Limits...
Comparative Study of Voxel-Based Epileptic Foci Localization Accuracy between Statistical Parametric Mapping and Three-dimensional Stereotactic Surface Projection

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) is widely used to help localize the hypometabolic epileptogenic focus for presurgical evaluation of drug-refractory epilepsy patients. Two voxel-based brain mapping methods to interpret 18F-FDG-PET, statistical parametric mapping (SPM) and three-dimensional stereotactic surface projection (3D-SSP), improve the detection rate of seizure foci. This study aimed to compare the consistency of epileptic focus detection between SPM and 3D-SSP for 18F-FDG-PET brain mapping analysis.

Methods: We retrospectively reviewed the clinical, electroecephalographic, and brain imaging results of 35 patients with refractory epilepsy. 18F-FDG-PET studies were revaluated by SPM, 3D-SSP, and visual assessment, and the results were compared to the magnetic resonance imaging (MRI) lesion location and to the presumed epileptogenic zone (PEZ) defined by video-electroencephalogram and other clinical data. A second consistency study compared PET analyses to histopathology and surgical outcomes in the 19 patients who underwent lesion resection surgery.

Results: Of the 35 patients, consistency with the PEZ was 29/35 for SPM, 25/35 for 3D-SSP, 14/35 for visual assessment, and 10/35 for MRI. Concordance rates with the PEZ were significantly higher for SPM and 3D-SSP than for MRI (P < 0.05) and visual assessment (P < 0.05). Differences between SPM and 3D-SSP and between visual assessment and MRI were not significant. In the 19 surgical patients, concordance with histopathology/clinical outcome was 14/19 for SPM, 15/19 for 3D-SSP, 14/19 for visual assessment, and 9/19 for MRI (P > 0.05). A favorable Engel outcome (class I/II) was found in 16 of 19 cases (84%), and failure of seizure control was found in 3 of 19 patients (class III/IV).

Conclusion: Voxel-based 18F-FDG-PET brain mapping analysis using SPM or 3D-SSP can improve the detection rate of the epileptic focus compared to visual assessment and MRI. Consistency with PEZ was similar between SPM and 3D-SSP; according to their own characteristics, 3D-SSP is recommended for primary evaluation due to greater efficiency and operability of the software, while SPM is recommended for high-accuracy localization of complex lesions. Therefore, joint application of both software packages may be the best solution for FDG-PET analysis of epileptic focus localization.

No MeSH data available.


Related in: MedlinePlus

PET imaging results of three cases with non-favorable outcome. In each panel, the upper part is the SPM-PET result (P < 0.001, voxel size 200 corrected), and the lower part is the SD-SSP-PET result with Z-score. (A) Case 8 was diagnosed with encephalitis by postoperative pathological diagnosis. He received right posterior temporal lobe lesion resection with a very poor outcome (Engel IV). Both the SPM-PET and the 3D-SSP-PET result maps reveal a hypometabolic region in right temporal lobe. SPM-PET also shows another hypometabolic area in the right Sylvian fissure extending from the insula. However, the 3D-SSP-PET result map shows a diffuse hypometabolic distribution in the right parietal lobe and frontal lobe. (B) Case 12 underwent right insular lesion resection according to PEZ with a postoperative outcome of Engel III. The SPM-PET result map shows another epileptic locus in the right posterior central gyrus. In addition to a hypometabolic region in the right Sylvian fissure extending from the insula, the posterior central gyrus region shows a high Z-score in the 3D-SSP result. (C) Case 17 underwent left anterior temporal lobectomy with a non-favorable outcome (Engel III). SPM-PET and 3D-SSP-PET result maps show ideal consistency in the localization of a hypometabolic region in the left temporal lobe. Failure of seizure control may have resulted from removal of a region smaller than the real epileptic zone to avoid functional loss.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5037321&req=5

Figure 5: PET imaging results of three cases with non-favorable outcome. In each panel, the upper part is the SPM-PET result (P < 0.001, voxel size 200 corrected), and the lower part is the SD-SSP-PET result with Z-score. (A) Case 8 was diagnosed with encephalitis by postoperative pathological diagnosis. He received right posterior temporal lobe lesion resection with a very poor outcome (Engel IV). Both the SPM-PET and the 3D-SSP-PET result maps reveal a hypometabolic region in right temporal lobe. SPM-PET also shows another hypometabolic area in the right Sylvian fissure extending from the insula. However, the 3D-SSP-PET result map shows a diffuse hypometabolic distribution in the right parietal lobe and frontal lobe. (B) Case 12 underwent right insular lesion resection according to PEZ with a postoperative outcome of Engel III. The SPM-PET result map shows another epileptic locus in the right posterior central gyrus. In addition to a hypometabolic region in the right Sylvian fissure extending from the insula, the posterior central gyrus region shows a high Z-score in the 3D-SSP result. (C) Case 17 underwent left anterior temporal lobectomy with a non-favorable outcome (Engel III). SPM-PET and 3D-SSP-PET result maps show ideal consistency in the localization of a hypometabolic region in the left temporal lobe. Failure of seizure control may have resulted from removal of a region smaller than the real epileptic zone to avoid functional loss.

Mentions: Reasons for the unfavorable clinical outcomes were suggested by SPM and 3D-SSP analyses, detailed in Figures 4 and 5. In two cases (cases 8 and 12), EZ resection was incomplete as there was another epileptic foci aside from the PEZ. Although case 17 showed good consistency for all diagnostic methods, the resected region was likely smaller than the real EZ, so seizure control failed. In the favorable outcome group, there was discordance between SPM and 3D-SSP results in three cases (cases 5, 7, and 13) in Figure 6. More specifically, SPM showed PCS in case 5, 3D-SSP in case 13, and both in case 7.


Comparative Study of Voxel-Based Epileptic Foci Localization Accuracy between Statistical Parametric Mapping and Three-dimensional Stereotactic Surface Projection
PET imaging results of three cases with non-favorable outcome. In each panel, the upper part is the SPM-PET result (P < 0.001, voxel size 200 corrected), and the lower part is the SD-SSP-PET result with Z-score. (A) Case 8 was diagnosed with encephalitis by postoperative pathological diagnosis. He received right posterior temporal lobe lesion resection with a very poor outcome (Engel IV). Both the SPM-PET and the 3D-SSP-PET result maps reveal a hypometabolic region in right temporal lobe. SPM-PET also shows another hypometabolic area in the right Sylvian fissure extending from the insula. However, the 3D-SSP-PET result map shows a diffuse hypometabolic distribution in the right parietal lobe and frontal lobe. (B) Case 12 underwent right insular lesion resection according to PEZ with a postoperative outcome of Engel III. The SPM-PET result map shows another epileptic locus in the right posterior central gyrus. In addition to a hypometabolic region in the right Sylvian fissure extending from the insula, the posterior central gyrus region shows a high Z-score in the 3D-SSP result. (C) Case 17 underwent left anterior temporal lobectomy with a non-favorable outcome (Engel III). SPM-PET and 3D-SSP-PET result maps show ideal consistency in the localization of a hypometabolic region in the left temporal lobe. Failure of seizure control may have resulted from removal of a region smaller than the real epileptic zone to avoid functional loss.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037321&req=5

Figure 5: PET imaging results of three cases with non-favorable outcome. In each panel, the upper part is the SPM-PET result (P < 0.001, voxel size 200 corrected), and the lower part is the SD-SSP-PET result with Z-score. (A) Case 8 was diagnosed with encephalitis by postoperative pathological diagnosis. He received right posterior temporal lobe lesion resection with a very poor outcome (Engel IV). Both the SPM-PET and the 3D-SSP-PET result maps reveal a hypometabolic region in right temporal lobe. SPM-PET also shows another hypometabolic area in the right Sylvian fissure extending from the insula. However, the 3D-SSP-PET result map shows a diffuse hypometabolic distribution in the right parietal lobe and frontal lobe. (B) Case 12 underwent right insular lesion resection according to PEZ with a postoperative outcome of Engel III. The SPM-PET result map shows another epileptic locus in the right posterior central gyrus. In addition to a hypometabolic region in the right Sylvian fissure extending from the insula, the posterior central gyrus region shows a high Z-score in the 3D-SSP result. (C) Case 17 underwent left anterior temporal lobectomy with a non-favorable outcome (Engel III). SPM-PET and 3D-SSP-PET result maps show ideal consistency in the localization of a hypometabolic region in the left temporal lobe. Failure of seizure control may have resulted from removal of a region smaller than the real epileptic zone to avoid functional loss.
Mentions: Reasons for the unfavorable clinical outcomes were suggested by SPM and 3D-SSP analyses, detailed in Figures 4 and 5. In two cases (cases 8 and 12), EZ resection was incomplete as there was another epileptic foci aside from the PEZ. Although case 17 showed good consistency for all diagnostic methods, the resected region was likely smaller than the real EZ, so seizure control failed. In the favorable outcome group, there was discordance between SPM and 3D-SSP results in three cases (cases 5, 7, and 13) in Figure 6. More specifically, SPM showed PCS in case 5, 3D-SSP in case 13, and both in case 7.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) is widely used to help localize the hypometabolic epileptogenic focus for presurgical evaluation of drug-refractory epilepsy patients. Two voxel-based brain mapping methods to interpret 18F-FDG-PET, statistical parametric mapping (SPM) and three-dimensional stereotactic surface projection (3D-SSP), improve the detection rate of seizure foci. This study aimed to compare the consistency of epileptic focus detection between SPM and 3D-SSP for 18F-FDG-PET brain mapping analysis.

Methods: We retrospectively reviewed the clinical, electroecephalographic, and brain imaging results of 35 patients with refractory epilepsy. 18F-FDG-PET studies were revaluated by SPM, 3D-SSP, and visual assessment, and the results were compared to the magnetic resonance imaging (MRI) lesion location and to the presumed epileptogenic zone (PEZ) defined by video-electroencephalogram and other clinical data. A second consistency study compared PET analyses to histopathology and surgical outcomes in the 19 patients who underwent lesion resection surgery.

Results: Of the 35 patients, consistency with the PEZ was 29/35 for SPM, 25/35 for 3D-SSP, 14/35 for visual assessment, and 10/35 for MRI. Concordance rates with the PEZ were significantly higher for SPM and 3D-SSP than for MRI (P&thinsp;&lt;&thinsp;0.05) and visual assessment (P&thinsp;&lt;&thinsp;0.05). Differences between SPM and 3D-SSP and between visual assessment and MRI were not significant. In the 19 surgical patients, concordance with histopathology/clinical outcome was 14/19 for SPM, 15/19 for 3D-SSP, 14/19 for visual assessment, and 9/19 for MRI (P&thinsp;&gt;&thinsp;0.05). A favorable Engel outcome (class I/II) was found in 16 of 19 cases (84%), and failure of seizure control was found in 3 of 19 patients (class III/IV).

Conclusion: Voxel-based 18F-FDG-PET brain mapping analysis using SPM or 3D-SSP can improve the detection rate of the epileptic focus compared to visual assessment and MRI. Consistency with PEZ was similar between SPM and 3D-SSP; according to their own characteristics, 3D-SSP is recommended for primary evaluation due to greater efficiency and operability of the software, while SPM is recommended for high-accuracy localization of complex lesions. Therefore, joint application of both software packages may be the best solution for FDG-PET analysis of epileptic focus localization.

No MeSH data available.


Related in: MedlinePlus