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Related Experiment Video

Updated: Jun 4, 2025

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
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Nuclear Medicine Imaging in Epilepsy.

Aakanksha Sriwastwa1, Andrew Timothy Trout1, Bruce Wayne Mahoney1

  • 1From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219 (A.S., A.T.T., B.W.M., L.L.W., J.L.S.); and Department of Radiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH (A.T.T.).

Radiographics : a Review Publication of the Radiological Society of North America, Inc
|January 2, 2025
PubMed
Summary

Nuclear medicine imaging, including PET and SPECT scans, is crucial for locating the seizure focus in medically refractory focal epilepsy (MRFE) patients, guiding surgical planning for better outcomes.

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Area of Science:

  • Neurology
  • Radiology
  • Nuclear Medicine

Background:

  • Medically refractory focal epilepsy (MRFE) affects one-third of epilepsy patients, significantly reducing quality of life.
  • Surgical resection of the seizure focus in noneloquent cortex offers a chance for seizure freedom and minimal neurocognitive deficit.
  • Accurate localization of the epileptogenic zone (EZ) is paramount for successful epilepsy surgery.

Purpose of the Study:

  • To review nuclear medicine imaging techniques for epilepsy presurgical planning.
  • To guide radiologists in performing and interpreting functional imaging studies for MRFE.
  • To enhance multidisciplinary discussions for complex epilepsy cases.

Main Methods:

  • Review of radiotracers, imaging acquisition, and postprocessing for PET and SPECT in epilepsy.
  • Analysis of common causes, radiologic appearances, and interpretation pitfalls of MRFE.
  • Focus on functional imaging's role in nonlesional epilepsy and electrophysiologic-structural discordance.

Main Results:

  • PET (e.g., Fluorine 18-fluorodeoxyglucose) identifies hypometabolism in the EZ; SPECT assesses regional cerebral perfusion.
  • Functional imaging is vital for nonlesional epilepsy, multiple lesions, or discordant findings.
  • Nuclear medicine unmasks subtle abnormalities and evaluates brain functional integrity.

Conclusions:

  • Nuclear medicine imaging is indispensable for precise EZ localization in epilepsy surgery planning.
  • Optimized imaging performance and interpretation facilitate effective patient management.
  • This review aids radiologists in contributing to successful epilepsy surgical outcomes.