title: Diagnostic performance of 18F-FDG PET and ictal 99mTc-HMPAO SPET in pediatric temporal lobe epilepsy: quantitative analysis by statistical parametric mapping, statistical probabilistic anatomical map, and subtraction ictal SPET.
abstract: We investigated the diagnostic performance of 18F-FDG PET and ictal (99m)Tc-HMPAO SPET in pediatric temporal lobe epilepsy (TLE). Twenty-one pediatric TLE patients were enrolled in this study. Their diagnoses were confirmed by histology and post-surgical outcome (Engel class I or II). The patients' ages were 18 or younger (15+/-3 years). Of the 21 patients, 21 patients underwent 18F-FDG PET scan and 15 underwent ictal (99m)Tc-HMPAO SPET. Preoperative PET and/or ictal SPET images were reviewed by simple visual assessment and by statistical parametric mapping (SPM). Asymmetric indices (AI) were calculated using statistical probabilistic anatomical map (SPAM) on 18F-FDG PET. In nine patients who underwent both ictal and interictal SPET, SISCOM (subtraction ictal SPET coregistered to MR template) was performed. PET correctly localized epileptogenic zones in 20 of 21 (95%) by visual assessment. SPM analysis of PET correctly localized epileptogenic zones in 18 of 21 (86%). Ictal SPET correctly localized epileptogenic zones in 12 of 15 (80%) by visual assessment. SPM analysis of ictal SPET correctly localized epileptogenic zones in 12 of 15 (80%). SISCOM correctly localized 8 of 9 (89%), which was equal to that of visual assessment of ictal SPET. The AIs of the temporal lobes by PET were -15+/-8.4 in the left and 9.9+/-8.9 in the right TLE (normal control: -2.9+/-2.8), and correctly localized epileptogenic zones in all cases. As is found in adult TLE, PET and ictal SPET efficiently localized epileptogenic zones in pediatric TLE. SPM analysis of PET or ictal SPET could be used as an aid to visual assessment. Moreover, SISCOM was equal visual assessment of ictal SPET images in terms of lesion localizations.
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, South Korea.
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Lee
authors.forename: Won Jun
authors.initials: WJ
authors.lastname: Kang
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Lee
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Lee
authors.forename: Hee
authors.initials: H
authors.lastname: Hwang
authors.forename: Ki Joong
authors.initials: KJ
authors.lastname: Kim
authors.forename: Yong-Seung
authors.initials: YS
authors.lastname: Hwang
authors.forename: June-Key
authors.initials: JK
authors.lastname: Chung
authors.forename: Myung Chul
authors.initials: MC
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001931:Brain Mapping; D002648:Child; D003937:Diagnosis, Differential; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D007839:Functional Laterality; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography; D011336:Probability; D019690:Technetium Tc 99m Exametazime; D014055:Tomography, Emission-Computed / Q000379:methods; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019788:Fluorodeoxyglucose F18; D019690:Technetium Tc 99m Exametazime