3], however FCDs can be di cult to identify by imaging even though using optimal MRI protocols [4][5][6][7]. 18 F-FDG PET has proved to be useful in negative MRI cases, and the additional value of the co-registration of PET and MRI has been demonstrated [8][9][10][11][12][13]. More recently, new hybrid PET/MR imaging has been developed, allowing simultaneous acquisition of brain metabolism images provided by 18 F-FDG PET and morphological/functional images by MRI under the same clinical conditions.…”

Section: Introductionmentioning

confidence: 99%

18f-fdg Pet/mr in Focal Epilepsy: a New Step for Improving the Detection of Epileptogenic Lesions

FLAUS

MELLERIO

RODRIGO

et al. 2021

Preprint

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Purpose: Hybrid PET/MR is a promising tool in focal drug-resistant epilepsy, however the additional value for the detection of epileptogenic lesions and surgical decision-making remains to be established.Methods: We retrospectively compared 18F-FDG PET/MR images with those obtained by a previous 18F-FDG PET co-registered with MRI (PET+MR) in 25 consecutive patients (16 females, 13-60 year-old) investigated for focal drug-resistant epilepsy. Visual analysis was performed by two readers blinded from imaging modalities, asked to assess the technical characteristics (co-registration, quality of images), confidence in results, location of PET abnormalities and presence of a structural lesion on MRI. The clinical impact on surgical strategy and outcome was assessed independently.Results: The location of epilepsy was temporal in 9 patients and extra-temporal in 16 others. MRI was initially considered negative in 21 of them. PET alone demonstrated metabolic abnormalities in 19 cases (76%), and the co-registration with MRI allowed the detection of 4 additional structural lesions. PET/MR was considered better performing than PET+MR in 56% of patients. The increase in sensitivity was 13% and new structural lesions (mainly focal cortical dysplasias) were detected in 6 patients (24%). Change of surgical decision-making was substantial for 40% of patients, consisting in avoiding invasive monitoring in 6 patients and modifying the planning in 4 others. Seizure-free outcome was obtained in 13/14 patients who underwent a cortical resection.Conclusion: Hybrid PET/MR improves the detection of epileptogenic lesions, allowing to optimize the presurgical work-up and to increase the proportion of successful surgery even in the more complex cases.

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“…At present, there are abundant available fusion software for fusing PET data with separately acquired MRI images satisfactorily (Ding et al, 2018). However, only hybrid PET/MRI system can provide the real time matched functional information representing disease states, which may undergo changes between the two separated imaging studies.…”

Section: Future Perspectivementioning

confidence: 99%

“…This combined dual-modalities (either sequential or simultaneous) could generate preferable soft tissue contrast of brain tissue, flexible acquisition parameters and minimized exposure to radiation (Musafargani et al, 2018). Fusion of PET and MRI images acquired at different time points from separated devices, has been performed routinely for brain imaging in a number of clinical centers (Zhu et al, 2017b; Ding et al, 2018). However, it must be pointed out that the physiological or mental state studied, respectively, by PET and MRI may differ in varying levels during the two separated imaging sessions.…”

Section: Introductionmentioning

confidence: 99%

MRI-Driven PET Image Optimization for Neurological Applications

Zhu

2019

Front. Neurosci.

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Positron emission tomography (PET) and magnetic resonance imaging (MRI) are established imaging modalities for the study of neurological disorders, such as epilepsy, dementia, psychiatric disorders and so on. Since these two available modalities vary in imaging principle and physical performance, each technique has its own advantages and disadvantages over the other. To acquire the mutual complementary information and reinforce each other, there is a need for the fusion of PET and MRI. This combined dual-modality (either sequential or simultaneous) could generate preferable soft tissue contrast of brain tissue, flexible acquisition parameters, and minimized exposure to radiation. The most unique superiority of PET/MRI is mainly manifested in MRI-based improvement for the inherent limitations of PET, such as motion artifacts, partial volume effect (PVE) and invasive procedure in quantitative analysis. Head motion during scanning significantly deteriorates the effective resolution of PET image, especially for the dynamic scan with lengthy time. Hybrid PET/MRI device can offer motion correction (MC) for PET data through MRI information acquired simultaneously. Regarding the PVE associated with limited spatial resolution, the process and reconstruction of PET data can be further optimized by using acquired MRI either sequentially or simultaneously. The quantitative analysis of dynamic PET data mainly relies upon an invasive arterial blood sampling procedure to acquire arterial input function (AIF). An image-derived input function (IDIF) method without the need of arterial cannulization, can serve as a potential alternative estimation of AIF. Compared with using PET data only, combining anatomical or functional information from MRI for improving the accuracy in IDIF approach has been demonstrated. Yet, due to the interference and inherent disparity between the two modalities, these methods for optimizing PET image based on MRI still have many technical challenges. This review discussed upon the most recent progress, current challenges and future directions of MRI-driven PET data optimization for neurological applications, with either sequential or simultaneous acquisition approach.

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18F-FDG PET and high-resolution MRI co-registration for pre-surgical evaluation of patients with conventional MRI-negative refractory extra-temporal lobe epilepsy

Cited by 50 publications

References 11 publications

Utility of MRI, PET, and ictal SPECT in presurgical evaluation of non-lesional pediatric epilepsy

Utility of MRI, PET, and ictal SPECT in presurgical evaluation of non-lesional pediatric epilepsy

18f-fdg Pet/mr in Focal Epilepsy: a New Step for Improving the Detection of Epileptogenic Lesions

MRI-Driven PET Image Optimization for Neurological Applications

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