[ ¹⁸ F]DPA-714 PET Imaging in the Presurgical Evaluation of Patients With Drug-Resistant Focal Epilepsy

Abstract

Background and Objective: Translocator protein 18 kDa (TSPO) positron emission tomography (PET) imaging is used to monitor glial activation. Recent studies have proposed TSPO PET as a marker of the epileptogenic zone (EZ) in drug-resistant focal epilepsy (DRFE). This study aims to assess the contributions of TSPO imaging using [18F]DPA-714 PET and [18F]FDG PET for localizing the EZ during pre-surgical assessment of DRFE, when phase 1 pre-surgical assessment does not provide enough information. Methods: We compared [18F]FDG and [18F]DPA-714 PET images of 23 patients who had undergone a phase 1 pre-surgical assessment, using qualitative visual analysis and quantitative analysis, at both the voxel and the regional levels. PET abnormalities (increase in binding for [18F]DPA-714 vs decrease in binding for [18F]FDG) were compared with clinical hypotheses concerning the localization of the EZ based on phase 1 pre-surgical assessment. The additional value of [18F]DPA-714 PET imaging to [18F]FDG for refining the localization of the EZ was assessed. To strengthen the visual analysis, [18F]DPA-714 PET imaging were also reviewed by two experienced clinicians blind to the EZ location. Results: The study included 23 patients. Visual analysis of [18F]DPA-714 PET was significantly more accurate than [18F]FDG PET to both, show anomalies (95.7% vs 56.5%, p=0.022) and provide additional information to refine the EZ localization (65.2% vs 17.4%, p=0.019). All 10 patients with normal [18F]FDG PET had anomalies when using [18F]DPA-714 PET. The additional value of [18F]DPA-714 PET appeared to be greater in patients with normal brain MRI or with neocortical EZ (especially if insula is involved). Regional analysis of [18F]DPA-714 and [18F]FDG PET provided similar results. However, using voxel-wise analysis, [18F]DPA-714 was more effective than [18F]FDG for unveiling clusters whose localization was more often consistent with the EZ hypothesis (87.0% vs 39.1%, p=0.019). Non-relevant bindings were seen in 14 of 23 patients in visual analysis, and in 9 patients out of 23 in voxel-wise analysis. Conclusion: [18F]DPA-714 PET imaging provides valuable information for pre-surgical assessments of patients with DRFE. TSPO PET could become an additional tool to help to the localization of the EZ, especially in patients with negative [18F]FDG PET. Classification of Evidence: This study provide Class IV evidence on the utility of [18F]DPA-714 PET compared to [18F]FDG PET in identifying the epileptic zone in patients undergoing phase 1 pre-surgical evaluation for intractable epilepsy.

Determinants of successful ictal SPECT injection in phase 1 epilepsy presurgical evaluation: Findings from the pediatric epilepsy research consortium surgery database project

“… 2 In patients with DRE that do not have an MRI‐evident lesion, PET, SPECT, and magnetoencephalography (MEG) scans hold special value in localizing interictal and ictal changes that can suggest the location of the SOZ and may guide further invasive electroencephalography (EEG) studies. 3 , 4 , 5 …”

Corrections to Received Date Information

“…Due to an error in the Neurology editorial office's content management system, several papers were published with incorrect received date information. The correct received dates, which should have been listed in the Publication History section, are provided for each paper below.“Association Between Hippocampal Volumes and Cognition in Cerebral Amyloid Angiopathy” by Perosa et al 1 : Received by Neurology July 8, 2022.“Association of Blood-Based DNA Methylation Markers With Late-Onset Alzheimer Disease” by Acha et al 2 : Received by Neurology August 28, 2022.“Association of Glycemic Variability With Imaging Markers of Vascular Burden, β-Amyloid, Brain Atrophy, and Cognitive Impairment” by Jang et al 3 : Received by Neurology January 17, 2023.“Association of Motor Function With Cognitive Trajectories and Structural Brain Differences” by Wang et al 4 : Received by Neurology December 17, 2022.“Association of Neighborhood-Level Socioeconomic Factors With Delay to Hospital Arrival in Patients With Acute Stroke” by Forman et al 5 : Received by Neurology January 10, 2023.“Association of Spinal Cord Atrophy and Brain Paramagnetic Rim Lesions With Progression Independent of Relapse Activity in People With MS” by Cagol et al 6 : Received by Neurology January 19, 2023.“Clinical Reasoning: A 74-Year-Old Woman Presenting With Monocular Ptosis and Binocular Diplopia” by Liu et al 7 : Received by Neurology November 16, 2022.“Clinical Reasoning: A Woman With Progressive Painless Sequential Monocular Vision Loss” by Ditrapani et al 8 : Received by Neurology August 8, 2022.“Comparison of 2 Methods for Estimating Multiple Sclerosis–Related Mortality” by Rollot et al 9 : Received by Neurology October 20, 2022.“Cumulative Use of Proton Pump Inhibitors and Risk of Dementia: The Atherosclerosis Risk in Communities Study” by Northuis et al 10 : Received by Neurology January 4, 2023.“Effectiveness of Yoga Intervention in Reducing Felt Stigma in Adults With Epilepsy: A Randomized Controlled Trial” by Kaur et al 11 : Received by Neurology October 14, 2022.“[18F]DPA-714 PET Imaging in the Presurgical Evaluation of Patients With Drug-Resistant Focal Epilepsy” by Cheval et al 12 : Received by Neurology November 26, 2022.“Fine Particulate Matter and Parkinson Disease Risk Among Medicare Beneficiaries” by Krzyzanowski et al 13 : Received by Neurology October 30, 2022.“Interplay Between Chronic Kidney Disease, Hypertension, and Stroke” by Kelly et al 14 : Received by Neurology September 14, 2022.“Measures of Aging Biology in Saliva and Blood as Novel Biomarkers for Stroke and Heart Disease in Older Adults” by Waziry et al 15 : Received by Neurology November 28, 2022.“Molecular and Phenotypic Characterization of the RORB-Related Disorder” by Gokce-Samar et al 16 : Received by Neurology January 5, 2023.“Mortality and Causes of Death in Children With Cerebral Palsy With Scoliosis Treated With and Without Surgery” by Ahonen et al 17 : Received by Neurology February 13, 2023.“Movement Disorders in Patients With Genetic Developmental and Epileptic Encephalopathies” by van der Veen et al 18 : Received by Neurology February 17, 2023.“MRI vs CT for Baseline Im...…”

“…“[18F]DPA-714 PET Imaging in the Presurgical Evaluation of Patients With Drug-Resistant Focal Epilepsy” by Cheval et al 12 : Received by Neurology November 26, 2022.…”