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Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
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Global temporal lobe asymmetry as a semi-quantitative imaging biomarker for temporal lobe epilepsy lateralization: A
Jonah Peter1, Mohsen Khosravi, Thomas J Werner
1Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, USA. abass.alavi@uphs.upenn.edu.
Hellenic Journal of Nuclear Medicine
|July 15, 2018
Summary
Global semi-quantitative analysis using fluorine-18-flurodeoxyglucose positron emission tomography (18F-FDG PET) reliably lateralizes seizures in temporal lobe epilepsy (TLE). However, it is less effective for diagnosing TLE compared to healthy individuals.
Area of Science:
- Neurology
- Nuclear Medicine
- Medical Imaging
Background:
- Unilateral temporal lobe epilepsy (TLE) is a common cause of drug-resistant epilepsy.
- Accurate lateralization of the seizure focus is crucial for surgical planning.
- 18F-FDG PET is a functional imaging technique used to assess brain metabolism.
Purpose of the Study:
- To evaluate the effectiveness of global semi-quantitative 18F-FDG PET analysis for lateralizing seizure foci in unilateral TLE.
- To assess the diagnostic utility of this method in distinguishing TLE patients from healthy controls.
Main Methods:
- Retrospective analysis of 18F-FDG PET scans from 17 unilateral TLE patients and 23 controls.
- Calculation of globally averaged standardized uptake value (gSUVmean) for each temporal lobe.
- Computation of lateralization indices (LI) and absolute lateralization indices (|LI|) to quantify asymmetry.
- Logistic regression and ROC curve analysis to assess predictive performance.
Main Results:
- A statistically significant difference in gSUVmean computed LI was observed between left and right TLE patients (P<0.01).
- 18F-FDG PET correctly lateralized 82% of TLE patients with an AUC of 0.80 using LI.
- No significant difference in |LI| was found between TLE patients and controls (P=0.22), with diagnostic accuracy of 65% and AUC of 0.44.
- High intra-observer (96%) and inter-observer (96%, 91%) reproducibility was demonstrated.
Conclusions:
- Global semi-quantitative analysis of 18F-FDG PET, specifically gSUVmean computed LI, is a reliable and reproducible method for seizure lateralization in unilateral TLE.
- gSUVmean computed |LI| is not effective for diagnosing TLE in this cohort.
- Future research should explore machine learning techniques combining gSUVmean with other predictors for improved TLE diagnosis.
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