Article Figures & Data
Figures
- Fig 1.
Receiver operating characteristic curves for SUVr, CBF, and combined SUVr and CBF to predict EZ. The combined PET and ASL obtain the highest area under the curve (0.970) with high sensitivity (100%) and specificity (90.9%). PET has more diagnostic information with an area under the curve of 0.926, compared with ASL (area under the curve of 0.679). The combined PET and ASL show the best performance in specificity for predicating EZ.
- Fig 2.
FCD type Ib in a 23-year-old patient with a history of seizures, onset at 14 years of age. A, T1-weighted axial image has normal findings. B and C, PET and PET-T1WI fused images (arrow) indicate a well-defined area of focal hypometabolism in the left temporal lobe region. D and E, ASL and ASL-T1WI fused images (arrow) show hypoperfusion in the same brain region. After a left anterior temporal lobectomy, histopathologic findings showed FCD type Ib. After a postoperative follow-up of at least 1 year, the patient was classified as having an Engel class I outcome.
- Fig 3.
FCD type IIIa–HS in a 29-year-old patient with a history of seizures, onset at 15 years of age. A, T1-weighted axial image has normal findings. B and C, PET and PET-T1WI fused images (arrows) indicate a well-defined area of focal hypometabolism in the left temporal lobe region. However, ASL and ASL-T1WI fused images (D and E, arrows) have normal findings in the same brain region. After a left anterior temporal lobectomy, histopathologic findings of the surgical specimen were consistent with FCD type IIIa–HS. This patient with TLE had an Engel class I outcome after >1 year of follow-up.
- Fig 4.
FCD type I in a 26-year-old patient with a history of seizure onset at 14 years of age. The T1-weighted axial image (A), PET image (B), and fused image (C) have normal findings. D and E, ASL and ASL-T1WI fused images (circles) show a well-defined area of focal hypoperfusion in the left temporal lobe region. After a left temporal lobe resection, pathologic findings were consistent with FCD type I. The patient had a follow-up time of >1 year, showing Engel class I outcome.
- Fig 5.
Regional comparison across the 20 patients for ROIs with hypometabolism in PET and hypoperfusion in ASL (r = 0.587, P < .001).
- Fig 6.
SPM analysis of [18F] FDG-PET images in localizing the EZ between patients and healthy controls. The hypometabolic region is mainly identified in the middle temporal gyrus. The threshold P value is set at .001.
- Fig 7.
Brain regions of metabolism and perfusion asymmetry of patients compared with controls by SPM analysis in PET (A) and ASL images (B), respectively. The regions of metabolism and perfusion asymmetry are mainly identified in the middle temporal gyrus and superior temporal gyrus, respectively. The threshold P value is set at .001.
Tables
Patient No. Sex Age (yr) Age at Onset (yr) Epilepsy Duration (yr) Seizure Frequency Side of Operation Histopathology 1 F 26 14 12 4–5 Times/mo Left Left temporal region (FCD type I) 2 M 28 7 21 1–2 Times/day Left Left temporal region (FCD type I) 3 M 31 26 5 2–4 Times/mo Left Left temporal region (FCD type I) 4 M 23 14 9 2–5 Times/mo Left Left temporal region (FCD type Ib) 5 M 29 15 14 6–8 Times/mo Left Left temporal region (FCD type IIIa-HS) 6 F 24 12 12 2–3 Times/day Left Left temporal region (FCD type IIIa-HS) 7 F 38 17 21 3–5 Times/mo Left Left temporal region (FCD type IIIa-HS) 8 F 27 2 25 2–3 Times/mo Right Right temporal region (FCD type IIIa-HS) 9 M 23 16 7 3–4 Times/mo Right Right temporal region (FCD type I) 10 F 14 8 6 2–3 Times/day Left Left temporal region (FCD type I) 11 M 16 10 6 6–9 Times/mo Left Left temporal region (FCD type I) 12 M 26 14 12 3–4 Times/mo Right Right temporal region (FCD type I) 13 M 29 5 24 1 Time/day Right Right temporal region (FCD type I) 14 F 16 13 3 1 Time/mo Right Right temporal region (FCD type Ib) 15 M 24 11 13 2–4 Times/mo Right Right temporal region (FCD type IIIa-HS) 16 M 35 12 23 3–5 Times/mo Right Right temporal region (FCD type Ic) 17 M 19 14 5 3 Times/mo Right Right temporal region (FCD type Ib) 18 M 22 15 7 7–8 Times/mo Right Right temporal region (FCD type Ic) 19 M 17 1 16 1–2 Times/mo Left Left temporal region (FCD type Ic) 20 F 52 12 40 2–3 Times/mo Left Left temporal region (FCD type Ic) Patient No. PET Findings in PET/MR Imaging ASL Findings in PET/MR Imaging Histopathology 1 Normal Left temporal Left temporal region (FCD type I) 2 Left parietal and temporal Left frontal, parietal, and temporal Left temporal region (FCD type I) 3 Left temporal Negative Left temporal region (FCD type I) 4 Left temporal Left temporal Left temporal region (FCD type Ib) 5 Left temporal Negative Left temporal region (FCD type IIIa-HS) 6 Left temporal Left temporal Left temporal region (FCD type IIIa-HS) 7 Left frontal, parietal, and temporal Left frontal, parietal, and temporal Left temporal region (FCD type IIIa-HS) 8 Right temporal Negative Right temporal region (FCD type IIIa-HS) 9 Right temporal Right temporal Right temporal region (FCD type I) 10 Left temporal Left temporal Left temporal region (FCD type I) 11 Left frontal, parietal, and temporal Left frontal, parietal, and temporal Left temporal region (FCD type I) 12 Right temporal Right temporal Right temporal region (FCD type I) 13 Left frontal and right temporal Right temporal Right temporal region (FCD type I) 14 Right temporal Negative Right temporal region (FCD type Ib) 15 Right temporal Right temporal Right temporal region (FCD type IIIa-HS) 16 Left temporal Left temporal Right temporal region (FCD type Ic) 17 Right temporal Right temporal Right temporal region (FCD type Ib) 18 Right temporal Right temporal Right temporal region (FCD type Ic) 19 Right temporal Negative Left temporal region (FCD type Ic) 20 Left temporal Negative Left temporal region (FCD type Ic)
