PT  - JOURNAL ARTICLE
AU  - Khalaf, A.M.
AU  - Nadel, H.R.
AU  - Dahmoush, H.M.
TI  - Simultaneously Acquired MRI Arterial Spin-Labeling and Interictal FDG-PET Improves Diagnosis of Pediatric Temporal Lobe Epilepsy
AID  - 10.3174/ajnr.A7421
DP  - 2022 Mar 01
TA  - American Journal of Neuroradiology
PG  - 468--473
VI  - 43
IP  - 3
4099  - http://www.ajnr.org/content/43/3/468.short
4100  - http://www.ajnr.org/content/43/3/468.full
SO  - Am. J. Neuroradiol.2022 Mar 01; 43
AB  - BACKGROUND AND PURPOSE: Interictal FDG-PET scans are a routine diagnostic technique for the identification of epileptogenic foci in the presurgical work-up of medically refractory pediatric epilepsy. With the advent of PET/MR imaging, it has become possible to simultaneously acquire FDG-PET and arterial spin-labeling perfusion data. The objective of this study was to evaluate whether the incorporation of arterial spin-labeling data with interictal FDG-PET could improve the diagnostic performance metrics of FDG-PET for identification of epileptogenic foci.MATERIALS AND METHODS: Forty-five pediatric patients with a mean age of 10.8 years were retrospectively included in this study. These patients all underwent PET/MR imaging to diagnose suspected focal epilepsy.RESULTS: When compared to interpretations of interictal FDG findings alone, FDG combined with arterial spin-labeling findings resulted in significantly decreased sensitivity (0.64 versus 0.52, P = .02), significantly increased specificity (0.50 versus 0.75, P = .04), and an increased positive predictive value (0.59 versus 0.75). The decreased sensitivity was found to be primarily driven by patients with extratemporal lobe epilepsy, as a subgroup analysis showed decreased sensitivity for patients with extratemporal epilepsy (0.52 versus 0.38, P = .04), but not for temporal epilepsy (0.83 versus 0.75, P = .16). Additionally, substantial agreement between focal FDG hypometabolism and arterial spin-labeling hypoperfusion was demonstrated with the Cohen κ (0.70, P < .01).CONCLUSIONS: These findings suggest that simultaneously acquired interictal FDG-PET and arterial spin-labeling data can improve the diagnosis of epileptogenic foci, especially in the setting of temporal lobe epilepsy where they improve specificity and positive predictive value, with preservation of sensitivity.ASLarterial spin-labelingMEGmagnetoencephalographyTc99m-ECDtechnetium Tc99m ethyl cysteinate dimmersEEGstereotactic electroencephalogramvEEGvideo electroencephalogram