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The Utility of a 3-Dimensional, Large-Field-Of-View, Sodium Iodide Crystal–Based PET Scanner in the Presurgical Evaluation of Partial Epilepsy

Australian Center for Clinical Neuropharmacology and Victorian Epilepsy Centres, St. Vincent’s, Royal Melbourne, and Alfred Hospitals, Fitzroy, Victoria; and Center for Positron Emission, Peter MacCallum Cancer Institute, University of Melbourne, Fitzroy, Victoria, Australia

View larger version (87K): [in a new window]   FIGURE 1. (A) From left to right, axial (plane of acquisition) and reformatted coronal and sagittal FDG PET images from 39-y-old man with medically refractory right TLE show prominent focal hypometabolism anteromesially in right temporal lobe. (B) MR images show no significant abnormalities.

View larger version (71K): [in a new window]   FIGURE 2. Axial and coronal FDG PET (A), proton density–weighted MRI (B), and T2-weighted MRI (C) images from 13-y-old girl with medically refractory extratemporal seizures. MRI findings were initially reported as normal, whereas FDG PET showed region of focal hypometabolism around left inferior rolandic area (arrows). Review of MR images showed small region of cortical signal change with blurring of gray matter–white matter junction corresponding to region of PET hypometabolism, consistent with focal cortical dysplasia.

View larger version (88K): [in a new window]   FIGURE 3. From left to right, coronal, sagittal, and axial FDG PET images (A) from patient with right temporal lobe seizures (on ictal EEG) but normal MRI findings (B). Interpretation of FDG PET images was discordant between the 2 independent reviewers, with 1 initially diagnosing right temporal hypometabolism with low confidence. On joint review, reviewers decided that PET images were nonlocalizing.