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Ictal 18F-FDG PET/MRI in a Patient With Cortical Heterotopia and Focal Epilepsy
Ferdinando F Calabria1, Giuseppe Lucio Cascini, Antonio Gambardella
1From the *Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council; †Department of Diagnostic Imaging, Nuclear Medicine Unit, ‡Department of Medical and Surgical Sciences, Institute of Neurology, and §Neuroradiology Unit, Magna Graecia University, Catanzaro, Italy.
Abstract:
A 19-year-old man with epilepsy underwent ictal F-FDG PET/MRI, showing a 5 mm heterotopic nodule in the periventricular white matter, adjacent to the frontal horn of the left lateral ventricle (SUVmax, 5.5; glucidic cerebral metabolic rate, 0.317 μmol/mL). A repeated F-FDG PET/MRI, during seizure freedom, showed, at visual analysis, subtle decrease of the nodule metabolism. SUVmax and glucidic cerebral metabolic rate were clearly reduced to 3.7 and 0.226, respectively. Ictal F-FDG PET/MRI could be useful in epilepsy because of the added value of SUVmax and cerebral metabolic rate of glucose analysis to understand the relationship between heterotopy and epilepsy.
Insights
Ictal fluorodeoxyglucose F-18 positron emission tomography/magnetic resonance imaging (FDG PET/MRI) revealed a heterotopic nodule in a patient with epilepsy. Reduced nodule metabolism during seizure freedom suggests FDG PET/MRI
Area of Science:
- Neuroimaging
- Epileptology
- Neurology
Background:
- Epilepsy is a neurological disorder characterized by recurrent seizures.
- Heterotopic nodules are developmental abnormalities that can be associated with epilepsy.
- Fluorodeoxyglucose F-18 positron emission tomography/magnetic resonance imaging (FDG PET/MRI) is a neuroimaging technique used to assess brain metabolism.
Observation:
- A 19-year-old male with epilepsy presented with a 5 mm heterotopic nodule near the left lateral ventricle.
- Ictal FDG PET/MRI showed elevated metabolism in the nodule (SUVmax 5.5).
- Repeat FDG PET/MRI during seizure freedom demonstrated a decrease in nodule metabolism (SUVmax 3.7).
Findings:
- The heterotopic nodule exhibited significantly reduced glucose metabolism when the patient was seizure-free.
- Quantitative analysis of SUVmax and cerebral metabolic rate of glucose (CMRO2) correlated with seizure activity.
- The findings suggest a link between the heterotopic nodule's metabolic activity and epilepsy.
Implications:
- Ictal FDG PET/MRI may be a valuable tool for evaluating the role of heterotopic nodules in epilepsy.
- Metabolic changes in heterotopic nodules can be detected using quantitative FDG PET/MRI.
- This technique could aid in understanding the pathophysiology of epilepsy associated with brain malformations.
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