Positron emission tomography and single photon emission computed tomography

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Neuroimaging significantly impacts epilepsy evaluation and treatment.
• Understanding technical limitations and clinical context is crucial for maximizing neuroimaging's potential.

Purpose of the Study:

• To review the utility of various neuroimaging techniques in epilepsy management.
• To assess the reliability and applications of positron emission tomography (PET) and single photon emission computed tomography (SPECT) in presurgical epilepsy evaluation.

Main Methods:

• Review of PET and SPECT applications in epilepsy.
• Evaluation of 18F-2-deoxyglucose (FDG)-PET for epileptogenic zone localization.
• Assessment of cerebral blood flow (CBF) studies (interictal and activation) using PET and SPECT.
• Discussion of receptor ligand availability for PET and SPECT.

Main Results:

• FDG-PET and SPECT are valuable for presurgical localization of epileptogenic zones.
• Interictal CBF studies using PET or SPECT are unreliable for epilepsy localization.
• PET CBF activation studies are useful for presurgical cognitive mapping, potentially replacing the intracarotid amytal test.
• Available receptor ligands include benzodiazepine, opiate, and cholinergic tracers.
• Reported findings include increased mu opiate receptor binding, decreased benzodiazepine receptor binding, and increased monoamine oxidase B receptor binding.

Conclusions:

• Neuroimaging techniques, when interpreted within clinical and electrophysiological context, are vital for epilepsy patient care.
• PET and SPECT offer distinct roles, with FDG-PET and activation CBF studies being particularly useful for presurgical evaluation.
• Further research utilizing receptor ligands may provide additional insights into epilepsy pathophysiology.