Presurgical lateralization of seizure focus and language dominant hemisphere with O-15 water PET imaging.
OBJECTIVE
The purpose of this study was to assess the value of same day blood flow PET in both the identification of the language dominant hemisphere and in the lateralization of the epileptic focus in patients who were preoperatively evaluated for complex partial seizures.


METHODS
The charts of 24 patients who had temporal lobectomies for seizures were retrospectively reviewed. All PET scans were acquired by using O-15 water tracer (H2(15)O) in both resting and language activation conditions. PET language laterality results were compared to Intracarotid amytal procedure (IAP) results. For epileptic focus lateralizations, regions of interest (ROI) analysis of temporal lobes was performed on resting scans.


RESULTS
IAP testing was discordant with PET language mapping in 1 out of 24 cases. This patient had a decline in cognitive abilities as measured by postoperative neuropsychologic testing. For epileptic focus lateralization, the PET was highly sensitive (87%) and specific (100%). Lateralizations with the PET were in agreement with surgical sites in all cases. Eighteen patients (75%) were seizure free and 4 patients (17%) were significantly improved after surgery.


CONCLUSIONS
The results suggest that O-15 water PET is sensitive and specific in both the lateralization of epileptic focus and the language dominant hemisphere and can be a cost-effective and noninvasive method in presurgical evaluation of patients with complex partial seizures.
Tatlidil
R
R
Research Imaging Center, University of Texas Health Science Center in San Antonio, USA.
Xiong
J
J
Luther
S
S
D000328:Adult; D000654:Amobarbital; D004292:Dominance, Cerebral; D004569:Electroencephalography; D017029:Epilepsy, Complex Partial / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007802:Language; D008297:Male; D008499:Medical Records; D008568:Memory; D008875:Middle Aged; D010104:Oxygen Radioisotopes; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014055:Tomography, Emission-Computed / Q000379:methods*; D016896:Treatment Outcome; D014867:Water
D006993:Hypnotics and Sedatives; D010104:Oxygen Radioisotopes; D014867:Water; D000654:Amobarbital