FDG-PET/MRI in the presurgical evaluation of pediatric epilepsy

Area of Science:

• Neurology
• Medical Imaging
• Pediatric Epilepsy

Background:

• Accurate identification of the epileptogenic zone is crucial for successful epilepsy surgery in pediatric patients.
• Drug-resistant epilepsy often presents challenges in precisely localizing the seizure onset zone, impacting surgical outcomes.
• Integrating Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) offers complementary information for presurgical evaluation.

Purpose of the Study:

• To review the role of combined 18F-FDG-PET and MRI in the presurgical assessment of pediatric epilepsy.
• To highlight the advantages of simultaneous PET/MRI and retrospective image co-registration.
• To share a decade of experience using simultaneous PET/MRI in pediatric epilepsy surgery planning.

Main Methods:

• Review of literature and illustrative cases focusing on 18F-FDG-PET and MRI integration.
• Discussion of simultaneous PET/MRI scanning versus retrospective co-registration of separately acquired data.
• Analysis of the complementary roles of functional (PET) and structural (MRI) imaging in lesional and non-lesional epilepsy.

Main Results:

• Combined PET and MRI provide superior diagnostic precision compared to either modality alone.
• 18F-FDG-PET highlights metabolic abnormalities, while MRI precisely localizes structural lesions.
• Simultaneous PET/MRI offers efficient co-registration, minimizing sedation and radiation exposure in children.

Conclusions:

• The integration of PET and MRI significantly enhances the presurgical evaluation of pediatric drug-resistant epilepsy.
• Both simultaneous PET/MRI and retrospective co-registration are valuable, with simultaneous imaging offering advantages in pediatric cases.
• Improved identification of the epileptogenic zone through combined imaging leads to better surgical planning and potentially improved clinical outcomes.