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PET/MRI and PET/MRI/SISCOM coregistration in the presurgical evaluation of refractory focal epilepsy.
Epilepsy Res 2015; 111:1-9ER

Abstract

We aimed to investigate the usefulness of coregistration of positron emission tomography (PET) and magnetic resonance imaging (MRI) findings (PET/MRI) and of coregistration of PET/MRI with subtraction ictal single-photon emission computed tomography (SPECT) coregistered to MRI (SISCOM) (PET/MRI/SISCOM) in localizing the potential epileptogenic zone in patients with drug-resistant epilepsy. We prospectively included 35 consecutive patients with refractory focal epilepsy whose presurgical evaluation included a PET study. Separately acquired PET and structural MRI images were coregistered for each patient. When possible, ictal SPECT and SISCOM were obtained and coregistered with PET/MRI. The potential location of the epileptogenic zone determined by neuroimaging was compared with the seizure onset zone determined by long-term video-EEG monitoring and with invasive EEG studies in patients who were implanted. Structural MRI showed no lesions in 15 patients. In these patients, PET/MRI coregistration showed a hypometabolic area in 12 (80%) patients that was concordant with seizure onset zone on EEG in 9. In 7 patients without MRI lesions, PET/MRI detected a hypometabolism that was undetected on PET alone. SISCOM, obtained in 25 patients, showed an area of hyperperfusion concordant with the seizure onset zone on EEG in 7 (58%) of the 12 of these patients who had normal MRI findings. SISCOM hyperperfusion was less extensive than PET hypometabolism. A total of 19 patients underwent surgery; 11 of these underwent invasive-EEG monitoring and the seizure onset zone was concordant with PET/MRI in all cases. PET/MRI/SISCOM coregistration, performed in 4 of these patients, was concordant in 3 (75%). After epilepsy surgery, 13 (68%) patients are seizure-free after a mean follow-up of 4.5 years. PET/MRI and PET/MRI/SISCOM coregistration are useful for determining the potential epileptogenic zone and thus for planning invasive EEG studies and surgery more precisely, especially in patients without lesions on MRI.

Authors+Show Affiliations

Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Neurology Unit, Medical Division, Hospital Plató, Barcelona, Spain. Electronic address: santiago.fernandez@hospitalplato.com.Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: DONAIRE@clinic.ub.es.Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: eulalia.seresroig@epfl.ch.Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: SETOAIN@clinic.ub.es.Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: BARGALLO@clinic.ub.es.Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: CFALCON@clinic.ub.es.Pediatric Epilepsy Unit, Hospital Sant Joan de Déu, Barcelona, Spain. Electronic address: Sanmarti@hsjdbcn.org.Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: iratxe.maestrosaiz@osakidetza.net.Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: JRUMIA@clinic.ub.es.Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: LPINTOR@clinic.ub.es.Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: BOGET@clinic.ub.es.Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: JAPARICI@clinic.ub.es.Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain. Electronic address: MCARRENO@clinic.ub.es.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25769367

Citation

Fernández, S, et al. "PET/MRI and PET/MRI/SISCOM Coregistration in the Presurgical Evaluation of Refractory Focal Epilepsy." Epilepsy Research, vol. 111, 2015, pp. 1-9.
Fernández S, Donaire A, Serès E, et al. PET/MRI and PET/MRI/SISCOM coregistration in the presurgical evaluation of refractory focal epilepsy. Epilepsy Res. 2015;111:1-9.
Fernández, S., Donaire, A., Serès, E., Setoain, X., Bargalló, N., Falcón, C., ... Carreño, M. (2015). PET/MRI and PET/MRI/SISCOM coregistration in the presurgical evaluation of refractory focal epilepsy. Epilepsy Research, 111, pp. 1-9. doi:10.1016/j.eplepsyres.2014.12.011.
Fernández S, et al. PET/MRI and PET/MRI/SISCOM Coregistration in the Presurgical Evaluation of Refractory Focal Epilepsy. Epilepsy Res. 2015;111:1-9. PubMed PMID: 25769367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - PET/MRI and PET/MRI/SISCOM coregistration in the presurgical evaluation of refractory focal epilepsy. AU - Fernández,S, AU - Donaire,A, AU - Serès,E, AU - Setoain,X, AU - Bargalló,N, AU - Falcón,C, AU - Sanmartí,F, AU - Maestro,I, AU - Rumià,J, AU - Pintor,L, AU - Boget,T, AU - Aparicio,J, AU - Carreño,M, Y1 - 2015/01/03/ PY - 2014/08/02/received PY - 2014/11/19/revised PY - 2014/12/12/accepted PY - 2015/3/15/entrez PY - 2015/3/15/pubmed PY - 2015/12/15/medline KW - Multimodal imaging KW - PET/MRI coregistration KW - Refractory epilepsy KW - SISCOM SP - 1 EP - 9 JF - Epilepsy research JO - Epilepsy Res. VL - 111 N2 - We aimed to investigate the usefulness of coregistration of positron emission tomography (PET) and magnetic resonance imaging (MRI) findings (PET/MRI) and of coregistration of PET/MRI with subtraction ictal single-photon emission computed tomography (SPECT) coregistered to MRI (SISCOM) (PET/MRI/SISCOM) in localizing the potential epileptogenic zone in patients with drug-resistant epilepsy. We prospectively included 35 consecutive patients with refractory focal epilepsy whose presurgical evaluation included a PET study. Separately acquired PET and structural MRI images were coregistered for each patient. When possible, ictal SPECT and SISCOM were obtained and coregistered with PET/MRI. The potential location of the epileptogenic zone determined by neuroimaging was compared with the seizure onset zone determined by long-term video-EEG monitoring and with invasive EEG studies in patients who were implanted. Structural MRI showed no lesions in 15 patients. In these patients, PET/MRI coregistration showed a hypometabolic area in 12 (80%) patients that was concordant with seizure onset zone on EEG in 9. In 7 patients without MRI lesions, PET/MRI detected a hypometabolism that was undetected on PET alone. SISCOM, obtained in 25 patients, showed an area of hyperperfusion concordant with the seizure onset zone on EEG in 7 (58%) of the 12 of these patients who had normal MRI findings. SISCOM hyperperfusion was less extensive than PET hypometabolism. A total of 19 patients underwent surgery; 11 of these underwent invasive-EEG monitoring and the seizure onset zone was concordant with PET/MRI in all cases. PET/MRI/SISCOM coregistration, performed in 4 of these patients, was concordant in 3 (75%). After epilepsy surgery, 13 (68%) patients are seizure-free after a mean follow-up of 4.5 years. PET/MRI and PET/MRI/SISCOM coregistration are useful for determining the potential epileptogenic zone and thus for planning invasive EEG studies and surgery more precisely, especially in patients without lesions on MRI. SN - 1872-6844 UR - https://www.unboundmedicine.com/medline/citation/25769367/PET/MRI_and_PET/MRI/SISCOM_coregistration_in_the_presurgical_evaluation_of_refractory_focal_epilepsy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0920-1211(14)00372-6 DB - PRIME DP - Unbound Medicine ER -