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Xiao L, Yang J, Zhu H, Zhou M, Li J, Liu D, Tang Y, Feng L, Hu S. [ 18F]SynVesT-1 and [ 18F]FDG quantitative PET imaging in the presurgical evaluation of MRI-negative children with focal cortical dysplasia type II. Eur J Nucl Med Mol Imaging 2024; 51:1651-1661. [PMID: 38182838 DOI: 10.1007/s00259-024-06593-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/01/2024] [Indexed: 01/07/2024]
Abstract
PURPOSE MRI-negative children with focal cortical dysplasia type II (FCD II) are one of the most challenging cases in surgical epilepsy management. We aimed to utilize quantitative positron emission tomography (QPET) analysis to complement [18F]SynVesT-1 and [18F]FDG PET imaging and facilitate the localization of epileptogenic foci in pediatric MRI-negative FCD II patients. METHODS We prospectively enrolled 17 MRI-negative children with FCD II who underwent [18F]SynVesT-1 and [18F]FDG PET before surgical resection. The QPET scans were analyzed using statistical parametric mapping (SPM) with respect to healthy controls. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of [18F]SynVesT-1 PET, [18F]FDG PET, [18F]SynVesT-1 QPET, and [18F]FDG QPET in the localization of epileptogenic foci were assessed. Additionally, we developed a multivariate prediction model based on dual trace PET/QPET assessment. RESULTS The AUC values of [18F]FDG PET and [18F]SynVesT-1 PET were 0.861 (sensitivity = 94.1%, specificity = 78.2%, PPV = 38.1%, NPV = 98.9%) and 0.908 (sensitivity = 82.4%, specificity = 99.2%, PPV = 93.3%, NPV = 97.5%), respectively. [18F]FDG QPET showed lower sensitivity (76.5%) and NPV (96.6%) but higher specificity (95.0%) and PPV (68.4%) than visual assessment, while [18F]SynVesT-1 QPET exhibited higher sensitivity (94.1%) and NPV (99.1%) but lower specificity (97.5%) and PPV (84.2%). The multivariate prediction model had the highest AUC value (AUC = 0.996, sensitivity = 100.0%, specificity = 96.6%, PPV = 81.0%, NPV = 100%). CONCLUSIONS The multivariate prediction model based on [18F]SynVesT-1 and [18F]FDG PET/QPET assessments holds promise in noninvasively identifying epileptogenic regions in MRI-negative children with FCD II. Furthermore, the combination of visual assessment and QPET may improve the sensitivity and specificity of diagnostic tests in localizing epileptogenic foci and achieving a preferable surgical outcome in MRI-negative FCD II.
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Affiliation(s)
- Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jinhui Yang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Karimzadeh A, Baradaran-Salimi K, Voges B, Apostolova I, Sauvigny T, Lanz M, Klutmann S, Stodieck S, Meyer PT, Buchert R. Short post-injection seizure duration is associated with reduced power of ictal brain perfusion SPECT to lateralize the seizure onset zone. EJNMMI Res 2024; 14:40. [PMID: 38630381 PMCID: PMC11024078 DOI: 10.1186/s13550-024-01095-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/13/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of the post-injection electrical seizure duration on the identification of the seizure onset zone (SOZ) in ictal brain perfusion SPECT in presurgical evaluation of drug-resistant epilepsy. METHODS 176 ictal SPECT performed with 99mTc-HMPAO (n = 140) or -ECD (n = 36) were included retrospectively. Visual interpretation of the SPECT images (together with individual MRI and statistical hyperperfusion maps) with respect to lateralization (right, left, none) and localization (temporal, frontal, parietal, occipital) of the SOZ was performed by 3 independent readers. Between-readers agreement was characterized by Fleiss' κ. An ictal SPECT was considered "lateralizing" if all readers agreed on right or left hemisphere. It was considered "localizing" if it was lateralizing and all readers agreed on the same lobe within the same hemisphere. The impact of injection latency and post-injection seizure duration on the proportion of lateralizing/localizing SPECT was tested by ANOVA with dichotomized (by the median) injection latency and post-injection seizure duration as between-subjects factors. RESULTS Median [interquartile range] (full range) of injection latency and post-injection seizure duration were 30 [24, 40] (3-120) s and 50 [27, 70] (-20-660) s, respectively. Fleiss' κ for lateralization of the SOZ was largest for the combination of early (< 30 s) injection and long (> 50 s) post-injection seizure duration (κ = 0.894, all other combinations κ = 0.659-0.734). Regarding Fleiss' κ for localization of the SOZ in the 141 (80.1%) lateralizing SPECT, it was largest for early injection and short post-injection seizure duration (κ = 0.575, all other combinations κ = 0.329-0.368). The proportion of lateralizing SPECT was lower with short compared to long post-injection seizure duration (estimated marginal means 74.3% versus 86.3%, p = 0.047). The effect was mainly driven by cases with very short post-injection seizure duration ≤ 10 s (53.8% lateralizing). Injection latency in the considered range had no significant impact on the proportion of lateralizing SPECT (p = 0.390). The proportion of localizing SPECT among the lateralizing cases did not depend on injection latency or post-injection seizure duration (p ≥ 0.603). CONCLUSIONS Short post-injection seizure duration is associated with a lower proportion of lateralizing cases in ictal brain perfusion SPECT.
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Affiliation(s)
- Amir Karimzadeh
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Kian Baradaran-Salimi
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Berthold Voges
- Department of Neurology and Epileptology, Protestant Hospital Alsterdorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Lanz
- Department of Neurology and Epileptology, Protestant Hospital Alsterdorf, Hamburg, Germany
| | - Susanne Klutmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Stefan Stodieck
- Department of Neurology and Epileptology, Protestant Hospital Alsterdorf, Hamburg, Germany
| | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Jin B, Xu J, Wang C, Wang S, Li H, Chen C, Ye L, He C, Cheng H, Zhang L, Wang S, Wang J, Aung T. Functional profile of perilesional gray matter in focal cortical dysplasia: an fMRI study. Front Neurosci 2024; 18:1286302. [PMID: 38318464 PMCID: PMC10838983 DOI: 10.3389/fnins.2024.1286302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Objectives We aim to investigate the functional profiles of perilesional gray matter (GM) in epileptic patients with focal cortical dysplasia (FCD) and to correlate these profiles with FCD II subtypes, surgical outcomes, and different antiseizure medications (ASMs) treatment response patterns. Methods Nine patients with drug-responsive epilepsy and 30 patients with drug-resistant epilepsy (11 were histologically confirmed FCD type IIa, 19 were FCD type IIb) were included. Individual-specific perilesional GM and contralateral homotopic GM layer masks were generated. These masks underwent a two-voxel (2 mm) dilation from the FCD lesion and contralateral homotopic region, resulting in 10 GM layers (20 mm). Layer 1, the innermost, progressed to Layer 10, the outermost. Amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) analyses were conducted to assess the functional characteristics of ipsilateral perilesional GM and contralateral homotopic GM. Results Compared to the contralateral homotopic GM, a significant reduction of ALFF was detected at ipsilateral perilesional GM layer 1 to 6 in FCD type IIa (after Bonferroni correction p < 0.005, paired t-test), whereas a significant decrease was observed at ipsilateral perilesional GM layer 1 to 2 in FCD type IIb (after Bonferroni correction p < 0.005, paired t-test). Additionally, a significant decrease of the ReHo was detected at ipsilateral perilesional GM layer 1 compared to the CHRs in FCD type IIb. Notably, complete resection of functional perilesional GM alterations did not correlate with surgical outcomes. Compared to the contralateral homotopic GM, a decreased ALFF in the ipsilateral perilesional GM layer was detected in drug-responsive patients, whereas decreased ALFF in the ipsilateral perilesional GM layer 1-6 and decreased ReHo at ipsilateral perilesional GM layer 1 were observed in drug-resistant patients (after Bonferroni correction p < 0.005, paired t-test). Conclusion Our findings indicate distinct functional profiles of perilesional GM based on FCD histological subtypes and ASMs' response patterns. Importantly, our study illustrates that the identified functional alterations in perilesional GM may not provide sufficient evidence to determine the epileptogenic boundary required for surgical resection.
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Affiliation(s)
- Bo Jin
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiahui Xu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chao Wang
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shan Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Li
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Chen
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linqi Ye
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenmin He
- Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Cheng
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lisan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jin Wang
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Thandar Aung
- Department of Neurology, Epilepsy Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Lang M, Colby S, Ashby-Padial C, Bapna M, Jaimes C, Rincon SP, Buch K. An imaging review of the hippocampus and its common pathologies. J Neuroimaging 2024; 34:5-25. [PMID: 37872430 DOI: 10.1111/jon.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
The hippocampus is a complex structure located in the mesial temporal lobe that plays a critical role in cognitive and memory-related processes. The hippocampal formation consists of the dentate gyrus, hippocampus proper, and subiculum, and its importance in the neural circuitry makes it a key anatomic structure to evaluate in neuroimaging studies. Advancements in imaging techniques now allow detailed assessment of hippocampus internal architecture and signal features that has improved identification and characterization of hippocampal abnormalities. This review aims to summarize the neuroimaging features of the hippocampus and its common pathologies. It provides an overview of the hippocampal anatomy on magnetic resonance imaging and discusses how various imaging techniques can be used to assess the hippocampus. The review explores neuroimaging findings related to hippocampal variants (incomplete hippocampal inversion, sulcal remnant and choroidal fissure cysts), and pathologies of neoplastic (astrocytoma and glioma, ganglioglioma, dysembryoplastic neuroepithelial tumor, multinodular and vacuolating neuronal tumor, and metastasis), epileptic (mesial temporal sclerosis and focal cortical dysplasia), neurodegenerative (Alzheimer's disease, progressive primary aphasia, and frontotemporal dementia), infectious (Herpes simplex virus and limbic encephalitis), vascular (ischemic stroke, arteriovenous malformation, and cerebral cavernous malformations), and toxic-metabolic (transient global amnesia and opioid-associated amnestic syndrome) etiologies.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha Colby
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Monika Bapna
- School of Medicine, Georgetown University, Washington, DC, USA
| | - Camilo Jaimes
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sandra P Rincon
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Prener M, Drejer V, Ziebell M, Jensen P, Madsen CG, Olsen S, Thomsen G, Pinborg LH, Paulson OB. Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. II: Methodological considerations on hyper- and hypoperfusion. Epilepsia Open 2023; 8:1503-1511. [PMID: 37750050 PMCID: PMC10690685 DOI: 10.1002/epi4.12833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Single-photon emission computed tomography (SPECT) with the tracer 99m Tc-HMPAO is a method to visualize the cerebral hyperperfusion during an epileptic seizure and thus localize the epileptogenic zone and seizure propagation. Subtraction of interictal from Ictal SPECT Co-registered to MRI (SISCOM) visualizes areas with relative increases in cerebral blood flow. The purpose of this retrospective study is to explore the added value of visualizing areas of hypoperfusion as well as hyperperfusion, so-called reversed SISCOM. METHODS Fifty-six patients operated for epilepsy who had been investigated with SISCOM were included in the analysis. The patients were divided into two groups based on seizure duration after tracer injection, above or below 30 s. The preoperative SISCOM description was compared to the area of resection and given a concordance score. The 56 SISCOM were recalculated visualizing also areas of hypoperfusion and again compared to the site of resection using the same scale of concordance. The reversed SISCOM were categorized into three subgroups: "Altered Conclusion," "Confirmed Conclusion," and "Adds Nothing." If an area of hyperperfusion had an area of hypoperfusion in close proximity, it was re-interpreted as noise, thus possibly altering the conclusion. If the areas of hypoperfusion were in the opposite hemisphere it was interpreted as confirming factor. Further the concordance scores from conventional SISCOM and reversed SISCOM was compared to surgical outcome to explore the difference in sensitivity, positive predictive value (PPV), and odds ratio. RESULTS In approximately half of the cases reversed SISCOM added additional value, meaning either altered the conclusion or confirmed the conclusion. The sensitivity, PPV, and odds ratio was also better in the subgroup of long, >30 s seizure duration after injection, and got worse in the group with short, <30 s seizure duration after injection. SIGNIFICANCE Adding reversed SISCOM performed better than conventional SISCOM at predicting good surgical outcome.
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Affiliation(s)
- Martin Prener
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Veronica Drejer
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Morten Ziebell
- Department of NeurosurgeryRigshospitaletCopenhagenDenmark
| | - Per Jensen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Camilla Gøbel Madsen
- Department of Radiology, Centre for Functional and Diagnostic imaging and ResearchCopenhagen University Hospital Amager and HvidovreHvidovreDenmark
| | - Svitlana Olsen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Gerda Thomsen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Lars H. Pinborg
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
- Epilepsy Clinic, Department of Neurology, Rigshospitalet, Copenhagen, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Olaf B. Paulson
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Rogeau A, Lilburn DML, Kaplar Z, Anderson C, Scott CJ, Chowdhury FA, Fraioli F, Bomanji JB. Identifying and troubleshooting the pitfalls of ictal/interictal brain perfusion SPECT studies. Nucl Med Commun 2023; 44:1053-1058. [PMID: 37661779 DOI: 10.1097/mnm.0000000000001755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Epilepsy is a prevalent condition, and surgical intervention can benefit patients with refractory seizures. Single photon emission computed tomography (SPECT) using 99mTc-HMPAO or 99mTc-ECD provides assessment of regional cerebral blood flow and is the primary non-invasive approach for imaging brain perfusion in ictal and interictal states. Ictal/interictal SPECT is valuable in localising epileptogenic foci, particularly when MRI and electroencephalography are negative. However, to obtain accurate images reflecting brain perfusion in both states, meticulous preparation of the patient, timely radiotracer injection and close coordination between neurology and nuclear medicine teams are essential. Tracers also have inherent limitations, and patients may present with coexisting brain pathologies for which coregistration of SPECT images with MRI is recommended to improve diagnostic accuracy. Inconclusive SPECT findings may require repeating the exam or considering additional investigations. A comprehensive approach, considering various factors, is crucial for accurate interpretation of SPECT studies in presurgical epilepsy evaluations. This article provides a summary of the organisation and key challenges involved in conducting ictal/interictal SPECT studies, covering the entire process from a patient's hospital arrival to the integration of results within their presurgical pathway and using our experience of 182 patients over 10 years.
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Affiliation(s)
- Antoine Rogeau
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Nuclear Medicine, Lille University Hospitals, Lille, France
| | - David M L Lilburn
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Imaging, School of Medicine, University College London
| | - Zoltan Kaplar
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Cameron Anderson
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Catherine J Scott
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fahmida A Chowdhury
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Imaging, School of Medicine, University College London
| | - Jamshed B Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
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7
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Prener M, Drejer V, Ziebell M, Jensen P, Madsen CG, Olsen S, Thomsen G, Pinborg LH, Paulson OB. Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. I: Predictive value and methodological considerations. Epilepsia Open 2023; 8:1064-1074. [PMID: 37464953 PMCID: PMC10472396 DOI: 10.1002/epi4.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE This retrospective study investigates the predictive value of ictal subtraction single-photon emission computed tomography (SPECT) co-registered to magnetic resonance imaging (MRI) (SISCOM) for successful epilepsy surgery. METHODS 57 patients examined with SISCOM as a part of epilepsy surgery evaluation were divided into two groups based on seizure duration after tracer injection (group 1: Seizure duration above or equal to 30 s, group 2: Seizure duration under 30 s). SISCOM was compared to the surgical site and categorized as good or poor concordance. Subsequently, Odds ratios (ORs) and positive predictive values (PPVs) were calculated for each group for good surgical outcome, freedom from disabling seizures. RESULTS The PPVs and ORs for good surgical outcome was 74.1% and 5.71 for group 1 and 40% and 0.22 for group 2. SISCOM had a similar positive predictive value regardless of whether the focus was in the same or neighboring lobe, but same hemisphere as the resection. CONCLUSION In conclusion, the implementation of a precise definition for a well-executed ictal SPECT scan with respect to seizure duration after injection enhances the positive predictive value (PPV) and odds ratio (OR) for successful surgical outcome, surpassing previous findings, whether the focus in resected lobe or the neighboring.
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Affiliation(s)
- Martin Prener
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Veronica Drejer
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Morten Ziebell
- Department of NeurosurgeryRigshospitaletCopenhagenDenmark
| | - Per Jensen
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Camilla Gøbel Madsen
- Department of Radiology, Centre for Functional and Diagnostic imaging and ResearchCopenhagen University Hospital Amager and HvidovreHvidovreDenmark
| | - Svitlana Olsen
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Gerda Thomsen
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Lars H. Pinborg
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
- Department of Neurology, Epilepsy ClinicRigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Olaf B. Paulson
- Department of Neurology, Neurobiology Research UnitRigshospitalet BlegdamsvejCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Ota Y, Liao E, Shah G, Srinivasan A, Capizzano AA. Comprehensive Update and Review of Clinical and Imaging Features of SMART Syndrome. AJNR Am J Neuroradiol 2023; 44:626-633. [PMID: 37142432 PMCID: PMC10249687 DOI: 10.3174/ajnr.a7859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023]
Abstract
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a delayed complication of cranial irradiation, with subacute onset of stroke-like symptoms including seizures, visual disturbance, speech impairment, unilateral hemianopsia, facial droop, and aphasia, often associated with migraine-type headache. The diagnostic criteria were initially proposed in 2006. However, the diagnosis of SMART syndrome is challenging because clinical symptoms and imaging features of SMART syndrome are indeterminate and overlap with tumor recurrence and other neurologic diseases, which may result in inappropriate clinical management and unnecessary invasive diagnostic procedures. Recently, various imaging features and treatment recommendations for SMART syndrome have been reported. Radiologists and clinicians should be familiar with updates on clinical and imaging features of this delayed radiation complication because recognition of this entity can facilitate proper clinical work-up and management. This review provides current updates and a comprehensive overview of the clinical and imaging features of SMART syndrome.
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Affiliation(s)
- Y Ota
- From The Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - E Liao
- From The Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - G Shah
- From The Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A Srinivasan
- From The Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A A Capizzano
- From The Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Schulte F, Bitzer F, Gärtner FC, Bauer T, von Wrede R, Baumgartner T, Rácz A, Borger V, von Oertzen T, Vatter H, Essler M, Surges R, Rüber T. The diagnostic value of ictal SPECT-A retrospective, semiquantitative monocenter study. Epilepsia Open 2023; 8:183-192. [PMID: 36658093 PMCID: PMC9977750 DOI: 10.1002/epi4.12694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Ictal single photon emission computed tomography (SPECT) can be used as an advanced diagnostic modality to detect the seizure onset zone in the presurgical evaluation of people with epilepsy. In addition to visual assessment (VSA) of ictal and interictal SPECT images, postprocessing methods such as ictal-interictal SPECT analysis using SPM (ISAS) can visualize regional ictal blood flow differences. We aimed to evaluate and differentiate the diagnostic value of VSA and ISAS in the Bonn cohort. METHODS We included 161 people with epilepsy who underwent presurgical evaluation at the University Hospital Bonn between 2008 and 2020 and received ictal and interictal SPECT and ISAS. We retrospectively assigned SPECT findings to one of five categories according to their degree of concordance with the clinical focus hypothesis. RESULTS Seizure onset zones could be identified more likely on a sublobar concordance level by ISAS than by VSA (31% vs. 19% of cases; OR = 1.88; 95% Cl [1.04, 3.42]; P = 0.03). Both VSA and ISAS more often localized a temporal seizure onset zone than an extratemporal one. Neither VSA nor ISAS findings were predicted by the latency between seizure onset and tracer injection (P = 0.75). In people who underwent successful epilepsy surgery, VSA and ISAS indicated the correct resection site in 54% of individuals, while MRI and EEG showed the correct resection localization in 96% and 33% of individuals, respectively. It was more likely to become seizure-free after epilepsy surgery if ISAS or VSA had been successful. There was no MR-negative case with successful surgery, indicating that ictal SPECT is more useful for confirmation than for localization. SIGNIFICANCE The results of the most extensive clinical study of ictal SPECT to date allow an assessment of the diagnostic value of this elaborate examination and emphasize the importance of postprocessing routines.
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Affiliation(s)
- Freya Schulte
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Felix Bitzer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Tim von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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10
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Xiao L, Zhou M, Tang Y, Hu S. 18 F-SynVesT-1 positron emission tomography in a hypothalamic hamartoma with abnormal uptake. Epilepsia 2023; 64:e43-e47. [PMID: 36745038 DOI: 10.1111/epi.17533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
Hypothalamic hamartomas (HHs) are uncommon benign lesions of neuronal and glial cells in the inferior hypothalamus. They have been linked to epilepsy, premature puberty, and cognitive and behavioral impairment. We report a 13-year-old patient who was referred to a multidisciplinary treatment team for epilepsy with 6 months of convulsive seizures. Sustained seizure control was not achieved despite the use of multiple antiepileptic agents. He had been plagued by unexplained paroxysmal bursts of laughter for >11 years. Video-electroencephalography showed diffuse epileptic discharges prominent in the right hemisphere in both interictal and ictal phases. Magnetic resonance imaging demonstrated an isointense gray matter mass on the right lateral walls of the third ventricle, with focal hypometabolism on 18 F-fluorodeoxyglucose positron emission tomography (PET). The patient subsequently was enrolled in a clinical trial of 18 F-SynVesT-1 PET in epilepsy, and an increased 18 F-SynVesT-1 uptake was noted in the mass. After excluding hormonal abnormalities, the patient underwent open resection targeting HHs. We used 18 F-SynVesT-1 as a specific PET tracer for synaptic vesicle glycoprotein 2A, which is ubiquitously expressed in brain synapses. 18 F-SynVesT-1 PET may hold promise as a supplementary tool in the presurgical localization and evaluation of HHs.
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Affiliation(s)
- Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Biological Nanotechnology of the National Health Commission, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
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11
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Xu L, Lai L, Wen Y, Lin J, Chen B, Zhong Y, Cheng Y, Zhang X, Guan J, Mikulis DJ, Lin Y, Yan G, Wu R. Angiopep-2, an MRI Biomarker, Dynamically Monitors Amyloid Deposition in Early Alzheimer's Disease. ACS Chem Neurosci 2023; 14:226-234. [PMID: 36599050 PMCID: PMC9854622 DOI: 10.1021/acschemneuro.2c00513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
The reliable and dynamic detection of amyloid β-protein (Aβ) deposition using imaging technology is necessary for preclinical Alzheimer's disease (AD), which may significantly improve prognosis. The present study aimed to evaluate the feasibility of applying angiopep-2 (ANG), a chemical exchange saturation transfer-magnetic resonance imaging (CEST-MRI) biomarker, for monitoring Aβ deposition in vivo. ANG exerted a good chemical exchange saturation transfer (CEST) effect and displayed a moderate binding affinity to Aβ1-42 in vitro. Six-month-old mice with AD injected with ANG exhibited a significantly enhanced CEST effect than controls in vivo; this effect gradually became more apparent at 8, 10, and 12 months. Spatial learning impairment caused by abundant Aβ deposition (representing mild cognitive impairment in AD patients) develops at 12 months in APPswe/PSEN1dE9 (line 85) AD mice. To conclude, the CEST of ANG could display very earlier age-related Aβ pathological progress in mice with AD, consistent with immunohistochemistry. ANG has extraordinary potential for clinical transformation as an imaging biomarker to diagnose early AD and track its progress dynamically and nonradiationally.
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Affiliation(s)
- Liang Xu
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
- Department
of Medical Imaging, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518000, P. R. China
| | - Lingfeng Lai
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
| | - Yaqi Wen
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
| | - Jia Lin
- Department
of Ultrasound, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
| | - Beibei Chen
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
| | - Yazhi Zhong
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
| | - Yan Cheng
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
| | - XiaoLei Zhang
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
- Provincial
Key Laboratory for Breast Cancer Diagnosis and Treatment, Guangdong
Province, Shantou, Guangdong 515041, P. R. China
| | - Jitian Guan
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
- Provincial
Key Laboratory for Breast Cancer Diagnosis and Treatment, Guangdong
Province, Shantou, Guangdong 515041, P. R. China
| | - David J Mikulis
- Joint
Department of Medical Imaging and the Functional Neuroimaging Laboratory
(D.J.M.), University Health Network, Toronto M2J4A6, Canada
| | - Yan Lin
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
- Provincial
Key Laboratory for Breast Cancer Diagnosis and Treatment, Guangdong
Province, Shantou, Guangdong 515041, P. R. China
| | - Gen Yan
- Department
of Radiology, The Second Affiliated Hospital
of Xiamen Medical College, Xiamen, Fujian 361023, P. R. China
| | - Renhua Wu
- Department
of Medical Imaging, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515000, P. R. China
- Provincial
Key Laboratory for Breast Cancer Diagnosis and Treatment, Guangdong
Province, Shantou, Guangdong 515041, P. R. China
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12
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Guo K, Wang J, Wang Z, Wang Y, Cui B, Zhao G, Lu J. Morphometric analysis program and quantitative positron emission tomography in presurgical localization in MRI-negative epilepsies: a simultaneous PET/MRI study. Eur J Nucl Med Mol Imaging 2021; 49:1930-1938. [PMID: 34939175 DOI: 10.1007/s00259-021-05657-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/12/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE To evaluate morphometric analysis program (MAP) and quantitative positron emission tomography (QPET) in epileptogenic zone (EZ) identification using a simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) system in MRI-negative epilepsies. METHODS Seventy-one localization-related MRI-negative epilepsies who underwent preoperative simultaneous PET/MRI examination and surgical resection were enrolled retrospectively. MAP was performed on a T1-weighted volumetric sequence, and QPET was analyzed using statistical parametric mapping (SPM) with comparison to age- and gender-matched normal controls. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MAP, QPET, MAP + QPET, and MAP/QPET in EZ localization were assessed. The correlations between surgical outcome and modalities concordant with cortical resection were analyzed. RESULTS Forty-five (63.4%) patients had Engel I seizure outcomes. The sensitivity, specificity, PPV, and NPV of MAP were 64.4%, 69.2%, 78.3%, and 52.9%, respectively. The sensitivity, specificity, PPV, NPV of QPET were 73.3%, 65.4%, 78.6%, and 58.6%, respectively. MAP + QPET, defined as two tests concordant with cortical resection, had reduced sensitivity (53.3%) but increased specificity (88.5%) relative to individual tests. MAP/QPET, defined as one or both tests concordant with cortical resection, had increased sensitivity (86.7%) but reduced specificity (46.2%) relative to individual tests. The regions determined by MAP, QPET, MAP + QPET, or MAP/QPET concordant with cortical resection were significantly associated with the seizure-free outcome. CONCLUSION QPET has a superior sensitivity than MAP, while the combined MAP + QPET obtained from a simultaneous PET/MRI scanner may improve the specificity of the diagnostic tests in EZ localization coupled with the preferable surgical outcome in MRI-negative epilepsies.
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Affiliation(s)
- Kun Guo
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Jingjuan Wang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Zhenming Wang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Yihe Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bixiao Cui
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China. .,Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
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13
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Lu C, Wang K, Meng F, Wang Y, Shan Y, Wei P, Zhao G. 18F-FDG-PET glucose hypometabolism pattern in patients with epileptogenic hypothalamic hamartoma. Front Med 2021; 15:913-921. [PMID: 34811641 DOI: 10.1007/s11684-021-0874-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/29/2021] [Indexed: 11/29/2022]
Abstract
Epileptogenic hypothalamic hamartoma is characterized by intractable gelastic seizures. A systematic analysis of the overall brain metabolic pattern in patients with hypothalamic hamartoma (HH) could facilitate the understanding of the epileptic brain network and the associated brain damage effects of HH. In this study, we retrospectively evaluated 27 patients with epileptogenic HH (8 female patients; age, 2-33 years) by using 18F-fluorodeoxyglucose-positron emission tomography. The correlations among tomography result, seizure type, sex, and structural magnetic resonance imaging were assessed. Whole metabolic patterns and voxel-based morphometry findings were assessed by group analysis with healthy controls. Assessment of the whole metabolic pattern in patients with HH revealed several regional metabolic reductions in the cerebrum and an overall metabolic reduction in the cerebellum. In addition, areas showing hypometabolism in the neocortex were more widely distributed ipsilaterally than contralaterally to the HH. Reductions in glucose metabolism and gray matter volume in the neocortex were predominant ipsilateral to the HH. In conclusion, the glucose hypometabolism pattern in patients with epileptogenic HH involved the neocortex, subcortical regions, and cerebellum. The characteristics of glucose hypometabolism differed across seizure type and sex. Reductions in glucose metabolism and structural changes may be based on different mechanisms, but both are likely to occur ipsilateral to the HH in the neocortex. We hypothesized that the dentato-rubro-thalamic tract and cerebro-ponto-cerebellar tract, which are responsible for intercommunication between the cerebral cortex, subcortical regions, and cerebellar regions, may be involved in a pathway related to seizure propagation, particularly gelastic seizures, in patients with HH.
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Affiliation(s)
- Chao Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
| | - Kailiang Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
| | - Fei Meng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
| | - Yihe Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China. .,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China.
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China. .,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China.
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China. .,China International Neuroscience Institute (CHINA-INI), Beijing, 100053, China. .,Center of Epilepsy, Beijing Institute for Brain Disorder, Beijing, 100069, China.
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14
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Abstract
PET/MR imaging is in routine clinical use and is at least as effective as PET/CT for oncologic and neurologic studies with advantages with certain PET radiopharmaceuticals and applications. In addition, whole body PET/MR imaging substantially reduces radiation dosages compared with PET/CT which is particularly relevant to pediatric and young adult population. For cancer imaging, assessment of hepatic, pelvic, and soft-tissue malignancies may benefit from PET/MR imaging. For neurologic imaging, volumetric brain MR imaging can detect regional volume loss relevant to cognitive impairment and epilepsy. In addition, the single-bed position acquisition enables dynamic brain PET imaging without extending the total study length which has the potential to enhance the diagnostic information from PET.
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Affiliation(s)
- Farshad Moradi
- Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA.
| | - Andrei Iagaru
- Department of Radiology, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA
| | - Jonathan McConathy
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT 773, Birmingham, AL 35249, USA
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