FDG-PET improves surgical outcome in negative MRI Taylor-type focal cortical dysplasias.

Abstract:

OBJECTIVE:To determine the diagnostic accuracy and prognostic value of ¹⁸FDG-PET in a recent series of patients operated for intractable partial epilepsy associated with histologically proven Taylor-type focal cortical dysplasia (TTFCD) and negative MRI. METHODS:Of 23 consecutive patients (12 male, 7-38 years old) with negative 1.5-Tesla MRI, 10 exhibited subtle nonspecific abnormalities (e.g., unusual sulcus depth or gyral pattern) and the 13 others had strictly normal MRI. FDG-PET was analyzed both visually after coregistration on MRI and using SPM5 software. Metabolic data were compared with the epileptogenic zone (EZ) determined by stereo-EEG (SEEG) and surgical outcome. RESULTS:Visual PET analysis disclosed a focal or regional hypometabolism in 18 cases (78%) corresponding to a single gyrus (n = 9) or a larger cortical region (n = 9). PET/MRI coregistration detected a partially hypometabolic gyrus in 4 additional cases. SPM5 PET analysis (n = 18) was concordant with visual analysis in 13 cases. Location of PET abnormalities was extratemporal in all cases, involving eloquent cortex in 15 (65%). Correlations between SEEG, PET/MRI, and histologic findings (n = 20) demonstrated that single hypometabolic gyri (n = 11) corresponded to EZ and TTFCD, which was localized at the bottom of the sulcus. Larger hypometabolic areas (n = 9) also included the EZ and the dysplastic cortex but were more extensive. Following limited cortical resection (mean follow-up 4 years), seizure freedom without permanent motor deficit was obtained in 20/23 patients (87%). CONCLUSIONS:¹⁸FDG-PET coregistered with MRI is highly sensitive to detect TTFCD and greatly improves diagnosis and surgical prognosis of patients with negative MRI.

journal_name

Neurology

journal_title

Neurology

authors

Chassoux F,Rodrigo S,Semah F,Beuvon F,Landre E,Devaux B,Turak B,Mellerio C,Meder JF,Roux FX,Daumas-Duport C,Merlet P,Dulac O,Chiron C

doi

10.1212/WNL.0b013e31820203a9

subject

Has Abstract

pub_date

2010-12-14 00:00:00

pages

2168-75

issue

24

eissn

0028-3878

issn

1526-632X

pii

75/24/2168

journal_volume

75

pub_type

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