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European Radiology
Published in: European Radiology 2/2024

15-08-2023 | Epilepsy | Nuclear Medicine

[18F]FDG PET metabolic patterns in mesial temporal lobe epilepsy with different pathological types

Authors: Yongxiang Tang, Ling Xiao, Chijun Deng, Haoyue Zhu, Xiaomei Gao, Jian Li, Zhiquan Yang, Dingyang Liu, Li Feng, Shuo Hu

Published in: European Radiology | Issue 2/2024

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Abstract

Objectives

To investigate [18F]FDG PET patterns of mesial temporal lobe epilepsy (MTLE) patients with distinct pathologic types and provide possible guidance for predicting long-term prognoses of patients undergoing epilepsy surgery.

Methods

This was a retrospective review of MTLE patients who underwent anterior temporal lobectomy between 2016 and 2021. Patients were classified as having chronic inflammation and gliosis (gliosis, n = 44), hippocampal sclerosis (HS, n = 43), or focal cortical dysplasia plus HS (FCD-HS, n = 13) based on the postoperative pathological diagnosis. Metabolic patterns and the severity of metabolic abnormalities were investigated among MTLE patients and healthy controls (HCs). The standardized uptake value (SUV), SUV ratio (SUVr), and asymmetry index (AI) of regions of interest were applied to evaluate the severity of metabolic abnormalities. Imaging processing was performed with statistical parametric mapping (SPM12).

Results

With a mean follow-up of 2.8 years, the seizure freedom (Engel class IA) rates of gliosis, HS, and FCD-HS were 54.55%, 62.79%, and 69.23%, respectively. The patients in the gliosis group presented a metabolic pattern with a larger involvement of extratemporal areas, including the ipsilateral insula. SUV, SUVr, and AI in ROIs were decreased for patients in all three MTLE groups compared with those of HCs, but the differences among all three MTLE groups were not significant.

Conclusions

MTLE patients with isolated gliosis had the worst prognosis and hypometabolism in the insula, but the degree of metabolic decrease did not differ from the other two groups. Hypometabolic regions should be prioritized for [18F]FDG PET presurgical evaluation rather than [18F]FDG uptake values.

Clinical relevance statement

This study proposes guidance for optimizing the operation scheme in patients with refractory MTLE and emphasizes the potential of molecular neuroimaging with PET using selected tracers to predict the postsurgical histology of patients with refractory MTLE epilepsy.

Key Points

• MTLE patients with gliosis had poor surgical outcomes and showed a distinct pattern of decreased metabolism in the ipsilateral insula.
• In the preoperative assessment of MTLE, it is recommended to prioritize the evaluation of glucose hypometabolism areas over [18F]FDG uptake values.
• The degree of glucose hypometabolism in the epileptogenic focus was not associated with the surgical outcomes of MTLE.
Appendix
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Literature
1.
Wiebe S, Blume WT, Girvin JP, Eliasziw M (2001) A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345:311–318PubMed
2.
Schmidt D, Stavem K (2009) Long-term seizure outcome of surgery versus no surgery for drug-resistant partial epilepsy: a review of controlled studies. Epilepsia 50:1301–1309PubMed
3.
Paglioli E, Palmini A, Paglioli E et al (2004) Survival analysis of the surgical outcome of temporal lobe epilepsy due to hippocampal sclerosis. Epilepsia 45:1383–1391PubMed
4.
Bulacio JC, Jehi L, Wong C et al (2012) Long-term seizure outcome after resective surgery in patients evaluated with intracranial electrodes. Epilepsia 53:1722–1730PubMed
5.
Najm I, Jehi L, Palmini A, Gonzalez-Martinez J, Paglioli E, Bingaman W (2013) Temporal patterns and mechanisms of epilepsy surgery failure. Epilepsia 54:772–782PubMed
6.
Chassoux F, Artiges E, Semah F et al (2017) (18)F-FDG-PET patterns of surgical success and failure in mesial temporal lobe epilepsy. Neurology 88:1045–1053PubMed
7.
Jeha LE, Najm IM, Bingaman WE et al (2006) Predictors of outcome after temporal lobectomy for the treatment of intractable epilepsy. Neurology 66:1938–1940PubMed
8.
9.
Ryvlin P, Cross JH, Rheims S (2014) Epilepsy surgery in children and adults. Lancet Neurol 13:1114–1126PubMed
10.
Tang K, Gardner S, Snuderl M (2020) The role of liquid biopsies in pediatric brain tumors. J Neuropathol Exp Neurol 79:934–940PubMedPubMedCentral
11.
Serrano GE, Intorcia A, Carew J et al (2015) Feasibility study: comparison of frontal cortex needle core versus open biopsy for detection of characteristic proteinopathies of neurodegenerative diseases. J Neuropathol Exp Neurol 74:934–942PubMed
12.
Sidhu MK, Duncan JS, Sander JW (2018) Neuroimaging in epilepsy. Curr Opin Neurol 31:371–378PubMed
13.
Muhlhofer W, Tan YL, Mueller SG, Knowlton R (2017) MRI-negative temporal lobe epilepsy-what do we know? Epilepsia 58:727–742PubMed
14.
Dlugos DJ, Jaggi J, O’Connor WM et al (1999) Hippocampal cell density and subcortical metabolism in temporal lobe epilepsy. Epilepsia 40:408–413PubMed
15.
Vielhaber S, Von Oertzen JH, Kudin AF et al (2003) Correlation of hippocampal glucose oxidation capacity and interictal FDG-PET in temporal lobe epilepsy. Epilepsia 44:193–199PubMed
16.
Zhang M, Huang H, Liu W et al (2022) Combined quantitative T2 mapping and [(18)F]FDG PET could improve lateralization of mesial temporal lobe epilepsy. Eur Radiol 32:6108–6117PubMedPubMedCentral
17.
Fisher RS, Cross JH, French JA et al (2017) Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 58:522–530PubMed
18.
Engel JJ, Ness PV, Rasmussen TB, Ojemann LM (1993) The outcome with respect to epileptic seizures. Surgical Treatment of the Epilepsies, 2nd edn. Raven Press, New York, pp 609–621
19.
Therriault J, Pascoal TA, Savard M et al (2021) Topographic distribution of amyloid-β, tau, and atrophy in patients with behavioral/dysexecutive Alzheimer disease. Neurology 96:e81–e92PubMedPubMedCentral
20.
Pascoal TA, Benedet AL, Tudorascu DL et al (2021) Longitudinal 18F-MK-6240 tau tangles accumulation follows Braak stages. Brain 144:3517–3528PubMedPubMedCentral
21.
López-González FJ, Silva-Rodríguez J, Paredes-Pacheco J et al (2020) Intensity normalization methods in brain FDG-PET quantification. Neuroimage 222:117229PubMed
22.
BoscoloGalazzo I, Mattoli MV, Pizzini FB et al (2016) Cerebral metabolism and perfusion in MR-negative individuals with refractory focal epilepsy assessed by simultaneous acquisition of (18)F-FDG PET and arterial spin labeling. Neuroimage Clin 11:648–657
23.
Gaillard WD, Weinstein S, Conry J et al (2007) Prognosis of children with partial epilepsy: MRI and serial 18FDG-PET. Neurology 68:655–659PubMed
24.
Li Y, Feng J, Zhang T et al (2021) Brain metabolic characteristics distinguishing typical and atypical benign epilepsy with centro-temporal spikes. Eur Radiol 31:9335–9345PubMed
25.
Zhu Y, Feng J, Wu S et al (2017) Glucose metabolic profile by visual assessment combined with statistical parametric mapping analysis in pediatric patients with epilepsy. J Nucl Med 58:1293–1299PubMed
26.
Perani D, Della Rosa PA, Cerami C et al (2014) Validation of an optimized SPM procedure for FDG-PET in dementia diagnosis in a clinical setting. Neuroimage Clin 6:445–454PubMedPubMedCentral
27.
Matías-Guiu JA, Cabrera-Martín MN, Pérez-Castejón MJ et al (2015) Visual and statistical analysis of 18F-FDG PET in primary progressive aphasia. Eur J Nucl Med Mol Imaging 42:916–927PubMed
28.
Tzourio-Mazoyer N, Landeau B, Papathanassiou D et al (2002) Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. Neuroimage 15:273–289PubMed
29.
Blümcke I, Thom M, Aronica E et al (2013) International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: a Task Force report from the ILAE Commission on Diagnostic Methods. Epilepsia 54:1315–1329PubMed
30.
Blumcke I, Thom M, Aronica E et al (2013) International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: a Task Force report from the ILAE Commission on Diagnostic Methods. Epilepsia 54:1315–1329PubMed
31.
Gao HM, Hong JS (2008) Why neurodegenerative diseases are progressive: uncontrolled inflammation drives disease progression. Trends Immunol 29:357–365PubMedPubMedCentral
32.
Zhang Z, Liao W, Chen H et al (2011) Altered functional-structural coupling of large-scale brain networks in idiopathic generalized epilepsy. Brain 134:2912–2928PubMed
33.
Zijlmans M, Zweiphenning W, van Klink N (2019) Changing concepts in presurgical assessment for epilepsy surgery. Nat Rev Neurol 15:594–606PubMed
34.
Englot DJ, Morgan VL, Chang C (2020) Impaired vigilance networks in temporal lobe epilepsy: mechanisms and clinical implications. Epilepsia 61:189–202PubMedPubMedCentral
35.
Unnwongse K, Alexopoulos AV, Busch RM et al (2013) Nonlesional atypical mesial temporal epilepsy: electroclinical and intracranial EEG findings. Neurology 81:1848–1855PubMedPubMedCentral
36.
Hattingen E, Enkirch SJ, Jurcoane A et al (2018) Hippocampal “gliosis only” on MR imaging represents a distinct entity in epilepsy patients. Neuroradiology 60:161–168PubMed
37.
Barba C, Rheims S, Minotti L et al (2016) Temporal plus epilepsy is a major determinant of temporal lobe surgery failures. Brain 139:444–451PubMed
38.
Cook GJ, Fogelman I, Maisey MN (1996) Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med 26:308–314PubMed
39.
Knuuti J, Hustinx R (2008) Highlights of the annual congress of the European Association of Nuclear Medicine, Copenhagen 2007. Eur J Nucl Med Mol Imaging 35:655–672PubMed
40.
Fischer BM, Olsen MW, Ley CD et al (2006) How few cancer cells can be detected by positron emission tomography? A frequent question addressed by an in vitro study. Eur J Nucl Med Mol Imaging 33:697–702PubMed
41.
42.
43.
Finnema SJ, Toyonaga T, Detyniecki K et al (2020) Reduced synaptic vesicle protein 2A binding in temporal lobe epilepsy: a [(11) C]UCB-J positron emission tomography study. Epilepsia 61:2183–2193PubMed
44.
Choi JY, Kim SJ, Hong SB et al (2003) Extratemporal hypometabolism on FDG PET in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy. Eur J Nucl Med Mol Imaging 30:581–587PubMed
45.
Wong CH, Bleasel A, Wen L et al (2010) The topography and significance of extratemporal hypometabolism in refractory mesial temporal lobe epilepsy examined by FDG-PET. Epilepsia 51:1365–1373PubMed
46.
Benedek K, Juhász C, Chugani DC, Muzik O, Chugani HT (2006) Longitudinal changes in cortical glucose hypometabolism in children with intractable epilepsy. J Child Neurol 21:26–31PubMed
47.
Yu W, Krook-Magnuson E (2015) Cognitive collaborations: bidirectional functional connectivity between the cerebellum and the hippocampus. Front Syst Neurosci 9:177PubMedPubMedCentral
48.
49.
Ferner R, Day R, Bradberry SM (2022) Phenytoin and damage to the cerebellum - a systematic review of published cases. Expert Opin Drug Saf 21:957–977PubMed
Metadata
Title
[18F]FDG PET metabolic patterns in mesial temporal lobe epilepsy with different pathological types
Authors
Yongxiang Tang
Ling Xiao
Chijun Deng
Haoyue Zhu
Xiaomei Gao
Jian Li
Zhiquan Yang
Dingyang Liu
Li Feng
Shuo Hu
Publication date
15-08-2023
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2024
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-023-10089-1

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