Dynamic 18F-FDG-PET kinetic parameters for epileptogenic zone localization in drug-resistant epilepsy

Frontiers in Physics

Physics

Thiravat Hemachudha¹  Chusak Limotai²  Suda Jirasakuldej²  Chanan Sukprakun³  Kitiwat Khamwan⁴  Supatporn Tepmongkol⁵  Attapon Jantarato⁶ 

[1] Department of Medicine (Neurology), Neuroscience Centre for Research and Development, Thai Red Cross Emerging Infectious Disease-Health Science Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Chulalongkorn Comprehensive Epilepsy Center of Excellence (CCEC), King Chulalongkorn Memorial Hospital, Bangkok, Thailand;Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Chulalongkorn Comprehensive Epilepsy Center of Excellence (CCEC), King Chulalongkorn Memorial Hospital, Bangkok, Thailand;Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;National Cyclotron and PET Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand;

关键词: drug-resistant epilepsy;    pharmacokinetic modeling;    compartmental modeling;    dynamic-PET;    PMOD software;    epileptogenic zone localization;   

DOI  :  10.3389/fphy.2023.1233059

 received in 2023-06-01, accepted in 2023-09-25,  发布年份 2023

来源: Frontiers

【 摘 要 】

Objective: Precisely localizing the seizure onset zone remains a challenging task in drug-resistant epilepsy (DRE) patients especially given its critical role in successful surgery and effective management. This study aimed to investigate the kinetic parameters of regional 18F-fluorodeoxyglucose (FDG) uptake in DRE patients, aiming to identify the kinetic parameters best enabling the identification of the epileptogenic region.Methods: Consecutive DRE patients with clinically mandated interictal 18F-FDG PET/CT were recruited from October 2019 to September 2020 for pre-surgical evaluation. Immediately after injecting 18F-FDG of 112–179 MBq, dynamic data were acquired for 90 min. The motion correction and resampling to the Montreal atlas was performed in order to generate a transformation matrix. 116 volume of interests (VOIs) and regional time-activity curves (TACs) were generated by employing the automated anatomical labeling (AAL) template using PMOD software. Kinetic parameters of FDG unidirectional blood-brain clearance (K1), efflux (k2), phosphorylation (k3), and net metabolic flux (Ki) were derived using irreversible 2-tissue-compartment model with an image-derived input function (IDIF). The kinetic parameters values obtained from all regions were ranked and compared with the presumed epileptogenic zone (EZ).Results: Eleven DRE patients (5 males, 6 females, mean age 35.1 ± 10.2 years) were analyzed. We found that the region with the lowest values of Ki provided correct lateralization in 7/7 (100%) of patient with temporal lobe epilepsy (TLE) and the region with the lowest Ki and k3 parameters showed concordance with the EZ in 100% and 71.4% of patients, respectively.Conclusion: The present parametric approach to the evaluation of FDG-PET may be more sensitive than semi-quantitative approaches for the detection of pathophysiology in the EZ of patients with medically unresponsive TLE in addition to the routine clinical investigations.

【 授权许可】

Unknown   
Copyright © 2023 Khamwan, Sukprakun, Limotai, Jirasakuldej, Jantarato, Hemachudha and Tepmongkol.