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The Added Value of [18F]‐Fluoro‐D‐deoxyglucose Positron Emission Tomography in Screening for Temporal Lobe Epilepsy Surgery
Author(s) -
Uijl Sabine G.,
Leijten Frans S. S.,
Arends Johan B. A. M.,
Parra Jaime,
Van Huffelen Alexander C.,
Moons Karel G. M.
Publication year - 2007
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2007.01197.x
Subject(s) - positron emission tomography , epilepsy , medicine , magnetic resonance imaging , temporal lobe , electroencephalography , epilepsy surgery , ictal , nuclear medicine , radiology , psychiatry
SummaryPurpose: [18F]‐Fluoro‐ d ‐deoxyglucose positron emission tomography (FDG‐PET) is an expensive, invasive, and not widely available technique used in the presurgical evaluation of temporal lobe epilepsy. We assessed its added value to the decision‐making process in relation to other commonly used tests.Methods: In a retrospective study of a large series of consecutive patients referred to the national Dutch epilepsy surgery program between 1996 and 2002, the contribution of FDG‐PET, magnetic resonance imaging (MRI), and video‐electroencephalogram (video‐EEG) monitoring findings, alone or in combination, to the decision whether to perform surgery was investigated. The impact of FDG‐PET was quantified by comparing documented decisions concerning surgery before and after FDG‐PET results.Results: Of 469 included patients, 110 (23%) underwent FDG‐PET. In 78 of these patients (71%), FDG‐PET findings led clinicians to change the decision they had made based on MRI and video‐EEG monitoring findings. In 17% of all referred patients, the decision regarding surgical candidacy was based on FDG‐PET findings. FDG‐PET was most useful when previous MRI results were normal (p < 0.0001) or did not show unilateral temporal abnormalities (p < 0.0001), or when ictal EEG results were not consistent with MRI findings (p < 0.0001) or videotaped seizure semiology (p = 0.027). The positive and negative predictive values for MRI and video‐EEG monitoring, which ranged from 0.48 to 0.67, were improved to 0.62 to 0.86 in combination with FDG‐PET.Conclusions: In patients referred for TLE surgery, FDG‐PET findings can form the basis for deciding whether a patient is eligible for surgery, and especially when MRI or video‐EEG monitoring are nonlocalizing.