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18 F ‐ FCWAY and 18 F‐FDG PET in MRI‐negative temporal lobe epilepsy
Author(s) -
Liew Clarissa J.,
Lim YoungMin,
Bonwetsch Robert,
Shamim Sadat,
Sato Susumu,
ReevesTyer Patricia,
Herscovitch Peter,
Dustin Irene,
Bagic Anto,
Giovacchini Giampiero,
Theodore William H.
Publication year - 2009
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.1528-1167.2008.01789.x
Subject(s) - temporal lobe , positron emission tomography , nuclear medicine , epilepsy , electroencephalography , medicine , hippocampus , magnetic resonance imaging , fusiform gyrus , radiology , functional magnetic resonance imaging , psychiatry
Summary Background: Positron emission tomography (PET) with 18 F‐fluorodeoxyglucose (FDG) shows widespread hypometabolism even in temporal lobe epilepsy (TLE) patients with mesial temporal foci. 18 F‐ trans ‐4‐fluoro‐ N ‐2‐[4‐(2‐methoxyphenyl) piperazin‐1‐yl]ethyl‐ N ‐(2‐pyridyl)cyclohexane carboxamide ( 18 F‐FCWAY) PET may show more specific 5‐HT 1A ‐receptor binding reduction in seizure initiation than in propagation regions. 18 FCWAY PET might be valuable for detecting epileptic foci, and distinguishing mesial from lateral temporal foci in MRI‐negative patients with TLE. Methods: We performed 18 F ‐ FCWAY‐PET and 18 F‐FDG‐PET in 12 MRI‐negative TLE patients who had had either surgery or subdural electrode recording, and 15 healthy volunteers. After partial volume correction for brain atrophy, free fraction‐corrected volume of distribution (V/f1) measurement and asymmetry indices (AIs) were computed. We compared 18 F ‐ FCWAY‐PET and 18 F‐FDG‐PET results with scalp video electroencephalography (EEG), invasive EEG, and surgical outcome. Results: Mean 18 F ‐ FCWAY V/f1, compared with normal controls, was decreased significantly in fusiform gyrus, hippocampus, and parahippocampus ipsilateral to epileptic foci, and AIs were significantly greater in hippocampus, parahippocampus, fusiform gyrus, amygdala, and inferior temporal regions. Eleven patients had clearly lateralized epileptogenic zones. Nine had congruent, and two nonlateralized, 18 F‐FCWAY PET. One patient with bitemporal seizure onset had nonlateralized 18 F‐FCWAY‐PET. 18 F‐FDG‐PET showed congruent hypometabolism in 7 of 11 EEG‐lateralized patients, bilateral hypometabolic regions in one, contralateral hypometabolism in one, as well as lateralized hypometabolism in the patient with bitemporal subdural seizure onset. Patients with mesial temporal foci tended to have lower superior and midtemporal 18 F‐FCWAY V/f1 binding AI than those with lateral or diffuse foci. Conclusion: 18 F‐FCWAY‐PET can detect reduced binding in patients with normal MRI, and may be more accurate than 18 F ‐ FDG‐PET.