Diagnostic performance of [18F]FDG-PET and ictal [99mTc]-HMPAO SPECT in occipital lobe epilepsy.
OBJECTIVE
We investigated whether interictal F-18 fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) or ictal [99mTc]-HMPAO single-photon emission computed tomography (SPECT) was useful to find epileptogenic zones in occipital lobe epilepsy (OLE).


METHODS
We reviewed visually and quantified patterns of hypometabolism in interictal [18F]FDG-PET and those of hyperperfusion in ictal SPECT in 17 OLE patients (27 plus minus 6.8 years old; M/F, 10/7; injection time, 30 plus minus 17 s). OLE was diagnosed based on invasive electroencephalography, surgery, and postsurgical outcome (Engel class I in all at an average of 26 months after surgery).


RESULTS
Epileptogenic zones were correctly localized in nine (60%) of 15 patients by interictal [18F]FDG-PET, and asymmetric indices corroborated visual diagnosis. Epileptogenic hemispheres were correctly lateralized in 14 (93%) of 15 patients on [18F]FDG-PET. Epileptogenic hemispheres were correctly lateralized in 13 (76%) of 17 patients using ictal SPECT, but localization was possible in only five (29%) patients. Interictal [18F]FDG-PET was helpful in two of the patients who showed no abnormality on magnetic resonance imaging (MRI) and no possible localization with ictal SPECT.


CONCLUSIONS
In OLE, ictal SPECT was helpful in lateralization, but less helpful in localization. Interictal [18F]FDG-PET was helpful in localization or lateralization of epileptogenic zones, even in patients with ambiguous MRI or ictal SPECT findings.
Kim
S K
SK
Department of Nuclear Medicine, College of Medicine, Seoul National University, Seoul, Korea.
Lee
D S
DS
Lee
S K
SK
Kim
Y K
YK
Kang
K W
KW
Chung
C K
CK
Chung
J K
JK
Lee
M C
MC
D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000098:blood supply / Q000000981:diagnostic imaging / Q000378:metabolism; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000706:statistics & numerical data; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D009778:Occipital Lobe / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019690:Technetium Tc 99m Exametazime; D014055:Tomography, Emission-Computed / Q000706:statistics & numerical data*; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*
D019788:Fluorodeoxyglucose F18; D019690:Technetium Tc 99m Exametazime