title: Yield of MRI, high-density electric source imaging (HD-ESI), SPECT and PET in epilepsy surgery candidates.
abstract: OBJECTIVE
  Preoperative workup aims at localizing the epileptogenic focus to achieve postoperative seizure-freedom. We studied the predictive value of non-invasive techniques, i.e. structural magnetic resonance imaging [MRI], high-density electric source imaging [HD-ESI] and metabolic imaging (positron emission tomography [PET]; single-photon emission computed tomography [SPECT]), in surgically treated patients.
  
  
  METHODS
  A prospective study of 190 epileptic operated patients, with >12 months follow-up and analyzed with state-of-the-art algorithms. 58 patients underwent all techniques. We computed sensitivity, specificity, predictive value and diagnostic odds ratio (OR) in relation to postoperative outcome.
  
  
  RESULTS
  Of 190 patients, 148 (77.9%) were seizure-free at follow-up. Resection of the epileptogenic focus was associated with favorable postsurgical outcome (p<0.05). Among 58 patients who underwent all tests, only MRI and HD-ESI were favorable outcome predictors (MRI: OR 10.9, p=0.004; HD-ESI: OR 13.1, p=0.004). Patients with concordant structural MRI and HD-ESI results had 92.3% (24/26) probability of favorable outcome. When both results were negative, probability was 0% (0/5); and when they disagreed, it was 63.0% (17/27).
  
  
  CONCLUSIONS
  Combination of MRI and HD-ESI offered the highest predictive value for postoperative seizure-freedom.
  
  
  CONCLUSIONS
  This finding highlights the added value of HD-ESI in the presurgical workup, in particular in combination with an informative MRI.
authors.affiliation: Department of Neurology, Geneva University Hospitals, Switzerland.
authors.forename: Agustina M
authors.initials: AM
authors.lastname: Lascano
authors.affiliation: Division of Clinical Epidemiology, Geneva University Hospitals, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Perneger
authors.affiliation: Department of Neurology, Geneva University Hospitals, Switzerland.
authors.forename: Serge
authors.initials: S
authors.lastname: Vulliemoz
authors.affiliation: Department of Neurology, Geneva University Hospitals, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Spinelli
authors.affiliation: Department of Nuclear Medicine, Geneva University Hospitals, Switzerland.
authors.forename: Valentina
authors.initials: V
authors.lastname: Garibotto
authors.affiliation: Child and Adolescent Department, Geneva University Hospitals, Switzerland.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Korff
authors.affiliation: Department of Neuroradiology, Geneva University Hospitals, Switzerland.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Vargas
authors.affiliation: Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, Campus Biotech, University of Geneva, Switzerland.
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Michel
authors.affiliation: Department of Neurology, Geneva University Hospitals, Switzerland. Electronic address: Margitta.Seeck@hcuge.ch.
authors.forename: Margitta
authors.initials: M
authors.lastname: Seeck
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D057234:Preoperative Period; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Drug-resistant epilepsy; Non-invasive procedures; Presurgical evaluation; Seizure-freedom; Temporal lobe epilepsy