The results of the first experience in the use of positron emission tomography in the Republic of Belarus for the diagnosis of epilepsy
The purpose of our study was to determine the capabilities of 18F-FDG PET/CT (fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography) for the lateralization and localization of the focus in temporal lobe epilepsy and mapping of eloquent areas of the brain in these patients. Materials and methods. 18F-FDG PET/CT was implemented on the basis of statistical analysis by means of three-dimensional stereotactic surface projection (3D-SSP) on the workstation ADW4.6 using the software package CortexID. At the same time, we have analyzed the clinical data, magnetic resonance imaging (MRI) and electroencephalography (EEG) results. Forty two patients (25 men and 17 women aged 33 ± 11 years) suffering from epilepsy with pharmacoresistant course of disease were examined using the following methods: brain MRI, 18F-FDG PET/CT, EEG and EEG-mapping. The time of the PET/CT since the last attack ranged from 3 to 14 days. Results. In 21 patients out of 42 (50 %), foci of hypometabolism were detected in the temporal lobe (mostly), and also parietal and frontal lobes of the cerebral hemispheres visually. The identified foci and areas of hypometabolism, as a rule, corresponded to the epileptogenic focus discovered by EEG-mapping. When comparing hypometabolic foci and areas identified visually and statistically on 18F-FDG PET/CT, the localization of epileptic focus according to the routine EEG was comparable in 16 of 42 patients and according to EEG-mapping in 20 of 42 patients. When evaluating 18F-FDG PET/CT using the software package ID Cortex, we have also detected hypometabolism and areas of metabolic activity asymmetry in 8 of 42 patients (19 %) that were not identified during standard visual assessment. In 31 % of cases (13 of 42 patients), there were no significant signs of pathological metabolic activity in the brain. Conclusions. 18F-FDG PET/CT of the brain is an important component of diagnostic algorithms in patients with epilepsy. It is important to note that cumulative evaluation of 18F-FDG PET/CT data with results of other research methods increases the diagnostic accuracy, as a feature of the pathogenesis of epilepsy are dynamic changes occurring in different brain structures. Foci of 18F-FDG hypometabolism can be considered as a functional failure and can be a relative indication for increasing integrative control of the brain using neuromodulation techniques or pharmacological correction.
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