Comparison of the diagnostic accuracy of PET/MRI to PET/CT-acquired FDG brain exams for seizure focus detection: a prospective study

• Published in: Pediatric radiology 2017-10, Vol.47 (11), p.1500-1507
• Main Authors: Paldino, Michael J., Yang, Erica, Jones, Jeremy Y., Mahmood, Nadia, Sher, Andrew, Zhang, Wei, Hayatghaibi, Shireen, Krishnamurthy, Ramkumar, Seghers, Victor
• Format: Article
• Language: English
• Subjects: Accuracy; Adolescent; Attenuation; Brain; Child; Child, Preschool; Children; Computed tomography; Deoxyglucose; Diagnosis; Diagnostic systems; Emission analysis; Epilepsy; Epilepsy - diagnostic imaging; Female; Females; Fluorine; Fluorodeoxyglucose F18; Humans; Image acquisition; Image quality; Imaging; Infant; Informed consent; Localization; Magnetic Resonance Imaging; Male; Males; Medical diagnosis; Medicine; Medicine & Public Health; Multimodal Imaging; Neuroimaging; Neuroradiology; Nuclear Medicine; Occupational health; Oncology; Original Article; Patients; Pediatrics; Population studies; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography; Prospective Studies; Quality assessment; Radioisotopes; Radiology; Radiopharmaceuticals; Readers; Seizing; Seizures; Surgery; Tomography; Ultrasound; Young Adult
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-017-3888-8

Background There is great interest in positron emission tomography (PET)/magnetic resonance (MR) as a clinical tool due to its capacity to provide diverse diagnostic information in a single exam. Objective The goal of this exam is to compare the diagnostic accuracy of PET/MR-acquired [F-18]2-fluoro-2-deoxyglucose (FDG) brain exams to that of PET/CT with respect to identifying seizure foci in children with localization-related epilepsy. Materials and methods Institutional Review Board approval and informed consent were obtained for this Health Insurance Portability and Accountability Act-compliant, prospective study. All patients referred for clinical FDG-PET/CT exams of the brain at our institution for a diagnosis of localization-related epilepsy were prospectively recruited to undergo an additional FDG-PET acquisition on a tandem PET/MR system. Attenuation-corrected FDG images acquired at PET/MR and PET/CT were interpreted independently by five expert readers. Readers were blinded to the scanner used for acquisition and attenuation correction as well as all other clinical and imaging data. A Likert scale scoring system (1-5) was used to assess image quality. The locale of seizure origin determined at multidisciplinary epilepsy surgery work rounds was considered the reference standard. Non-inferiority testing for paired data was used to compare the diagnostic accuracy of PET/MR to that of PET/CT. Results The final study population comprised 35 patients referred for a diagnosis of localization-related epilepsy (age range: 2-19 years; median: 11 years; 21 males, 14 females). Image quality did not differ significantly between the two modalities. The accuracy of PET/MR was not inferior to that of PET/CT for localization of a seizure focus ( P =0.017). Conclusion The diagnostic accuracy of FDG-PET images acquired on a PET/MR scanner and generated using MR-based attenuation correction was not inferior to that of PET images processed by traditional CT-based correction.