Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

Abstract

PET with 18 F-FDG has been used for presurgical localization of epileptogenic foci; however, in nonsurgical patients, the correlation between cerebral glucose metabolism and clinical severity has not been fully understood. The aim of this study was to evaluate the glucose metabolic profile using 18 F-FDG PET/CT imaging in patients with epilepsy. Methods: One hundred pediatric epilepsy patients who underwent 18 F-FDG PET/CT, MRI, and electroencephalography examinations were included. Fifteen age-matched controls were also included. 18 F-FDG PET images were analyzed by visual assessment combined with statistical parametric mapping (SPM) analysis. The absolute asymmetry index (jAIj) was calculated in patients with regional abnormal glucose metabolism. Results: Visual assessment combined with SPM analysis of 18 F-FDG PET images detected more patients with abnormal glucose metabolism than visual assessment only. The jAIj significantly positively correlated with seizure frequency (P , 0.01) but negatively correlated with the time since last seizure (P , 0.01) in patients with abnormal glucose metabolism. The only significant contributing variable to the jAIj was the time since last seizure, in patients both with hypometabolism (P 5 0.001) and with hypermetabolism (P 5 0.005). For patients with either hypometabolism (P , 0.01) or hypermetabolism (P 5 0.209), higher jAIj values were found in those with drug resistance than with seizure remission. In the post-1-y follow-up PET studies, a significant change of jAIj (%) was found in patients with clinical improvement compared with those with persistence or progression (P , 0.01). Conclusion: 18 F-FDG PET imaging with visual assessment combined with SPM analysis could provide cerebral glucose metabolic profiles in nonsurgical epilepsy patients. jAIj might be used for evaluation of clinical severity and progress in these patients. Patients with a prolonged period of seizure freedom may have more subtle (or no) metabolic abnormalities on PET. The clinical value of PET might be enhanced by timing the scan closer to clinical seizures.

Evolution of lobar abnormalities of cerebral glucose metabolism in 41 children with drug‐resistant epilepsy

“…We found that the baseline extent of hypometabolism was moderately correlated with the change in seizure frequency over time ( r = .37). Similar results were obtained in the previous study by our group, and in the univariate analysis in a cross‐sectional retrospective study by Zhu et al; however, their multivariate analysis showed that the only significant determinant of extent of hypometabolism was time since last seizure. This latter variable was not associated with the number of hypometabolic lobes in our present cohort.…”

Impairments in Oxidative Glucose Metabolism in Epilepsy and Metabolic Treatments Thereof

“…Based on 18 F-flurodeoxyglucose positron emission tomography imaging (FDG-PET) or similar techniques using 14 C-2 deoxy-glucose (2-DG), it has long been known that in human temporal lobe epilepsy (HTLE) as well as in chronic rodent epilepsy models interictal glucose metabolism in “epileptic foci/tissue” is impaired ( Kuhl et al, 1980 ; Dube et al, 2001 ; Vielhaber et al, 2003 ). Reduced FDG or 2-DG transport and trapping in tissue has been termed hypometabolism and in many instances there is no correlations to neuronal loss ( Kuhl et al, 1980 ; O’Brien et al, 1997 ; Dube et al, 2001 ; Vielhaber et al, 2003 ; Carne et al, 2004 ), Recent reviews show that FDG-PET-identified hypometabolism is useful to localize seizure foci also in other adult epilepsy forms and various pediatric epilepsy types [reviewed by ( Burneo et al, 2015 ; Sarikaya, 2015 ; Zhu et al, 2017 )]. Please note that these techniques can only provide information about glucose transport and the activity of hexokinase, as 2-DG and FDG are metabolized via hexokinase to produce 2-DG 6-phosphate or FDG 6-phosphate, respectively.…”

PET/MRI: a frontier in era of complementary hybrid imaging

“…In recent time, Yuankai Zhu et al evaluated the glucose metabolism in epileptic paediatric patients with the visual assessment and Statistical Parametric Mapping (SPM) (Fig. 11 ) (Zhu et al 2017 ). While SPM is designed to perform segmentation of brain tissues consisting of Grey Matter (GM), White Matter (WM) and Cerebrospinal Fluid, the FSL and Brainsuite can segment sub-cortical structures also.…”

“…( d ) Hypometabolic region undetected by visual assessment was identified in left mesial temporal lobe (solid arrow) by SPM analysis. (This research was originally published in Y. Zhu et al, “Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy, (Zhu et al 2017 )” J. Nucl. Med., vol.…”