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

• Published in: Journal of Nuclear Medicine Vol. 53; no. 9; pp. 1375 - 1382
• Main Authors: Theodore, William H, Martinez, Ashley R, Khan, Omar I, Liew, Clarissa J, Auh, Sungyoung, Dustin, Irene M, Heiss, John, Sato, Susumu
• Format: Journal Article
• Language: English
• Published: United States Society of Nuclear Medicine 01.09.2012
• Subjects: Adult; Brain; Cyclohexanes; Electroencephalography; Epilepsy; Female; Fluorodeoxyglucose F18; Glucose - metabolism; Humans; Magnetic Resonance Imaging; Male; Neurosurgical Procedures; Piperazines; Positron-Emission Tomography; Receptor, Serotonin, 5-HT1A - metabolism; Retrospective Studies; Serotonin 5-HT1 Receptor Antagonists; Studies; Temporal Lobe - diagnostic imaging; Temporal Lobe - metabolism; Temporal Lobe - surgery
• ISSN: 0161-5505; 1535-5667; 2159-662X
• DOI: 10.2967/jnumed.112.103093

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. 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. 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. 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.