Hungarian Brain Research Program((2017-1.2.1-NKP-2017-00002)
(NKFIH EFOP-3.6.2-16-2017-00008)
Szakterületek:
Orvos- és egészségtudomány
When MRI fails to detect a potentially epileptogenic lesion, the chance of a favorable
outcome after epilepsy surgery becomes significantly lower (from 60 to 90% to 20-65%).
Hybrid FDG-PET/MRI may provide additional information for identifying the epileptogenic
zone. We aimed to investigate the possible effect of the introduction of hybrid FDG-PET/MRI
into the algorithm of the decision-making in both lesional and non-lesional drug-resistant
epileptic patients.In a prospective study of patients suffering from drug-resistant
focal epilepsy, 30 nonlesional and 30 lesional cases with discordant presurgical results
were evaluated using hybrid FDG-PET/MRI.The hybrid imaging revealed morphological
lesion in 18 patients and glucose hypometabolism in 29 patients within the nonlesional
group. In the MRI positive group, 4 patients were found to be nonlesional, and in
9 patients at least one more epileptogenic lesion was discovered, while in another
17 cases the original lesion was confirmed by means of hybrid FDG-PET/MRI. As to the
therapeutic decision-making, these results helped to indicate resective surgery instead
of intracranial EEG (iEEG) monitoring in 2 cases, to avoid any further invasive diagnostic
procedures in 7 patients, and to refer 21 patients for iEEG in the nonlesional group.
Hybrid FDG-PET/MRI has also significantly changed the original therapeutic plans in
the lesional group. Prior to the hybrid imaging, a resective surgery was considered
in 3 patients, and iEEG was planned in 27 patients. However, 3 patients became eligible
for resective surgery, 6 patients proved to be inoperable instead of iEEG, and 18
cases remained candidates for iEEG due to the hybrid FDG-PET/MRI. Two patients remained
candidates for resective surgery and one patient became not eligible for any further
invasive intervention.The results of hybrid FDG-PET/MRI significantly altered the
original plans in 19 of 60 cases. The introduction of hybrid FDG-PET/MRI into the
presurgical evaluation process had a potential modifying effect on clinical decision-making.Trial
registry: Scientific Research Ethics Committee of the Medical Research Council of
Hungary.008899/2016/OTIG . Date of registration: 08 February 2016.
