title: The predictive value of FDG-PET with 3D-SSP for surgical outcomes in patients with temporal lobe epilepsy.
abstract: OBJECTIVE
  We retrospectively evaluated the diagnostic value of (18)F-2-fluorodeoxy-d-glucose positron emission tomography (FDG-PET) with statistical analysis for the foci detection and predictive utility for postsurgical seizure outcome of patients with mesial temporal lobe epilepsy (mTLE).
  
  
  METHODS
  We evaluated 40 patients who were diagnosed mTLE and underwent selective amygdalohippocampectomy (SAH) or anterior temporal lobectomy (ATL) in our institute. Preoperative interictal FDG-PET with statistical analysis using three-dimensional stereotactic surface projection (3D-SSP) was detected with several clinical data including seizure semiology, MRI, scalp electroencephalography, surgical procedure with SAH or ATL and postsurgical outcome. The region of interest (ROI) was defined on 'Hippocampus & Amygdala', 'Parahippocampal gyrus & Uncus', 'T1 & T2', and 'T3 & Fusiform gyrus'. We obtained the ratio of hypometabolism difference (RHD) by 3D-SSP, and evaluated the relation among hypometabolic extent, surgical outcome and surgical procedure.
  
  
  RESULTS
  The RHD in each ROIs ipsilateral to operative side was significantly higher than that of contralateral side in good outcome group. Hypometabolism of 'Hippocampus & Amygdala' was most reliable prognostic factor. Patients of discordant with presurgical examinations hardly showed obvious lateralized hypometabolism. Nevertheless, when they have significantly high RHD in mesial temporal lobe, good surgical outcome was expected. There was not significant difference of RHD distribution between SAH and ATL in good outcome group.
  
  
  CONCLUSIONS
  Significant hypometabolism in mesial temporal lobe on FDG-PET with 3D-SSP is useful to predict good surgical outcome for patients with mTLE, particularly in discordant patients with hypometabolism in mesial temporal structure. However, FDG-PET is not indicative of surgical procedure.
authors.affiliation: Department of Neurosurgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. Electronic address: thigo@jutendo.ac.jp.
authors.forename: Takuma
authors.initials: T
authors.lastname: Higo
authors.affiliation: Department of Neurosurgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Sugano
authors.affiliation: Department of Neurosurgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
authors.forename: Madoka
authors.initials: M
authors.lastname: Nakajima
authors.affiliation: Department of Neurosurgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
authors.forename: Kostadin
authors.initials: K
authors.lastname: Karagiozov
authors.affiliation: Department of Neurosurgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iimura
authors.affiliation: PET/CT Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University, 3-3-20 Shinsuna, Koto-ku, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: PET/CT Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University, 3-3-20 Shinsuna, Koto-ku, Tokyo, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Arai
mesh_terms: D000293:Adolescent; D000328:Adult; D000679:Amygdala / Q000601:surgery; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D002648:Child; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006624:Hippocampus / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 3D-SSP; FDG-PET; Temporal lobe epilepsy