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SAN DIEGO – Positron emission tomography/computed tomography can reveal seizure foci in patients with temporal lobe epilepsy who have normal magnetic resonance imaging.
PET/CT is more sensitive than ictal single-photon emission computed tomography (SPECT) imaging, MRI diffusion imaging (MRI-DI), and electroencephalography, and can play a pivotal role in the preoperative imaging work-up of patients with temporal lobe epilepsy, Dr. Jay J. Pillai reported at the annual meeting of the American Society of Neuroradiology.
In this retrospective study, 21 patients with EEG and clinical evidence of temporal lobe epilepsy underwent interictal PET/CT and structural MRI (1.5 Tesla), and 19 also underwent interictal MRI-DI. Ictal SPECT imaging was performed on six of these patients. Dr. Pillai stressed that these findings were only preliminary, and that additional investigation will be necessary to confirm these initial findings with a larger patient sample.
Eight patients had no structural abnormality on MRI. In all of these cases, PET/CT was able to lateralize the seizure focus. EEG was helpful in one case, and abnormal diffusion in the temporal lobes was detected with MRI-DI in two cases.
In the group overall, PET/CT was able to establish seizure focus lateralization in 95% of cases, a rate almost twice as high as that reported with structural MRI (52%), said Dr. Pillai, director of neuro-MRI at the Medical College of Georgia, Augusta. The sensitivity of PET/CT was higher than that found for ictal SPECT (83%), EEG (62%), and MRI-DI (58%).
Looking at how often the PET/CT and EEG findings concurred regarding the location of the seizure focus, Dr. Pillai found that PET/CT and EEG findings were in agreement 88% of the time, while lower rates of concordance were found for MRI-DI (59%) and ictal SPECT (60%). With MRI-DI, apparent diffusion coefficient (ADC) values in the abnormal temporal lobe were significantly higher than those in the normal contralateral temporal lobe. These ADC values are measures of magnitude of water diffusion in the brain.
In his presentation, Dr. Pillai described two patients in whom the various imaging modalities revealed discordant or otherwise inconclusive results. In these instances, PET/CT demonstrated definitive lateralization of the seizure focus, which the combination of interictal EEG, structural MRI, MRI-DI, and ictal SPECT failed to show to any convincing degree.
The results suggest that PET/CT may prove to be a highly sensitive method of localizing seizure foci in the temporal lobe, especially when findings from EEG and other imaging modalities are contradictory or falsely negative.
PET/CT findings were in accord with EEGs more often than were other imaging modalities. DR. PILLAI
SAN DIEGO – Positron emission tomography/computed tomography can reveal seizure foci in patients with temporal lobe epilepsy who have normal magnetic resonance imaging.
PET/CT is more sensitive than ictal single-photon emission computed tomography (SPECT) imaging, MRI diffusion imaging (MRI-DI), and electroencephalography, and can play a pivotal role in the preoperative imaging work-up of patients with temporal lobe epilepsy, Dr. Jay J. Pillai reported at the annual meeting of the American Society of Neuroradiology.
In this retrospective study, 21 patients with EEG and clinical evidence of temporal lobe epilepsy underwent interictal PET/CT and structural MRI (1.5 Tesla), and 19 also underwent interictal MRI-DI. Ictal SPECT imaging was performed on six of these patients. Dr. Pillai stressed that these findings were only preliminary, and that additional investigation will be necessary to confirm these initial findings with a larger patient sample.
Eight patients had no structural abnormality on MRI. In all of these cases, PET/CT was able to lateralize the seizure focus. EEG was helpful in one case, and abnormal diffusion in the temporal lobes was detected with MRI-DI in two cases.
In the group overall, PET/CT was able to establish seizure focus lateralization in 95% of cases, a rate almost twice as high as that reported with structural MRI (52%), said Dr. Pillai, director of neuro-MRI at the Medical College of Georgia, Augusta. The sensitivity of PET/CT was higher than that found for ictal SPECT (83%), EEG (62%), and MRI-DI (58%).
Looking at how often the PET/CT and EEG findings concurred regarding the location of the seizure focus, Dr. Pillai found that PET/CT and EEG findings were in agreement 88% of the time, while lower rates of concordance were found for MRI-DI (59%) and ictal SPECT (60%). With MRI-DI, apparent diffusion coefficient (ADC) values in the abnormal temporal lobe were significantly higher than those in the normal contralateral temporal lobe. These ADC values are measures of magnitude of water diffusion in the brain.
In his presentation, Dr. Pillai described two patients in whom the various imaging modalities revealed discordant or otherwise inconclusive results. In these instances, PET/CT demonstrated definitive lateralization of the seizure focus, which the combination of interictal EEG, structural MRI, MRI-DI, and ictal SPECT failed to show to any convincing degree.
The results suggest that PET/CT may prove to be a highly sensitive method of localizing seizure foci in the temporal lobe, especially when findings from EEG and other imaging modalities are contradictory or falsely negative.
PET/CT findings were in accord with EEGs more often than were other imaging modalities. DR. PILLAI
SAN DIEGO – Positron emission tomography/computed tomography can reveal seizure foci in patients with temporal lobe epilepsy who have normal magnetic resonance imaging.
PET/CT is more sensitive than ictal single-photon emission computed tomography (SPECT) imaging, MRI diffusion imaging (MRI-DI), and electroencephalography, and can play a pivotal role in the preoperative imaging work-up of patients with temporal lobe epilepsy, Dr. Jay J. Pillai reported at the annual meeting of the American Society of Neuroradiology.
In this retrospective study, 21 patients with EEG and clinical evidence of temporal lobe epilepsy underwent interictal PET/CT and structural MRI (1.5 Tesla), and 19 also underwent interictal MRI-DI. Ictal SPECT imaging was performed on six of these patients. Dr. Pillai stressed that these findings were only preliminary, and that additional investigation will be necessary to confirm these initial findings with a larger patient sample.
Eight patients had no structural abnormality on MRI. In all of these cases, PET/CT was able to lateralize the seizure focus. EEG was helpful in one case, and abnormal diffusion in the temporal lobes was detected with MRI-DI in two cases.
In the group overall, PET/CT was able to establish seizure focus lateralization in 95% of cases, a rate almost twice as high as that reported with structural MRI (52%), said Dr. Pillai, director of neuro-MRI at the Medical College of Georgia, Augusta. The sensitivity of PET/CT was higher than that found for ictal SPECT (83%), EEG (62%), and MRI-DI (58%).
Looking at how often the PET/CT and EEG findings concurred regarding the location of the seizure focus, Dr. Pillai found that PET/CT and EEG findings were in agreement 88% of the time, while lower rates of concordance were found for MRI-DI (59%) and ictal SPECT (60%). With MRI-DI, apparent diffusion coefficient (ADC) values in the abnormal temporal lobe were significantly higher than those in the normal contralateral temporal lobe. These ADC values are measures of magnitude of water diffusion in the brain.
In his presentation, Dr. Pillai described two patients in whom the various imaging modalities revealed discordant or otherwise inconclusive results. In these instances, PET/CT demonstrated definitive lateralization of the seizure focus, which the combination of interictal EEG, structural MRI, MRI-DI, and ictal SPECT failed to show to any convincing degree.
The results suggest that PET/CT may prove to be a highly sensitive method of localizing seizure foci in the temporal lobe, especially when findings from EEG and other imaging modalities are contradictory or falsely negative.
PET/CT findings were in accord with EEGs more often than were other imaging modalities. DR. PILLAI