title: FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy.
abstract: OBJECTIVE
  Patients with cortical dysplasia (CD) are difficult to treat because the MRI abnormality may be undetectable. This study determined whether fluorodeoxyglucose (FDG)-PET/MRI coregistration enhanced the recognition of CD in epilepsy surgery patients.
  
  
  METHODS
  Patients from 2004-2007 in whom FDG-PET/MRI coregistration was a component of the presurgical evaluation were compared with patients from 2000-2003 without this technique. For the 2004-2007 cohort, neuroimaging and clinical variables were compared between patients with mild Palmini type I and severe Palmini type II CD.
  
  
  RESULTS
  Compared with the 2000-2003 cohort, from 2004-2007 more CD patients were detected, most had type I CD, and fewer cases required intracranial electrodes. From 2004-2007, 85% of type I CD cases had normal non-University of California, Los Angeles (UCLA) MRI scans. UCLA MRI identified CD in 78% of patients, and 37% of type I CD cases had normal UCLA scans. EEG and neuroimaging findings were concordant in 52% of type I CD patients, compared with 89% of type II CD patients. FDG-PET scans were positive in 71% of CD cases, and type I CD patients had less hypometabolism compared with type II CD patients. Postoperative seizure freedom occurred in 82% of patients, without differences between type I and type II CD cases.
  
  
  CONCLUSIONS
  Incorporating fluorodeoxyglucose-PET/MRI coregistration into the multimodality presurgical evaluation enhanced the noninvasive identification and successful surgical treatment of patients with cortical dysplasia (CD), especially for the 33% of patients with nonconcordant findings and those with normal MRI scans from mild type I CD.
authors.affiliation: Reed Neurological Research Center, 710 Westwood Plaza, Room 2123, Los Angeles, CA 90095-1769, USA.
authors.forename: N
authors.initials: N
authors.lastname: Salamon
authors.forename: J
authors.initials: J
authors.lastname: Kung
authors.forename: S J
authors.initials: SJ
authors.lastname: Shaw
authors.forename: J
authors.initials: J
authors.lastname: Koo
authors.forename: S
authors.initials: S
authors.lastname: Koh
authors.forename: J Y
authors.initials: JY
authors.lastname: Wu
authors.forename: J T
authors.initials: JT
authors.lastname: Lerner
authors.forename: R
authors.initials: R
authors.lastname: Sankar
authors.forename: W D
authors.initials: WD
authors.lastname: Shields
authors.forename: J
authors.initials: J
authors.lastname: Engel
authors.forename: I
authors.initials: I
authors.lastname: Fried
authors.forename: H
authors.initials: H
authors.lastname: Miyata
authors.forename: W H
authors.initials: WH
authors.lastname: Yong
authors.forename: H V
authors.initials: HV
authors.lastname: Vinters
authors.forename: G W
authors.initials: GW
authors.lastname: Mathern
mesh_terms: D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18