Journal
EPILEPSY RESEARCH
Volume 172, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.eplepsyres.2021.106583
Keywords
PET; MRI; PET; CT; Drug-resistant epilepsy; Fluorodeoxyglucose; MRI-based attenuation correction
Categories
Funding
- PSI Foundation Resident Research Grant
- Mitacs Accelerate
- SJHCF
- MultiMagnetics Inc
- London X-Ray Associates
- Lawson Health Research Institute Internal Research Fund
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This study demonstrates that PET/MRI with optimal MRAC can achieve similar diagnostic performance as PET/CT in drug-resistant epilepsy, suggesting the potential value of PET/MRI in clinical practice for epilepsy imaging.
Objective: 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. Materials and methods: 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). Results: 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 <5% in most brain regions except the inferior temporal gyrus, temporal pole, and cerebellum. Diagnostic accuracy and sensitivity were similar between PET/ MRI and PET/CT (87 % vs. 85 % and 83 % vs. 83 %, respectively). Conclusion: We demonstrate here that PET/MRI with optimal MRAC can yield similar diagnostic performance as PET/CT. Nevertheless, further exploration of the potential added value of PET/MRI is necessary before clinical adoption of PET/MRI for epilepsy imaging.
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