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Open Access 01-12-2021 | Epilepsy | Research article

The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy

Authors: Márton Tóth, Péter Barsi, Zoltán Tóth, Katalin Borbély, János Lückl, Miklós Emri, Imre Repa, József Janszky, Tamás Dóczi, Zsolt Horváth, Péter Halász, Vera Juhos, Csilla Gyimesi, Beáta Bóné, Diána Kuperczkó, Réka Horváth, Ferenc Nagy, Anna Kelemen, Zsófia Jordán, Ákos Újvári, Koichi Hagiwara, Jean Isnard, Endre Pál, Attila Fekésházy, Dániel Fabó, Zsolt Vajda

Published in: BMC Neurology | Issue 1/2021

Abstract

Background

When MRI fails to detect a potentially epileptogenic lesion, the chance of a favorable outcome after epilepsy surgery becomes significantly lower (from 60 to 90% to 20–65%). Hybrid FDG-PET/MRI may provide additional information for identifying the epileptogenic zone. We aimed to investigate the possible effect of the introduction of hybrid FDG-PET/MRI into the algorithm of the decision-making in both lesional and non-lesional drug-resistant epileptic patients.

Methods

In a prospective study of patients suffering from drug-resistant focal epilepsy, 30 nonlesional and 30 lesional cases with discordant presurgical results were evaluated using hybrid FDG-PET/MRI.

Results

The hybrid imaging revealed morphological lesion in 18 patients and glucose hypometabolism in 29 patients within the nonlesional group. In the MRI positive group, 4 patients were found to be nonlesional, and in 9 patients at least one more epileptogenic lesion was discovered, while in another 17 cases the original lesion was confirmed by means of hybrid FDG-PET/MRI. As to the therapeutic decision-making, these results helped to indicate resective surgery instead of intracranial EEG (iEEG) monitoring in 2 cases, to avoid any further invasive diagnostic procedures in 7 patients, and to refer 21 patients for iEEG in the nonlesional group. Hybrid FDG-PET/MRI has also significantly changed the original therapeutic plans in the lesional group. Prior to the hybrid imaging, a resective surgery was considered in 3 patients, and iEEG was planned in 27 patients. However, 3 patients became eligible for resective surgery, 6 patients proved to be inoperable instead of iEEG, and 18 cases remained candidates for iEEG due to the hybrid FDG-PET/MRI. Two patients remained candidates for resective surgery and one patient became not eligible for any further invasive intervention.

Conclusions

The results of hybrid FDG-PET/MRI significantly altered the original plans in 19 of 60 cases. The introduction of hybrid FDG-PET/MRI into the presurgical evaluation process had a potential modifying effect on clinical decision-making.

Trial registration

Trial registry: Scientific Research Ethics Committee of the Medical Research Council of Hungary. Trial registration number: 008899/2016/OTIG. Date of registration: 08 February 2016.

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Title: The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy
Authors: Márton Tóth
Péter Barsi
Zoltán Tóth
Katalin Borbély
János Lückl
Miklós Emri
Imre Repa
József Janszky
Tamás Dóczi
Zsolt Horváth
Péter Halász
Vera Juhos
Csilla Gyimesi
Beáta Bóné
Diána Kuperczkó
Réka Horváth
Ferenc Nagy
Anna Kelemen
Zsófia Jordán
Ákos Újvári
Koichi Hagiwara
Jean Isnard
Endre Pál
Attila Fekésházy
Dániel Fabó
Zsolt Vajda
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Epilepsy
Published in: BMC Neurology / Issue 1/2021
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-021-02352-z

2024 ASCO Annual Meeting

Springer Medicine

The role of hybrid FDG-PET/MRI on decision-making in presurgical evaluation of drug-resistant epilepsy

Abstract

Background

Methods

Results

Conclusions

Trial registration

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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