(18)F-fluorodeoxyglucose and (18)F-flumazenil positron emission tomography in patients with refractory epilepsy - PubMed (original) (raw)

Review

. 2016 Jul 19;50(3):247-53.

doi: 10.1515/raon-2016-0032. eCollection 2016 Sep 1.

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Review

(18)F-fluorodeoxyglucose and (18)F-flumazenil positron emission tomography in patients with refractory epilepsy

Marina Hodolic et al. Radiol Oncol. 2016.

Abstract

Background: Epilepsy is a neurological disorder characterized by epileptic seizures as a result of excessive neuronal activity in the brain. Approximately 65 million people worldwide suffer from epilepsy; 20-40% of them are refractory to medication therapy. Early detection of disease is crucial in the management of patients with epilepsy. Correct localization of the ictal onset zone is associated with a better surgical outcome. The modern non-invasive techniques used for structural-functional localization of the seizure focus includes electroencephalography (EEG) monitoring, magnetic resonance imaging (MRI), single photon emission tomography/computed tomography (SPECT/CT) and positron emission tomography/computed tomography (PET/CT). PET/CT can predict surgical outcome in patients with refractory epilepsy. The aim of the article is to review the current role of routinely used tracer 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) as well as non routinely used (18)F-Flumazenil ((18)F-FMZ) tracers PET/CT in patients with refractory epilepsy.

Conclusions: Functional information delivered by PET and the morphologic information delivered by CT or MRI are essential in presurgical evaluation of epilepsy. Nowadays (18)F-FDG PET/CT is a routinely performed imaging modality in localization of the ictal onset zone in patients with refractory epilepsy who are unresponsive to medication therapy. Unfortunately, (18)F-FDG is not an ideal PET tracer regarding the management of patients with epilepsy: areas of glucose hypometabolism do not correlate precisely with the proven degree of change within hippocampal sclerosis, as observed by histopathology or MRI. Benzodiazepine-receptor imaging is a promising alternative in nuclear medicine imaging of epileptogenic focus. The use of (11)C-FMZ in clinical practice has been limited by its short half-life and necessitating an on-site cyclotron for production. Therefore, (18)F-FMZ might be established as one of the tracers of choice for patients with refractory epilepsy because of better sensitivity and anatomical resolution.

Keywords: 18F-FDG; 18F-Flumazenil; PET/CT; epilepsy; nuclear medicine.

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Figures

Figure 1

Figure 1

Focal epilepsy in 17 year old male patient. Interictal 18F-FDG PET (A): physiological distribution of 18F-FDG in the brain. Ictal 18F-FDG PET (B): hypermetabolism frontolateral in the right hemisphere (arrow).

Figure 2

Figure 2

18F-FDG PET **(B)**scan vs. 18F-Flumazenil PET **(C)**in a 19 year old female patient with bilateral hippocampal sclerosis as shown by MRI (A). Both PET modalities present low temporomesial uptake being larger on the left side, but benzodiazepinereceptor imaging appears sharper and presents a focal defect.

Figure 3

Figure 3

Focal epilepsy in 56 year old male patient. **(A)**MRI: astrogliosis of the right hippocampus (later proven by histology); **(B)**18F-FDG PET: minal temporomesial hypometabolism of both sides; **(C)**18F-Flumazenil PET: focal defect of tracer uptake at the right hippocampus.

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