FDG-PET images quantified by probabilistic atlas of brain and surgical prognosis of temporal lobe epilepsy.
OBJECTIVE
This study evaluated the relation between hypometabolism, diagnosed by fluorodeoxyglucose positron emission tomography (FDG-PET), and the surgical outcome of a large and homogeneous series of cases of mesial temporal lobe epilepsy (mTLE), by using a probabilistic atlas of the human brain (statistical probabilistic anatomical maps: SPAM).


METHODS
Ninety-five surgically proven intractable mTLE patients and 22 age-matched controls were spatially normalized to the average brain PET template of international consortium of brain mapping (ICBM). The diagnosis of mTLE was confirmed by the presence of hippocampal sclerosis on magnetic resonance imaging (MRI) and video-EEG monitoring. Counts from normalized PET images were multiplied by the probability from 98 volumes of interest (VOIs) of SPAM. Asymmetric indexes (AIs) reflecting the severity of hypometabolism were calculated by counts of selected 12 VOIs from SPAM images in both temporal lobes. Extent of hypometabolism was determined by the number of voxels showing decreased metabolism in each VOI segmented by SPAM.


RESULTS
Of the 95 patients studied, 76 (80%) were seizure free, and 19 (20%) had postoperative seizures for the > or =2-year follow-up period. No significant association between the severity of hypometabolism in each VOI of the temporal lobe and surgical outcome was identified (p > 0.05). The number of voxels showing decreased hypometabolism was not significantly different between the good- and poor-outcome groups (p > 0.05).


CONCLUSIONS
Our results demonstrated that focal severity and extent of hypometabolism quantified by a probabilistic atlas of brain were not related to the surgical outcome in mTLE patients who had hippocampal sclerosis on MRI. We should develop a more localized and specified anatomic map for mTLE for further results.
Departments of Neurology, Nuclear Medicine, and Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. sangunlee@dreamwiz.com
Sang Kun
SK
Lee
Dong Soo
DS
Lee
Jeong Seok
JS
Yeo
Jae Sung
JS
Lee
Yu Kyeong
YK
Kim
Myoung Jin
MJ
Jang
Kwang-Ki
KK
Kim
Seok-Ki
SK
Kim
Jong-Bai
JB
Oh
Chun-Kee
CK
Chung
D000328:Adult; D001931:Brain Mapping / Q000379:methods*; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006624:Hippocampus / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D011379:Prognosis; D012598:Sclerosis; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000601:surgery; D014055:Tomography, Emission-Computed / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014741:Video Recording
D019788:Fluorodeoxyglucose F18