Comparison of MR Imaging with PET and IctalSPECT in 118 Patients with Intractable Epilepsy
Hyung Jin Wona,
Kee-Hyun Chang,a,
Jung-Eun Cheona,
Hong Dae Kima,
Dong Soo Leea,
Moon Hee Hana,
In-One Kima,
Sang Kun Leea and
Chun-Kee Chunga
a From the Departments of Radiology (J.W.H., K-H.C., J-E.C., H.D.K., M.H.H., I-O.K.), Nuclear Medicine (D.S.L.), Neurology (S.K.L.), and Neurosurgery (C-K.C.), Seoul National University College of Medicine; and the Institute of Radiation Medicine (K-H.C., D.S.L., M.H.H., I-O,K.), SN
MRC, Seoul, Korea.
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FIG 1. Concordance among MR imaging, ictal SPECT, and PET in a 51-year-old woman with right temporal lobe epilepsy.
A, Oblique coronal fast spin-echo T2-weighted MR image (4000/120/4 [TR/TE/excitations]) shows atrophy and hyperintensity of right hippocampus (arrow).
B, Ictal SPECT scan shows hyperperfusion in right temporal lobe (arrows). Radioactivity ratio between right temporal cortex/left temporal cortex was 2.4:1.
C, FDG-PET scan shows hypometabolism in right temporal lobe (arrows). Radioactivity ratio between right temporal cortex/left temporal cortex was 0.4:1.
After anterior temporal lobectomy, pathologic diagnosis was hippocampal sclerosis. Engel's outcome was class I.
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FIG 2. Nonconcordance among MR imaging, ictal SPECT, and PET in a 31-year-old woman with right temporal lobe epilepsy.
A, Oblique coronal turbo spin-echo T2-weighted MR image (5000/100/3) shows atrophy and slight hyperintensity of left hippocampus (arrow).
B, Ictal SPECT scan shows slight hyperperfusion in right temporal lobe (arrows). Radioactivity ratio between right temporal cortex/left temporal cortex was 1.2:1.
C, FDG-PET scan shows slight hypometabolism in right temporal lobe (arrows). Radioactivity ratio between right temporal cortex/left temporal cortex was 0.5:1.
Invasive EEG (subdural grids) study showed the epileptogenic focus in the right temporal lobe. After right anterior temporal lobectomy, pathologic diagnosis was hippocampal sclerosis combined with microscopic cortical dysplasia. Engel's outcome at 1-year follow up was class II.
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FIG 3. False-negative MR findings in a 30-year-old man with left complex partial seizures. Ictal activity was shown in left temporal area on video/EEG.
A, Oblique coronal fast spin-echo T2-weighted MR image (4000/120/4) shows no abnormalities.
B, Ictal SPECT scan shows hyperperfusion in left temporal lobe (arrows). Radioactivity ratio between right temporal cortex/left temporal cortex was 1:2.4.
C, FDG-PET scan shows hypometabolism in left temporal lobe (arrows). Radioactivity ratio between right temporal cortex/left temporal cortex was 1:0.7.
Invasive EEG showed ictal activity in left temporal lobe. After left anterior temporal lobectomy, pathologic diagnosis was hippocampal sclerosis of a mild degree associated with mild cortical dysplasia. Engel's outcome was class II.
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