Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy

• Published in: Annals of neurology Vol. 42; no. 6; p. 829
• Main Authors: Knowlton, R C, Laxer, K D, Ende, G, Hawkins, R A, Wong, S T, Matson, G B, Rowley, H A, Fein, G, Weiner, M W
• Format: Journal Article
• Language: English
• Published: United States 01.12.1997
• Subjects: Adult; Case-Control Studies; Electroencephalography; Epilepsy, Temporal Lobe - diagnostic imaging; Epilepsy, Temporal Lobe - pathology; Epilepsy, Temporal Lobe - physiopathology; Epilepsy, Temporal Lobe - surgery; Female; Fluorodeoxyglucose F18; Functional Laterality; Hippocampus - diagnostic imaging; Hippocampus - pathology; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Tomography, Emission-Computed - methods; Treatment Outcome
• ISSN: 0364-5134
• DOI: 10.1002/ana.410420603

The purpose of this study was to compare 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), hippocampal volumetry (HV), T2 relaxometry, and proton magnetic resonance spectroscopic imaging (1H-MRSI) in the presurgical neuroimaging lateralization of patients with nonlesional, electroencephalogram (EEG)-defined unilateral temporal lobe epilepsy (TLE). Twenty-five patients were prospectively studied, along with age-matched controls. T2 relaxometry examinations were performed in 13 patients. Comparison of FDG-PET, HV, and 1H-MRSI was possible in 23 patients. FDG-PET lateralized 87% of patients, HV 65%, N-acetyl aspartate (NAA)/(choline [Cho] + creatine [Cr]) 61%, and [NAA] 57%. Combined HV and NAA/(Cho + Cr) results lateralized 83% of the patients, a value similar to PET. Of 10 patients with normal magnetic resonance imaging (MRI) scans, 2 were lateralized with HV, 6 with FDG-PET, 4 with NAA/(Cho + Cr), and 3 with [NAA]. T2 relaxometry lateralized no patients without hippocampal atrophy. Bilateral abnormality was present in 29 to 33% of patients with 1H-MRSI measures and 17% with HV. Only hippocampal atrophy correlated with postoperative seizure-free outcome. FDG-PET remains the most sensitive imaging method to correlate with EEG-lateralized TLE. Both FDG-PET and 1H-MRSI can lateralize patients with normal MRI, but only the presence of relative unilateral hippocampal atrophy is predictive of seizure-free outcome. Bilaterally abnormal MRI and 1H-MRSI measures do not preclude good surgical outcome.