Intertechnique Agreement in Epilepsy Imaging

Year 2019, Volume: 13 Issue: 4, 292 - 301, 30.07.2019

Altan Güneş , Dilek Yalnızoğlu , Ceren Günbey Bilge Volkan Salancı Figen Söylemezoğlu Burçak Biginer Eser Lay Ergün Güzide Turanlı Belkıs Erbaş Meral Topçu Serap Saygı Kader Karli Oğuz

https://doi.org/10.12956/tchd.541114

Abstract

Aim:To
analyze seizure semiology,
scalp video-electroencephalography,magnetic resonance imaging (MRI) and
18F-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) findings in
patients with medically refractory epilepsy,to assess the concordance rate (CR)
between clinical-electroencephalography findings (CEF) and neuroimaging studies
(NS) for localizing epileptogenic foci.

Material
and methods:This retrospective study included
108 consecutive patients (male/female=59/49;mean age=26.6±10.5 years) who were
classified according to CEF (either temporal or extra-temporal lobe epilepsy
[TLE]) between January 2011 and January 2017.Statistical analysis was performed
using a t, Mann-Whitney U, McNemar,
or χ² tests.

Results:Fifty-six patients had TLE (M/F=30/26,mean
age=30.1±8.9 years) and 52 had extra-TLE (M/F=29/23,mean age=22.8±10.9 years) according
to CEF.12/108 patients (M/F=6/6,mean age=28.7±10.2 years) underwent epilepsy
surgery and the mean postoperative follow-up period was 32 months.The
highest CR between CEF and NS (76%) was found in patients with non-hippocampal
sclerosis abnormality in TLE group.In patients with malformations of cortical
development on MRI,the CR (84.2%)
between CEF and MRI was better than those between CEF and FDG-PET (52.6%) (P=0.010).The
CR between CEF and NS for TLE (48.2%) was better than for extra-TLE (9.6%) (P<0.001).No
significant difference was found in the localization of the epileptogenic focus
between MRI and FDG-PET according to the seizure outcome of patients (P=1).

Conclusions:FDG-PET
may not help in revealing epileptic region in cases with abnormal MRI
especially in malformations of cortical development.The highest CR between CEF
and NS is found in TLE patients with findings inconclusive of hippocampal
sclerosis.With low CR between CEF and NS in extra-TLE,meticulous use of
multiple modalities is necessary for accurate pre-surgical evaluation.

Keywords

Medically refractory epilepsy, Magnetic resonance imaging

Epilepsi görüntülemesinde Modaliteler Arası Uyum

Abstract

Amaç: Medikal tedaviye
dirençli epilepsi hastalarında nöbet semiyolojisi, skalp-video elektroensefalografi,
manyetik rezonans görüntülüme (MRG) ve 18-floro-2-deoksi-glukoz
pozitron emisyon tomografi (FDG-PET) bulgularının değerlendirilmesi,
epileptojenik odağı lokalize etmede klinik-elektroensefalografi bulguları ile nörogörüntüleme
yöntemleri arasındaki uyumun değerlendirilmesi amaçlandı.

Gereç ve Yöntemler: Retrospektif olan çalışmamız
hastane etik kuru onayı alınarak yapıldı. Çalışmaya, Ocak 2011 ile Ocak 2017
tarihleri arasında, klinik-elektroensefalografi
bulgularına göre temporal (30 erkek, 26 kız, ortalama yaş 30,1±8,9 yıl) ve
ekstra-temporal lob epilepsi (29 erkek, 23 kız, ortalama yaş 22,8±10,9 yıl) gruplarına
ayrılan ardışık 108 hasta (59 erkek, 49 kız, ortalama yaş 26,6±10,5 yıl) dahil
edildi. Kategorik-sayısal değişkenler t, Mann-Whitney U, McNemar veya Ki-kare testi
ile analiz edildi.

Bulgular: Çalışmaya dahil edilen 108 hastanın 12’si (6 erkek, 6 kız, ortalama yaş 28,7±10,2 yıl) epilepsi
cerrahisi geçirdi ve bu hastaların operasyon sonrası ortalama takip süresi 32
aydı. Klinik-elektroensefalografi
bulguları ile nörogörüntüleme yöntemleri arasında en yüksek uyum (%76)
hippokampal skleroz dışı anormallikler sahip temporal lob epilepsili hastalarda
saptandı. MRG’de kortikal gelişimsel anormalliklere sahip hastalardaki, klinik-
elektroensefalografi bulguları ile MRG arasındaki uyum (%84,2), klinik-elektroensefalografi
bulguları ile FDG-PET arasındaki uyumdan (%52,6) yüksekti (p=0,010). Temporal lob
epilepsilerindeki klinik-elektroensefalografi
bulguları ile nörogörüntüleme yöntemleri arasındaki uyum (%48,2),
ekstra-temporal lob epilepsilerine (%9,6) göre daha yüksekti (p<0,001). Opere olan
hastaların takiplerine göre MRG ile FDG-PET arasında epileptojenik odağı
lokalize etmede anlamlı farklılık saptanmadı (p=1).

Sonuç: FDG-PET
epileptojenik odağın lokalize edilmesinde, özellikle MRG’de kortikal gelişimsel
anormalliklerin saptandığı hastalarda yardımcı olamayabilir. Klinik-elektroensefalografi
bulguları ile nörogörüntüleme yöntemleri arasındaki en yüksek uyum hippokampal
skleroz dışı anormalliklere sahip temporal lob epilepsili hastalarda saptandı. Ekstra-temporal
lob epilepsilerindeki klinik-elektroensefalografi bulguları ile
nörogörüntüleme yöntemleri arasındaki düşük uyum, ekstra-temporal lob
epilepsilerinin cerrahi öncesi değerlendirilmesinde, farklı
yöntemlerin kullanılmasını gerektirmektedir.

Keywords

Epilepsi, Manyetik rezonans görüntüleme

References

• Nguyen DK, Spencer SS. Recent advances in the treatment of epilepsy. Arch Neurol 2003; 60: 929–935. https://doi.org/10.1001/archneur.60.7.929.
• Cascino GD. Surgical treatment for epilepsy. Epilepsy Res 2004; 60: 179–186. https://doi.org/10.1016/j.eplepsyres.2004.07.003.
• Cascino GD. Neuroimaging in Epilepsy: Diagnostic Strategies in Partial Epilepsy. Semin Neurol 2008; 28: 523–532. https://doi.org/10.1055/s-0028-1083687.
• Cohen-Gadol AA, Wilhelmi BG, Collignon F, White JB, Britton JW, Cambier DM, et al. Long term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis. J Neurosurg 2006; 104: 513–524. https://doi.org/10.3171/jns.2006.104.4.513.
• Seo JH, Noh BH, Lee JS, Kim DS, Lee SK, Kim TS, et al. Outcome of surgical treatment in non-lesional intractable childhood epilepsy. Seizure 2009; 18(9): 625–629. https://doi.org/10.1016/j.seizure.2009.07.007.
• Gaillard WD, White S, Malow B, Flamini R, Weinstein S, Sato S, et al. FDG-PET in children and adolescents with partial seizures: role in epilepsy surgery evaluation. Epilepsy Res 1995; 20(1): 77–84. https://doi.org/10.1016/0920-1211(94)00065-5.
• Willmann O, Wennberg R, May T, Woermann FG, Pohlmann-Eden B. The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy: A meta-analysis. Seizure 2007; 16(6): 509–520. https://doi.org/10.1016/j.seizure.2007.04.001.
• O’Brien TJ, Hicks RJ, Ware R, Binns DS, Murphy M, Cook MJ. The utility of a 3-dimensional, large-field-of-view, sodium iodide crystal-based PET scanner in the presurgical evaluation of partial epilepsy. J Nucl Med 2001; 42(8): 1158–1165.
• Muzik O, Chugani DC, Shen C, da Silva EA, Shah J, Shah A, et al. Objective method for localization of cortical asymmetries using positron emission tomography to aid surgical resection of epileptic foci. Comput Aided Surg 1998; 3(2): 74–82. https://doi.org/10.1002/(SICI)1097-0150(1998)3:2<74::AID-IGS4>3.0.CO;2-H.
• Blümcke I, Thom M, Aronica E, Armstrong DD, Bartolomei F, Bernasconi A, et. al. International consensus classification of hippocampal. Epilepsia 2013; 54(7): 1315–1329. https://doi.org/10.1111/epi.12220.
• Cascino GD, Jack CR Jr, Parisi JE, Sharbrough FW, Hirschorn KA, Meyer FB, et al. Magnetic resonance imaging-based volume studies in temporal lobe epilepsy: pathological correlations. Ann Neurol 1991; 30(1): 31–36. https://doi.org/10.1002/ana.410300107.
• Cendes F, Andermann F, Gloor P, Evans A, Jones Gotman M, Watson C, et al. MRI volumetric measurement of amygdala and hippocampus in temporal lobe epilepsy. Neurology 1993; 43(4): 719–725. https://doi.org/10.1212/WNL.43.4.719.
• Engel J Jr, Henry TR, Risinger MW, Mazziotta JC, Sutherling WW, Levesque MF, et al. Presurgical evaluation for partial epilepsy: relative contributions of chronic depth-electrode recordings versus FDG-PET and scalp-sphenoidal ictal EEG. Neurology 1990; 40(11): 1670–1677. https://doi.org/10.1212/WNL.40.11.1670.
• Baron JC, Bousser MG, Comar D, Soussaline F, Castaigne P. Noninvasive tomographic study of cerebral blood flow and oxygen metabolism in vivo. Potentials, limitations, and clinical applications in cerebral ischemic disorders. Eur Neurol 1981; 20: 273–284. https://doi.org/10.1159/000115247.
• Blümcke I, Pauli E, Clusmann H, Schramm J, Becker A, Elger C, et al. A new clinicopathological classification system for mesial temporal sclerosis. Acta Neuropathol 2007; 113(3): 235–244. https://doi.org/10.1007/s00401-006-0187-0.
• Engel J Jr. Outcome with respect to epileptic seizures. In: Engel J Jr, editor. Surgical Treatment of the Epilepsies, New York: Raven;1987, p. 553–71.
• French JA, Williamson PD, Thadani VM, Darcey TM, Mattson RH, Spencer SS, et al. Characteristics of medial temporal lobeepilepsy: I. Results of history and physical examination. Ann Neurol 1993; 34(6): 774–780. https://doi.org/10.1002/ana.410340604.
• Harvey AS, Grattan-Smith JD, Desmond PM, Chow CW, Berkovic SF. Febrile seizures and hippocampal sclerosis: frequent and related findings in intractable temporal lobe epilepsy of childhood. Pediatr Neurol 1995; 12(3): 201–206. https://doi.org/10.1016/0887-8994(95)00022-8.
• Carne RP, O'Brien TJ, Kilpatrick CJ, MacGregor LR, Hicks RJ, Murphy MA, et al. MRI-negative PET-positive temporal lobe epilepsy: a distinct surgically remediable syndrome. Brain 2004; 127(10): 2276–2285. https://doi.org/10.1093/brain/awh257.
• Lerner JT, Salamon N, Hauptman JS, Velasco TR, Hemb M, Wu JY, et al. Assessment and surgical outcomes for mild type I and severe type II cortical dysplasia: a critical review and the UCLA experience. Epilepsia 2009; 50(6): 1310–1335. https://doi.org/10.1111/j.1528-1167.2008.01998.x.
• Gok B, Jallo g, Hayeri R, Wahl R, Aygun N. The evaluation of FDG-PET imaging for epileptogenic focus localization in patients with MRI positive and MRI negative temporal lobe epilepsy. Neuroradiology 2013; 55(5): 541–550. https://doi.org/10.1007/s00234-012-1121-x.
• Wieser HG. ILAE Commission on Neurosurgery of Epilepsy: ILAE commission report. Mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsia 2004; 45(6): 695–714. https://doi.org/10.1111/j.0013-9580.2004.09004.x.
• Kuzniecky R, Murro A, King D, Morawetz R, Smith J, Powers R, et al. Magnetic resonance imaging in childhood intractable partial epilepsies: Pathologic correlations. Neurology 1993; 43(4): 681–687. https://doi.org/10.1212/WNL.43.4.681.
• Kim S, Salamon N, Jackson HA, Blüml S, Panigrahy A.PET imaging in pediatric neuroradiology: current and future applications. Pediatr Radiol 2010; 40: 82-96. https://doi.org/10.1007/s00247-009-1457-5.
• Becker AJ, Blumcke I, Urbach H, Hans V, Majores M. Molecular neuropathology of epilepsy-associated glioneuronal malformations. J Neuropathol Exp Neurol 2006; 65(2): 99–108. https://doi.org/10.1097/01.jnen.0000199570.19344.33.
• Harvey AS, Cross JH, Shinnar S, Mathern BW. Defining the spectrum of international practice in pediatric epilepsy surgery patients. Epilepsia 2008; 49(1): 146–155. https://doi.org/10.1111/j.1528-1167.2007.01421.x.
• Spencer SS. The relative contributions of MRI, SPECT and PET imagining in epilepsy. Epilepsia 1994; 35(6): 72–89. https://doi.org/10.1111/j.1528-1157.1994.tb05990.x.
• Salamon N, Kung J, Shaw SJ, Koo J, Koh S, Wu JY, et al. FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy. Neurology 2008; 71(20): 1594–1601. https://doi.org/10.1212/01.wnl.0000334752.41807.2f.
• Kim SK, Na DG, Byun HS, Kim SE, Suh YL, Choi JY, et al. Focal cortical dysplasia: comparison of MRI and FDG-PET. J Comput Assist Tomogr 2000; 24(2): 296–302.
• Lee KK, Salamon N. [18F] fluorodeoxyglucose-positron-emission tomography and MR imaging coregistration for presurgical evaluation of medically refractory epilepsy. Am J Neuroradiol 2009; 30(10): 1811–1816. https://doi.org/10.3174/ajnr.A1637.
• Rubí S, Setoain X, Donaire A, Bargalló N, Sanmartí F, Carreño M, et al. Validation of FDG-PET/MRI coregistration in nonlesional refractory childhood epilepsy. Epilepsia 2011; 52(12): 2216–2224. https://doi.org/ 10.1111/j.1528-1167.2011.03295.x.
• Oldan JD, Shin HW, Khandani AH, Zamora C, Benefield T, Jewells V. Subsequent experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy. Seizure 2018; 61: 128–134. https://doi.org/10.1016/j.seizure.2018.07.022.
• Cendes F, Caramanos Z, Andermann F, Dubeau F, Arnold DL. Proton magnetic resonance spectroscopic imaging and magnetic resonance imaging volumetry in the lateralization of temporal lobe epilepsy: a series of 100 patients. Ann Neurol 1997; 42(5): 737–746. https://doi.org/10.1002/ana.410420510.
• Cheon JE, Chang KH, Kim HD, Han MH, Hong SH, Seong SO, et al. MR of hippocampal sclerosis: comparison of qualitative and quantitative assessments. Am J Neuroradiol 1998; 19(3): 465–468.