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Differential Features of Metabolic Abnormalities Between Medial and Lateral Temporal Lobe Epilepsy: Quantitative Analysis of ¹⁸F-FDG PET Using SPM

¹ Department of Nuclear Medicine, Seoul National University, College of Medicine, Seoul, Korea
² Department of Neurology, Seoul National University, College of Medicine, Seoul, Korea
³ Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Korea
⁴ Department of Diagnostic Radiology, Seoul National University, College of Medicine, Seoul, Korea
⁵ Department of Pathology, Seoul National University, College of Medicine, Seoul, Korea

Because limited resection could yield an equally good surgical outcome as standard anterior resection in temporal lobe epilepsy (TLE), the differentiation of medial from lateral TLE is important. We tried to find the differential features in metabolic abnormalities between medial and lateral TLE groups using quantitative analysis including statistical parametric mapping (SPM). Methods: We examined 113 ¹⁸F-FDG PET scans of TLE patients who had surgically and pathologically proven lesions and a good surgical outcome (78 medial TLE, 35 lateral TLE). Each scan was compared with those of 22 healthy control subjects to detect hypometabolic regions using a t test of the SPM method and interhemispheric asymmetry using 2-group, 2-condition analysis on SPM. Group analysis was performed between medial and lateral TLE using mirrored PET images. The sensitivity was defined as the detection rate of hypometabolism in the ipsilateral temporal lobes, and the specificity was defined as the nondetection rate in the contralateral lobes. The extent of the hypometabolism was calculated as the number of significant voxels, and the severity was calculated by the asymmetry index (ASI), in the medial or lateral temporal lobes on Statistical Probabilistic Anatomical Map template images. Results: The hypometabolism in the temporal lobes was detected ipsilateral to the seizure focus in 76% of the TLE patients (76% in medial TLE, 77% in lateral TLE) but on the contralateral temporal lobes in 32% of the patients. After considering interhemispheric temporal asymmetry, the sensitivity was found to be 89%, and the specificity was 91% without differences between the medial and lateral TLE groups. In both medial and the lateral TLE, the hypometabolism was more prominent in the lateral cortical structures than in the medial structures. The hypometabolism in the medial temporal structures was found less frequently in the lateral TLE group, and the extent of the hypometabolism was significantly larger in the medial TLE group. ASIs of the medial temporal structure and superior temproral gyrus of lateral temporal structure were significantly higher in the medial TLE. Conclusion: SPM analysis of ¹⁸F-FDG PET in TLE patients could localize accurately the seizure focus and helped in the discrimination of the medial TLE from the lateral TLE. We suggest the lateral TLE, rather than the medial TLE, should be considered when glucose metabolism is relatively preserved in the medial temporal structures.

Key Words: temporal lobe epilepsy • ¹⁸F-FDG PET • statistical parametric mapping

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