An evaluation of the diagnostic equivalence of 18F-FDG-PET between hybrid PET/MRI and PET/CT in drug-resistant epilepsy: A pilot study

•Visual assessments of PET/MRI and PET/CT images were similar and yielded comparable diagnostic outcome in our DRE cohort.•Quantitative FDG-PET bias between PET/MRI and PET/CT was low and of no practical significance.•PET/MRI with optimal brain MRAC can yield similar diagnostic performance as PET/CT...

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Published in:Epilepsy research 2021-05, Vol.172, p.106583-106583, Article 106583
Main Authors: Poirier, Stefan E., Kwan, Benjamin Y.M., Jurkiewicz, Michael T., Samargandy, Lina, Iacobelli, Maryssa, Steven, David A., Lam Shin Cheung, Victor, Moran, Gerald, Prato, Frank S., Thompson, R. Terry, Burneo, Jorge G., Anazodo, Udunna C., Thiessen, Jonathan D.
Format: Article
Language:English
Subjects:
Drug-resistant epilepsy
Fluorodeoxyglucose
MRI-based attenuation correction
PET/CT
PET/MRI
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Summary:•Visual assessments of PET/MRI and PET/CT images were similar and yielded comparable diagnostic outcome in our DRE cohort.•Quantitative FDG-PET bias between PET/MRI and PET/CT was low and of no practical significance.•PET/MRI with optimal brain MRAC can yield similar diagnostic performance as PET/CT.•Hybrid PET/MRI can reliably detect SOZ in DRE and is a promising tool for enhancing epilepsy treatment and management. Hybrid PET/MRI may improve detection of seizure-onset zone (SOZ) in drug-resistant epilepsy (DRE), however, concerns over PET bias from MRI-based attenuation correction (MRAC) have limited clinical adoption of PET/MRI. This study evaluated the diagnostic equivalency and potential clinical value of PET/MRI against PET/CT in DRE. MRI, FDG-PET and CT images (n = 18) were acquired using a hybrid PET/MRI and a CT scanner. To assess diagnostic equivalency, PET was reconstructed using MRAC (RESOLUTE) and CT-based attenuation correction (CTAC) to generate PET/MRI and PET/CT images, respectively. PET/MRI and PET/CT images were compared qualitatively through visual assessment and quantitatively through regional standardized uptake value (SUV) and z-score assessment. Diagnostic accuracy and sensitivity of PET/MRI and PET/CT for SOZ detection were calculated through comparison to reference standards (clinical hypothesis and histopathology, respectively). Inter-reader agreement in visual assessment of PET/MRI and PET/CT images was 78 % and 81 %, respectively. PET/MRI and PET/CT were strongly correlated in mean SUV (r = 0.99, p < 0.001) and z-scores (r = 0.92, p < 0.001) across all brain regions. MRAC SUV bias was
ISSN:0920-1211
1872-6844
DOI:10.1016/j.eplepsyres.2021.106583