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. 2012 Sep;53(9):1375-82.
doi: 10.2967/jnumed.112.103093. Epub 2012 Jul 10.

PET of serotonin 1A receptors and cerebral glucose metabolism for temporal lobectomy

William H Theodore  1 , Ashley R Martinez, Omar I Khan, Clarissa J Liew, Sungyoung Auh, Irene M Dustin, John Heiss, Susumu Sato
Affiliations

PET of serotonin 1A receptors and cerebral glucose metabolism for temporal lobectomy

William H Theodore et al. J Nucl Med. 2012 Sep.

Abstract

The objective of this study was to compare 5-hydroxytryptamine receptor 1A (5-HT(1A)) PET with cerebral metabolic rate of glucose (CMRglc) PET for temporal lobectomy planning.

Methods: We estimated 5-HT(1A) receptor binding preoperatively with (18)F-trans-4-fluoro-N-2-[4-(2-methoxyphenyl) piperazin-1-yl]ethyl-N-(2-pyridyl) cyclohexane carboxamide ((18)F-FCWAY) PET and CMRglc measurement with (18)F-FDG in regions drawn on coregistered MRI after partial-volume correction in 41 patients who had anterior temporal lobectomy with at least a 1-y follow-up. Surgery was tailored to individual preresection evaluations and intraoperative electrocorticography. Mean regional asymmetry values and the number of regions with asymmetry exceeding 2 SDs in 16 healthy volunteers were compared between seizure-free and non-seizure-free patients. (18)F-FCWAY but not (18)F-FDG and MRI data were masked for surgical decisions and outcome assessment.

Results: Twenty-six of 41 (63%) patients seizure-free since surgery had significantly different mesial temporal asymmetries, compared with 15 non-seizure-free patients for both (18)F-FCWAY (F(1,39) = 5.87; P = 0.02) and (18)F-FDG PET (F(1,38) = 5.79; P = 0.021). The probability of being seizure-free was explained by both (18)F-FDG and (18)F-FCWAY PET, but not MRI, with a significant additional (18)F-FCWAY effect (chi(2)(2) = 9.8796; P = 0.0072) after the probability of being seizure-free was explained by (18)F-FDG. Although MRI alone was not predictive, any combination of 2 lateralizing imaging studies was highly predictive of seizure freedom.

Conclusion: Our study provides class III evidence that both 5-HT(1A) receptor PET and CMRglc PET can contribute to temporal lobectomy planning. Additional studies should explore the potential for temporal lobectomy based on interictal electroencephalography and minimally invasive imaging studies.

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Figures

FIGURE 1
FIGURE 1
A 44-y-old patient with 9-y history of intractable seizures; surface electroencephalography revealed left temporal seizure onset. (A) Normal MRI result. (B) Normal 18F-FDG PET result. (C) 18F-FCWAY PET shows left temporal binding decrease.
See this image and copyright information in PMC

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