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Subsequent experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy
Jorge Daniel Oldan1, Hae Won Shin2, Amir Hossein Khandani1
1University of North Carolina-Chapel Hill, Department of Radiology, Chairman's Office 2006 Old Clinic, CB #7510 Chapel Hill, NC 27599, USA.
Purpose:
Epilepsy surgery is the most successful method of treating medically unresponsive epilepsy, but carries a risk of morbidity. PET/MR is an emerging technique that increases detection of focal lesions whose resection may result in symptom remission.
Methods:
Retrospective review of 74 focal epilepsy patients over a period of 3 years who had a PET/MR was performed following IRB permission and informed consent. 27 patients underwent surgery or RNS (responsive neurostimulator) placement.
Results:
Hybrid PET-MR identified new anatomic or functional lesions in 10 patients not identified with standalone 3 T MR. Of the 27 patients who underwent focal surgery (19) or RNS placement (8), 24 showed improvement (Engel's I-III), 2 did not (Engel's IV), and one had an RNS explanted due to infection. MR and PET were read by 2 separate neuroradiologists and nuclear medicine physicians, respectively. Modalities were evaluated in terms of ability to detect the correct lobe and side for a focal lesion whose resection improved symptoms. Prior standalone MR exhibited 71-77% sensitivity and 0% specificity (as there were only 2 nonresponders), MR associated with PET/MR had 68-71% sensitivity and 0-50% specificity (depending on whether a lesion was seen on one of the nonresponders), and PET had 68-71% sensitivity and 25-33% specificity. Using either PET or MR to identify a focal lesion, PET/MR had sensitivity of 78-82% and specificity 0-50%.
Conclusions:
PET-MR provides additional sensitivity when used as two combined modalities for detecting possible epileptic foci.
Insights
Positron emission tomography/magnetic resonance imaging (PET/MR) enhances the detection of focal lesions in epilepsy patients, improving surgical outcomes. This combined imaging technique offers greater sensitivity for identifying potential epileptic foci.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Epilepsy surgery is a key treatment for medically unresponsive epilepsy, but it carries risks.
- Focal lesions are often targeted for resection to achieve symptom remission.
- Emerging PET/MR technology shows promise in improving the detection of these lesions.
Purpose of the Study:
- To evaluate the diagnostic performance of combined PET/MR imaging in identifying focal lesions in patients with epilepsy.
- To assess the added value of PET/MR compared to standalone MR imaging for lesion detection.
- To correlate imaging findings with surgical outcomes in epilepsy patients.
Main Methods:
- A retrospective review of 74 focal epilepsy patients who underwent PET/MR imaging over three years.
- Analysis of 27 patients who proceeded to epilepsy surgery or responsive neurostimulator (RNS) placement.
- Comparison of lesion detection and localization by standalone MR, PET, and combined PET/MR.
Main Results:
- Hybrid PET-MR identified new lesions in 10 patients missed by standalone 3T MR.
- Of 27 patients undergoing surgery or RNS, 24 showed improvement (Engel's I-III).
- PET/MR demonstrated higher sensitivity (78-82%) and specificity (0-50%) for detecting lesions associated with improved outcomes compared to standalone modalities.
Conclusions:
- Combined PET-MR imaging offers enhanced sensitivity for detecting potential epileptic foci.
- This multimodal approach can improve the identification of surgically relevant lesions in epilepsy.
- PET/MR aids in better surgical planning and potentially improves outcomes for epilepsy patients.
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