Quantitative <scp>positron emission tomography</scp>–guided magnetic resonance imaging postprocessing in magnetic resonance imaging–negative epilepsies

Lin, Yicong; Fang, Yiqun; Wu, Guiyun; Jones, Stephen E.; Prayson, Richard A.; Moosa, Ahsan N.V.; Overmyer, Margit; Bena, James; Larvie, Mykol; Bingaman, William; González-Martínez, Jorge; Najm, Imad; Alexopoulos, Andreas V.; Wang, Z. Irene

doi:10.1111/epi.14474

Cited by 22 publications

(21 citation statements)

References 40 publications

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“…Despite the above efforts to optimize the yield of MRI, subtle FCD, particularly FCD type I, can remain undetected in a substantial number of cases by conventional imaging. In such cases, additional MRI sequences such as magnetization transfer imaging, and various postprocessing methods, including curvilinear reformatting and morphometric analysis of T1-weighted and T2-FLAIR images may be able to detect subtle structural abnormalities [5][6][7][8][9][10][11][12]. However, centers use different acquisition and post-processing protocols that can yield highly variable findings that are difficult to compare.…”

Section: Structural Mr Imaging In Detection Of Subtle Epileptogenic Lesionsmentioning

confidence: 99%

“…A recent study reported a practical and effective multimodal imaging approach to detect subtle epileptic abnormalities by combined, quantitative MRI and FDG-PET analyses in patients with negative preoperative MRI [12]. MRI scans underwent morphometric analysis to detect subtle FCD causing blurring of the grey/white matter junction.…”

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

confidence: 99%

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

Juhász

John

2020

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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: Structural Mr Imaging In Detection Of Subtle Epileptogenic Lesionsmentioning

confidence: 99%

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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“…Assessment of subtle but visually identifiable changes using T1, T2, and FLAIR images is the usual method for validating MAP results ( 17 , 41 , 44 ). Using positron emission tomography or magnetoencephalography to confine the MAP findings by adding functional or electrical information is another way ( 18 , 28 ). As a structural image that provides new information, even when voxel-based morphometric analysis based on FLAWS is unavailable, there are still practical implications using FLAWS with the current MAP.…”

Section: Discussionmentioning

confidence: 99%

“…True positive was defined as concordance between the FLAWS/MAP findings and resection with good surgical outcome, false positive as concordance between the FLAWS/MAP findings and resection with poor surgical outcome, true negative as non-concordance between the FLAWS/MAP findings and resection with poor surgical outcome, and false negative as non-concordance between FLAWS/MAP findings and resection with good surgical outcome. These definitions were based on those of previous reports in the literature ( 18 , 30 ).…”

Section: Methodsmentioning

confidence: 99%

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Fluid and White Matter Suppression Imaging and Voxel-Based Morphometric Analysis in Conventional Magnetic Resonance Imaging-Negative Epilepsy

Sun

Yang

et al. 2021

Front. Neurol.

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Purpose: Delineation of subtle lesions in magnetic resonance imaging (MRI)-negative patients is of great importance in preoperative epilepsy evaluation. The aim of our study was to explore the diagnostic value of the novel fluid and white matter suppression (FLAWS) sequence in comparison with a voxel-based MRI postprocessing morphometric analysis program (MAP) in a consecutive cohort of non-lesional patients.Methods: Surgical candidates with a negative finding on an official neuroradiology report were enrolled. High-resolution FLAWS image and MAP maps generated based on high-resolution three-dimensional (3D) T1 image were visually inspected for each patient. The findings of FLAWS or MAP-positive (FLAWS/MAP+) regions were compared with the surgical resection cavity in correlation with surgical outcome and pathology.Results: Forty-five patients were enrolled; the pathological examination revealed focal cortical dysplasia (FCD) in 32 patients and other findings in 13 patients. The positive rate, sensitivity, and specificity were 48.9%, 0.43, and 0.87, respectively, for FLAWS and 64.4%, 0.57, and 0.8, respectively, for MAP. Concordance between surgical resection and FLAWS+ or MAP+ regions was significantly associated with a seizure-free outcome (FLAWS: p = 0.002; MAP: p = 0.0003). A positive finding in FLAWS and MAP together with abnormalities in the same gyrus (FLAWS–MAP gyral+) was detected in 31.1% of patients. FLAWS+ only and MAP+ only were found in 7 (15.5%) and 14 (31.1%) patients, respectively.Conclusions: FLAWS showed a promising value for identifying subtle epileptogenic lesions and can be used as a complement to current MAP in patients with MRI-negative epilepsy.

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Radionuclide Imaging Studies in Pediatric Neurology

Kumar¹,

Juhász²,

Chugani³

2020

PET and SPECT in Neurology

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Quantitative positron emission tomography–guided magnetic resonance imaging postprocessing in magnetic resonance imaging–negative epilepsies

Cited by 22 publications

References 40 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

Fluid and White Matter Suppression Imaging and Voxel-Based Morphometric Analysis in Conventional Magnetic Resonance Imaging-Negative Epilepsy

Radionuclide Imaging Studies in Pediatric Neurology

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