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. 2023 Jul 3:10:1180541.
doi: 10.3389/fmed.2023.1180541. eCollection 2023.

Delayed 18F-FDG PET imaging provides better metabolic asymmetry in potential epileptogenic zone in temporal lobe epilepsy

Yang Hong  1 , Chang Fu  2 , Yazhou Xing  3 , James Tao  4 , Ting Zhao  5 , Na Wang  5 , Yanan Chen  5 , Yang You  2 , Zhe Ren  5 , Yingxing Hong  1 , Qi Wang  5 , Yibo Zhao  5 , Yang Yang  6 , Jiewen Zhang  5 , Junling Xu  2 , Xiong Han  1   5
Affiliations

Delayed 18F-FDG PET imaging provides better metabolic asymmetry in potential epileptogenic zone in temporal lobe epilepsy

Yang Hong et al. Front Med (Lausanne). .

Abstract

Objective: To investigate the value of 18F-FDG positron emission tomography/computed tomography (PET/CT) two time point imaging for the identification of the potential epileptogenic zone (EZ) in temporal lobe epilepsy (TLE).

Methods: Fifty-two patients with TLE were prospectively enrolled in the 18F-FDG PET/CT two time point imaging study. The early imaging was obtained approximately 40 min (43.44 ± 18.04 min) after 18F-FDG injection, and the delayed imaging was obtained about 2 to 3 h (160.46 ± 28.70 min) after the injection. Visual and semi-quantitative analysis of 18F-FDG uptake were performed at the two time points in EZ and contralateral symmetrical region. The mean standardized uptake value (SUVmean) of EZ and contralateral symmetrical region was calculated to determine the asymmetry index (AI) of the early and delayed images, as well as in the MRI positive and negative patient groups.

Results: Semi-quantitative analysis demonstrated that AI of the early and delayed 18F-FDG PET/CT images was 13.47 ± 6.10 and 16.43 ± 6.66, respectively. The ΔAI was 2.95 ± 3.05 in 52 TLE patients between the two time points. The AI of the EZ was significantly elevated in delayed images compared to the early images (p < 0.001). The AI of delayed imaging was also significantly elevated compared to the early imaging in both MRI positive (ΔAI = 2.81 ± 2.54, p < 0.001) and MRI negative (ΔAI = 3.21 ± 3.91, p < 0.003) groups, and more pronounced in MRI negative group. Visual analysis also showed that the delayed imaging appeared to be superior to the early imaging for identification of potential EZ.

Conclusion: Delayed 18F-FDG PET imaging provided significantly better than the early imaging in the identification of potential EZ, which can be valuable during epilepsy pre-surgical evaluation in patients with TLE.

Keywords: 18F-FDG PET/CT; asymmetry index; potential epileptogenic zone; temporal lobe epilepsy; two time point imaging.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
SUVmean changes of epileptogenic zone and contralateral regional at dual time points. EZ, epileptogenic zone.
Figure 2
Figure 2
Paired box line plots of AI of EZ in TLE patients. (A) AI changes in 52 TLE cases. (B) AI changes in MRI-positive group. (C) MRI-negative group. AI, asymmetry index.
Figure 3
Figure 3
ΔAIs of 52 patients with TLE. Orange dots indicate patients with elevated AI and green dots indicate patients with decreased AI in delayed PET imaging.
Figure 4
Figure 4
Identification of epileptogenic zones at dual time points on PET images in 4 cases. Case a (patient 6): EZ localized to the left mesial temporal lobe, two time point AIs of 14.92 (early time) and 23.64 (delayed time). Case b (patient 30): EZ localized to the right mesial temporal lobe, two time point AIs of 10.64 (early time) and 16.04 (delayed time). Case c (patient 32): EZ localized to the right lateral temporal pole, two time point AIs of 23.66 (early time) and 28.77 (delayed time). Case d (patient number 38): EZ localized to the left posterior temporal region, two time point AIs of 10.7 (early time) and 18.87 (delayed time).
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