Quantitative positron emission tomography–guided magnetic resonance imaging postprocessing in magnetic resonance imaging–negative epilepsies

Yicong Lin, Yu Hua Dean Fang, Guiyun Wu, Stephen E. Jones, Richard A. Prayson, Ahsan N.V. Moosa, Margit Overmyer, James Bena, Mykol Larvie, William Bingaman, Jorge A. Gonzalez-Martinez, Imad M. Najm, Andreas V. Alexopoulos, Z. Irene Wang

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Detection of focal cortical dysplasia (FCD) is of paramount importance in epilepsy presurgical evaluation. Our study aims at utilizing quantitative positron emission tomography (QPET) analysis to complement magnetic resonance imaging (MRI) postprocessing by a morphometric analysis program (MAP) to facilitate automated identification of subtle FCD. Methods: We retrospectively included a consecutive cohort of surgical patients who had a negative preoperative MRI by radiology report. MAP was performed on T1-weighted volumetric sequence and QPET was performed on PET/computed tomographic data, both with comparison to scanner-specific normal databases. Concordance between MAP and QPET was assessed at a lobar level, and the significance of concordant QPET-MAP + abnormalities was confirmed by postresective seizure outcome and histopathology. QPET thresholds of standard deviations (SDs) of −1, −2, −3, and −4 were evaluated to identify the optimal threshold for QPET-MAP analysis. Results: A total of 104 patients were included. When QPET thresholds of SD = −1, −2, and −3 were used, complete resection of the QPET-MAP + region was significantly associated with seizure-free outcome when compared with the partial resection group (P = 0.023, P < 0.001, P = 0.006) or the no resection group (P = 0.002, P < 0.001, P = 0.001). The SD threshold of −2 showed the best combination of positive rate (55%), sensitivity (0.68), specificity (0.88), positive predictive value (0.88), and negative predictive value (0.69). Surgical pathology of the resected QPET-MAP + areas revealed mainly FCD type I. Multiple QPET-MAP + regions were present in 12% of the patients at SD = −2. Significance: Our study demonstrates a practical and effective approach to combine quantitative analyses of functional (QPET) and structural (MAP) imaging data to improve identification of subtle epileptic abnormalities. This approach can be readily adopted by epilepsy centers to improve postresective seizure outcomes for patients without apparent lesions on MRI.

Original languageEnglish
Pages (from-to)1583-1594
Number of pages12
JournalEpilepsia
Volume59
Issue number8
DOIs
Publication statusPublished - 2018 Aug

Fingerprint

Positron-Emission Tomography
Epilepsy
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
Electrons
Malformations of Cortical Development
Seizures
Surgical Pathology
Radiology
Databases
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Lin, Y., Fang, Y. H. D., Wu, G., Jones, S. E., Prayson, R. A., Moosa, A. N. V., ... Wang, Z. I. (2018). Quantitative positron emission tomography–guided magnetic resonance imaging postprocessing in magnetic resonance imaging–negative epilepsies. Epilepsia, 59(8), 1583-1594. https://doi.org/10.1111/epi.14474
Lin, Yicong ; Fang, Yu Hua Dean ; Wu, Guiyun ; Jones, Stephen E. ; Prayson, Richard A. ; Moosa, Ahsan N.V. ; Overmyer, Margit ; Bena, James ; Larvie, Mykol ; Bingaman, William ; Gonzalez-Martinez, Jorge A. ; Najm, Imad M. ; Alexopoulos, Andreas V. ; Wang, Z. Irene. / Quantitative positron emission tomography–guided magnetic resonance imaging postprocessing in magnetic resonance imaging–negative epilepsies. In: Epilepsia. 2018 ; Vol. 59, No. 8. pp. 1583-1594.
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title = "Quantitative positron emission tomography–guided magnetic resonance imaging postprocessing in magnetic resonance imaging–negative epilepsies",
abstract = "Objective: Detection of focal cortical dysplasia (FCD) is of paramount importance in epilepsy presurgical evaluation. Our study aims at utilizing quantitative positron emission tomography (QPET) analysis to complement magnetic resonance imaging (MRI) postprocessing by a morphometric analysis program (MAP) to facilitate automated identification of subtle FCD. Methods: We retrospectively included a consecutive cohort of surgical patients who had a negative preoperative MRI by radiology report. MAP was performed on T1-weighted volumetric sequence and QPET was performed on PET/computed tomographic data, both with comparison to scanner-specific normal databases. Concordance between MAP and QPET was assessed at a lobar level, and the significance of concordant QPET-MAP + abnormalities was confirmed by postresective seizure outcome and histopathology. QPET thresholds of standard deviations (SDs) of −1, −2, −3, and −4 were evaluated to identify the optimal threshold for QPET-MAP analysis. Results: A total of 104 patients were included. When QPET thresholds of SD = −1, −2, and −3 were used, complete resection of the QPET-MAP + region was significantly associated with seizure-free outcome when compared with the partial resection group (P = 0.023, P < 0.001, P = 0.006) or the no resection group (P = 0.002, P < 0.001, P = 0.001). The SD threshold of −2 showed the best combination of positive rate (55{\%}), sensitivity (0.68), specificity (0.88), positive predictive value (0.88), and negative predictive value (0.69). Surgical pathology of the resected QPET-MAP + areas revealed mainly FCD type I. Multiple QPET-MAP + regions were present in 12{\%} of the patients at SD = −2. Significance: Our study demonstrates a practical and effective approach to combine quantitative analyses of functional (QPET) and structural (MAP) imaging data to improve identification of subtle epileptic abnormalities. This approach can be readily adopted by epilepsy centers to improve postresective seizure outcomes for patients without apparent lesions on MRI.",
author = "Yicong Lin and Fang, {Yu Hua Dean} and Guiyun Wu and Jones, {Stephen E.} and Prayson, {Richard A.} and Moosa, {Ahsan N.V.} and Margit Overmyer and James Bena and Mykol Larvie and William Bingaman and Gonzalez-Martinez, {Jorge A.} and Najm, {Imad M.} and Alexopoulos, {Andreas V.} and Wang, {Z. Irene}",
year = "2018",
month = "8",
doi = "10.1111/epi.14474",
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Lin, Y, Fang, YHD, Wu, G, Jones, SE, Prayson, RA, Moosa, ANV, Overmyer, M, Bena, J, Larvie, M, Bingaman, W, Gonzalez-Martinez, JA, Najm, IM, Alexopoulos, AV & Wang, ZI 2018, 'Quantitative positron emission tomography–guided magnetic resonance imaging postprocessing in magnetic resonance imaging–negative epilepsies', Epilepsia, vol. 59, no. 8, pp. 1583-1594. https://doi.org/10.1111/epi.14474

Quantitative positron emission tomography–guided magnetic resonance imaging postprocessing in magnetic resonance imaging–negative epilepsies. / Lin, Yicong; Fang, Yu Hua Dean; Wu, Guiyun; Jones, Stephen E.; Prayson, Richard A.; Moosa, Ahsan N.V.; Overmyer, Margit; Bena, James; Larvie, Mykol; Bingaman, William; Gonzalez-Martinez, Jorge A.; Najm, Imad M.; Alexopoulos, Andreas V.; Wang, Z. Irene.

In: Epilepsia, Vol. 59, No. 8, 08.2018, p. 1583-1594.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Quantitative positron emission tomography–guided magnetic resonance imaging postprocessing in magnetic resonance imaging–negative epilepsies

AU - Lin, Yicong

AU - Fang, Yu Hua Dean

AU - Wu, Guiyun

AU - Jones, Stephen E.

AU - Prayson, Richard A.

AU - Moosa, Ahsan N.V.

AU - Overmyer, Margit

AU - Bena, James

AU - Larvie, Mykol

AU - Bingaman, William

AU - Gonzalez-Martinez, Jorge A.

AU - Najm, Imad M.

AU - Alexopoulos, Andreas V.

AU - Wang, Z. Irene

PY - 2018/8

Y1 - 2018/8

N2 - Objective: Detection of focal cortical dysplasia (FCD) is of paramount importance in epilepsy presurgical evaluation. Our study aims at utilizing quantitative positron emission tomography (QPET) analysis to complement magnetic resonance imaging (MRI) postprocessing by a morphometric analysis program (MAP) to facilitate automated identification of subtle FCD. Methods: We retrospectively included a consecutive cohort of surgical patients who had a negative preoperative MRI by radiology report. MAP was performed on T1-weighted volumetric sequence and QPET was performed on PET/computed tomographic data, both with comparison to scanner-specific normal databases. Concordance between MAP and QPET was assessed at a lobar level, and the significance of concordant QPET-MAP + abnormalities was confirmed by postresective seizure outcome and histopathology. QPET thresholds of standard deviations (SDs) of −1, −2, −3, and −4 were evaluated to identify the optimal threshold for QPET-MAP analysis. Results: A total of 104 patients were included. When QPET thresholds of SD = −1, −2, and −3 were used, complete resection of the QPET-MAP + region was significantly associated with seizure-free outcome when compared with the partial resection group (P = 0.023, P < 0.001, P = 0.006) or the no resection group (P = 0.002, P < 0.001, P = 0.001). The SD threshold of −2 showed the best combination of positive rate (55%), sensitivity (0.68), specificity (0.88), positive predictive value (0.88), and negative predictive value (0.69). Surgical pathology of the resected QPET-MAP + areas revealed mainly FCD type I. Multiple QPET-MAP + regions were present in 12% of the patients at SD = −2. Significance: Our study demonstrates a practical and effective approach to combine quantitative analyses of functional (QPET) and structural (MAP) imaging data to improve identification of subtle epileptic abnormalities. This approach can be readily adopted by epilepsy centers to improve postresective seizure outcomes for patients without apparent lesions on MRI.

AB - Objective: Detection of focal cortical dysplasia (FCD) is of paramount importance in epilepsy presurgical evaluation. Our study aims at utilizing quantitative positron emission tomography (QPET) analysis to complement magnetic resonance imaging (MRI) postprocessing by a morphometric analysis program (MAP) to facilitate automated identification of subtle FCD. Methods: We retrospectively included a consecutive cohort of surgical patients who had a negative preoperative MRI by radiology report. MAP was performed on T1-weighted volumetric sequence and QPET was performed on PET/computed tomographic data, both with comparison to scanner-specific normal databases. Concordance between MAP and QPET was assessed at a lobar level, and the significance of concordant QPET-MAP + abnormalities was confirmed by postresective seizure outcome and histopathology. QPET thresholds of standard deviations (SDs) of −1, −2, −3, and −4 were evaluated to identify the optimal threshold for QPET-MAP analysis. Results: A total of 104 patients were included. When QPET thresholds of SD = −1, −2, and −3 were used, complete resection of the QPET-MAP + region was significantly associated with seizure-free outcome when compared with the partial resection group (P = 0.023, P < 0.001, P = 0.006) or the no resection group (P = 0.002, P < 0.001, P = 0.001). The SD threshold of −2 showed the best combination of positive rate (55%), sensitivity (0.68), specificity (0.88), positive predictive value (0.88), and negative predictive value (0.69). Surgical pathology of the resected QPET-MAP + areas revealed mainly FCD type I. Multiple QPET-MAP + regions were present in 12% of the patients at SD = −2. Significance: Our study demonstrates a practical and effective approach to combine quantitative analyses of functional (QPET) and structural (MAP) imaging data to improve identification of subtle epileptic abnormalities. This approach can be readily adopted by epilepsy centers to improve postresective seizure outcomes for patients without apparent lesions on MRI.

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