Presurgical evaluation of pediatric epilepsy patients prior to hemispherotomy: the prognostic value of18F-FDG PET.
OBJECTIVE The objective of this study was to investigate whether fluorine-18 fluorodeoxyglucose PET (18F-FDG PET) can help to predict seizure outcome after hemispherotomy and therefore may be useful in decision making and patient selection. METHODS Children and adolescents less than 18 years of age who underwent18F-FDG PET studies during presurgical evaluation prior to hemispherotomy and had follow-up data of at least 12 months after surgery were included. Seizure outcome was classified according to the recommendations of the International League Against Epilepsy. PET data were reevaluated by two specialists in nuclear medicine blinded to clinical data and to MRI. MRI studies were also reinterpreted visually by an experienced neuroradiologist blinded to clinical data and PET findings. RESULTS Thirty-five patients (17 girls) with a median age of 5 years (range 0.4-17.8 years) were evaluable. Of the 35 patients, 91.4% were seizure free after surgery, including 100% of those with unilateral18F-FDG-PET hypometabolism compared with only 75% of those with bilateral hypometabolism. With respect to MRI, seizure freedom after surgery was observed in 96.4% of the patients with unilateral lesions compared with only 71.4% in those with bilateral MRI lesions. The best seizure outcomes were noted in patients with unilateral findings in both PET and MRI (100% seizure freedom) whereas only 50% of those with bilateral findings in both imaging techniques were seizure free. Furthermore, 100% of the patients with unilateral PET hypometabolism and bilateral MRI findings were also seizure free, but only 87.5% of those with bilateral PET hypometabolism and unilateral MRI findings. CONCLUSIONS According to these results, candidate selection for hemispherotomy can be optimized by the use of18F-FDG PET as part of a multimodal presurgical evaluation program, especially in patients with inconsistent (bilateral) MRI findings.
Departments of 1 Biomedical Imaging and Image-Guided Therapy.
Tatjana
T
Traub-Weidinger
Pediatrics, and.
Philip
P
Weidinger
Pediatrics, and.
Gundrun
G
Gröppel
Departments of 1 Biomedical Imaging and Image-Guided Therapy.
Georgios
G
Karanikas
Departments of 1 Biomedical Imaging and Image-Guided Therapy.
Wolfgang
W
Wadsak
Departments of 1 Biomedical Imaging and Image-Guided Therapy.
Gregor
G
Kasprian
Neurosurgery, Medical University of Vienna, Austria.
Christian
C
Dorfer
Pediatrics, and.
Anastasia
A
Dressler
Pediatrics, and.
Angelika
A
Muehlebner
Departments of 1 Biomedical Imaging and Image-Guided Therapy.
Marcus
M
Hacker
Neurosurgery, Medical University of Vienna, Austria.
Thomas
T
Czech
Pediatrics, and.
Martha
M
Feucht
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D055815:Young Adult
D019788:Fluorodeoxyglucose F18
18F-FDG; 18F-FDG-PET = fluorine-18 fluorodeoxyglucose PET; EEG = electroencephalography; ILAE = International League Against Epilepsy; MCD = malformations of cortical development; PET; drug-resistant epilepsy; hemispherotomy