Functional neuroimaging strategy in temporal lobe epilepsy: A comparative study of <sup>18</sup>FDG‐PET and <sup>99m</sup>Tc‐HMPAO–SPECT

Ryvlin, Philippe; Philippon, B.; Cinotti, L.; Froment, J.-C.; Bars, Didier Le; Mauguı̀ere, François

doi:10.1002/ana.410310613

Cited by 73 publications

(29 citation statements)

References 17 publications

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“…Interictal studies using '8fluoro-2-deoxy-D-glucose ('*FDG) positron emission tomography (PET) in temporal lobe epilepsy have shown focal hypometabolism in 65-80% of patients (1,32,33). Comparative studies between "FDG PET and 9 9 T~m HMPAO SPECT have shown that where abnormalities of perfusion are demonstrated by SPECT, they correlate with areas of hypometabolism as detected by PET, but that abnormalities are seen less frequently with SPECT than with PET (33,34).…”

Section: Discussionmentioning

confidence: 99%

Interictal ⁹⁹Tc^m HMPAO SPECT and ¹H MRS in Children with Temporal Lobe Epilepsy

et al. 1997

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Summary:Purpose: To understand the pathological basis of" focal hypoperfusion seen on interictal 99Tcm hexamethylpropyleneamine oxime (HMPAO) single-photon-emission computed tomography (SPECT) in intractable temporal lobe epilepsy, and to determine why the technique may be misleading in the localization and lateralization of the seizure focus in some cases.Methods: Interictal 99Tcm HMPAO SPECT and proton magnetic resonance spectroscopy ('H MRS) of the mesial temporal regions were performed in 14 children with intractable temporal lobe epilepsy not caused by a foreign tissue lesion.Results: Hypoperfusion of one temporal lobe ipsilateral to thaseizure focus was demonstrated in 10 (71%) of the children; 'H MRS correctly lateralised in eight of these 10. No asymmetry of perfusion of the anterior temporal regions was seen in the remaining four children; on 'H MRS, three of these were bilaterally abnormal but nonlateralising. Repeated SPECT and 'H MRS in three children demonstrated changes over time, the findings from the two techniques being consistent with each other on both the initial and the repeated scans.Conclusions: Abnormalities demonstrated by 'H MRS correlate well with those seen on interictal SPECT and can help to understand the pathologic basis of these SPECT abnormalities. Furthermore, the presence of bilateral damage can result in an absence of perfusion asymmetry on interictal SPECT. Key Words: Temporal lobe epilepsy-Single-photon-emission computed tomography-Proton magnetic resonance spectroscopy-Child-Hypoperfusion-Neuronal loss.Studies of patients with epilepsy have shown that 9 9 T~m hexamethylpropyleneamine oxime (HMPAO) single-photon-emission computed tomography (SPECT) can aid in seizure localisation, with ictal studies demonstrating an area of hyperperfusion predictive of the seizure focus in <95% of cases (1-5). Interictal studies alone, however, have a low sensitivity in predicting the seizure focus in adults with temporal lobe epilepsy [-45-50% (6,7)]. More recent studies suggested that the sensitivity of interictal SPECT is higher in children than in adults, but that these studies are still not as reliable as ictal studies (1 3). There is the possibility of false localisation with hypoperfusion, seen on the side contralateral to the seizure focus (6); also, hypoperfusion, if correctly lateralising, may extend over a wider area than the temporal lobe (5,8,9). 9 9 T~m HMPAO SPECT studies are analysed for asymmetry of perfusion, whether by visual or semiquantitative

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Section: Discussionmentioning

confidence: 99%

Interictal ⁹⁹Tc^m HMPAO SPECT and ¹H MRS in Children with Temporal Lobe Epilepsy

et al. 1997

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“…Obwohl die SPECT preiswerter und leichter zugänglich ist als PET, stellt die Anwendung interiktaler SPECTUntersuchungen mit Blutflussmarkern, wie Tc-99m HMPAO und Tc-99m ECD, aufgrund ihrer geringen Sensitivität keine echte Alternative zur PET-Untersuchung mit FDG dar. Eine Minderperfusion in topographischer Korrelation zum elektroenzephalographisch definierten Anfallsursprung wird von den meisten Arbeitsgruppen übereinstimmend bei Temporallappenepilepsien in lediglich in etwa 40-60% der Fälle berichtet [56].…”

Section: Epilepsieunclassified

Klinische Relevanz von PET-Untersuchungen in der Neurologie und Psychiatrie

Bartenstein

2004

Klinische Neuroradiologie

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ZusammenfassungDie Positronenemissionstomographie (PET) ist auf internationaler Ebene inzwischen in der Diagnostik zerebraler Erkrankungen als klinische Routinediagnostik akzeptiert. Das vorrangig klinisch angewandte Radiopharmakon ist die 18F-FluorDeoxyglukose (FDG), die die Darstellung des regionalen zerebralen Glukosemetabolismus ermöglicht. Daneben gewinnen markierte Aminosäuren und Radiopharmaka, die Rezeptorsysteme und andere komplexe biochemische Vorgänge des zentralen Nervensystems darstellen, zunehmend an Bedeutung. Klinisch sinnvolle Anwendungen der Positronenemissionstomographie finden sich vor allem in der Diagnostik dementieller Syndrome, bei Basalganglienerkrankungen sowie bei Fragestellungen in der Neuroonkologie und der präoperativen Epilepsiediagnostik. Die folgende Arbeit vermittelt eine Übersicht über die derzeit als etabliert geltenden klinischen Indikationen zur Anwendung von PET bei neurologischen und psychiatrischen Fragestellungen. Schlüsselwörter: Positronenemissionstomographie (PET) · Neurologie · Psychiatrie · Übersicht AbstractPositron emission tomography (PET) is increasingly used for clinical routine applications in neurology and psychiatry. The main radiopharmaceutical used for these applications is 18F fluor-deoxyglucose (FDG), which monitors regional cerebral glucose metabolism. Labeled aminoacids and radiopharmaceuticals used for monitoring receptor systems and other complex biochemical processes of the central nervous system are gaining importance. PET is used clinically mainly in dementia, basal ganglia disorders, neuro-oncology and epilepsies. The present paper gives a review of the clinical applications of PET in neurology and psychiatry, which are currently considered as being established.

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“…used to lateralize the seizure focus, showing hypometabolism of the temporal lobe with an incidence of 60-90% (7,11,12). However, the hypometabolic zone in PET scans in patients with TLE is usually larger than the underlying lesion and the region that generates the epileptic seizures (13).…”

Section: Summary: Purposementioning

confidence: 99%

Regional Distribution of Interictal ³¹P Metabolic Changes in Patients with Temporal Lobe Epilepsy

et al. 1998

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Summary: Purpose:We compared the 3LP metabolites in different brain regions of patients with temporal lobe epilepsy (TLE) with those from controls.Methods: Ten control subjects and 1 1 patients with TLE were investigated with magnetic resonance imaging (MRI) and [31P]MR spectroscopic imaging (MRSI).[31P]MR spectra were selected from a variety of brain regions inside and outside the temporal lobe.Results: There were no asymmetries of inorganic phosphate (Pi), pH, or phosphomonoesters (PME) between regions in the left and right hemispheres of controls. In patients with TLE, Pi and pH were higher and PME was lower throughout the entire ipsilateral temporal lobe as compared with the contralateral side and there were no significant asymmetries outside the Temporal lobe epilepsy (TLE), with mesial temporal sclerosis (MTS) as the pathology, is a common neurological disorder of unknown etiology (1,2). Current diagnostic tests to lateralize and localize the seizure focus include scalp and depth electrode EEG, computed tomography (CT), positron emission tomography (PET), single photon emission CT (SPECT), and magnetic resonance imaging (MRI) (3-5). MRI is abnormal in -60-70% of cases with MTS (2-5) and is more sensitive than CT (6-8). Patients with unilateral hippocampal atrophy or increased hippocampal T, signal intensity concordant with the ictal EEG focus have -90% chance of becoming seizure-free after temporal lobectomy (9). However, in patients with a normal MRI scan (i.e., not concordant), the prognosis for a seizure-free outcome is 550% (10). PET with [ '8F]fluorodeoxyglucose (FDG) has also been temporal lobe. The degree of ipsilateralkontralateral asymmetry for all three metabolites was substantially greater for the temporal lobe than for the frontal, occipital, and parietal lobes, and these asymmetries provided additional data for seizure localization. As compared with levels in controls, Pi and pH were increased and PME were decreased on the ipsilateral side in patients with TLE. There were changes in Pi, pH, and PME on the contralateral side in persons with epilepsy as compared with controls, contrary to changes on the ipsilateral side.Conclusions: Our findings provide some insight into the metabolic changes that occur in TLE and may prove useful adjuncts for seizure focus lateralization or localization. Key Words: Magnetic resonance spectroscopic imagingPhosphorus metabolism-Focal epilepsy-Localization.used to lateralize the seizure focus, showing hypometabolism of the temporal lobe with an incidence of 60-90% (7,11,12). However, the hypometabolic zone in PET scans in patients with TLE is usually larger than the underlying lesion and the region that generates the epileptic seizures (13). Interictal SPECT shows decreased regional cerebral blood flow in 40-80% of all patients with TLE (14-17), but has a high frequency of false positives (1 1).Phosphorous (31P) MR spectroscopy (MRS) noninvasively detects a variety of 31P metabolites, including ATP, phosphocreatine (PCr), inorganic phosphate (Pi), phosphomonoester...

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Functional neuroimaging strategy in temporal lobe epilepsy: A comparative study of ¹⁸FDG‐PET and ^99mTc‐HMPAO–SPECT

Cited by 73 publications

References 17 publications

Interictal ⁹⁹Tc^m HMPAO SPECT and ¹H MRS in Children with Temporal Lobe Epilepsy

Interictal ⁹⁹Tc^m HMPAO SPECT and ¹H MRS in Children with Temporal Lobe Epilepsy

Klinische Relevanz von PET-Untersuchungen in der Neurologie und Psychiatrie

Regional Distribution of Interictal ³¹P Metabolic Changes in Patients with Temporal Lobe Epilepsy

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Functional neuroimaging strategy in temporal lobe epilepsy: A comparative study of 18FDG‐PET and 99mTc‐HMPAO–SPECT

Cited by 73 publications

References 17 publications

Interictal 99Tcm HMPAO SPECT and 1H MRS in Children with Temporal Lobe Epilepsy

Interictal 99Tcm HMPAO SPECT and 1H MRS in Children with Temporal Lobe Epilepsy

Klinische Relevanz von PET-Untersuchungen in der Neurologie und Psychiatrie

Regional Distribution of Interictal 31P Metabolic Changes in Patients with Temporal Lobe Epilepsy

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Functional neuroimaging strategy in temporal lobe epilepsy: A comparative study of ¹⁸FDG‐PET and ^99mTc‐HMPAO–SPECT

Interictal ⁹⁹Tc^m HMPAO SPECT and ¹H MRS in Children with Temporal Lobe Epilepsy

Interictal ⁹⁹Tc^m HMPAO SPECT and ¹H MRS in Children with Temporal Lobe Epilepsy

Regional Distribution of Interictal ³¹P Metabolic Changes in Patients with Temporal Lobe Epilepsy