Correlation Between PET and SISCOM in Temporal Lobe Epilepsy

Correlation Between PET and SISCOM in Temporal Lobe Epilepsy

Viviane Bouilleret, MD, PhD¹^,2, M. Paola Valenti, MD³, Edouard Hirsch, MD³, Franck Semah, MD¹ and Izzie J. Namer, MD, PhD⁴

¹ Service Hospitalier Frédéric Joliot, Commissariat à l’Energie Atomique, Orsay, France
² Service d’Explorations du Système Nerveux Central, Centre Hospitalier Universitaire du Kremlin Bicètre, Paris, France
³ Unité d’Explorations Fonctionnelles des Epilepsies, Clinique Neurologique, Centre Hospitalier Universitaire de Strasbourg, France
⁴ Faculté de Médecine, Institut de Physique Biologique, Strasbourg, France

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FIGURE 1. Images of representative patient. (A–C) First MRI (A), PET (B), and superimposed MRI-PET (C). (D–F) Second MRI obtained for SISCOM (D), difference SPECT (E), and SISCOM (F).

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FIGURE 2. PET and SISCOM abnormalities in ipsilateral and contralateral temporal lobe ( ${blacksquare}$ , PET and SISCOM abnormalities;

, PET abnormalities alone; ${square}$ , SISCOM abnormalities alone). (A) Mesial temporal structures. (B) Temporal pole. (C) Anterior part of superior temporal gyrus. (D) Posterior part of superior temporal gyrus.

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FIGURE 3. PET and SISCOM abnormalities in ipsilateral and contralateral temporal lobe ( ${blacksquare}$ , PET and SISCOM abnormalities;

, PET abnormalities alone; ${square}$ , SISCOM abnormalities alone). (A) Anterior part of middle temporal gyrus. (B) Posterior part of middle temporal gyrus. (C) Anterior part of inferior temporal gyrus. (D) Posterior part of inferior temporal gyrus. Functional changes occurred mainly in polar, mesial, and anterior ipsilateral regions. Polar region displayed higher rate of concordance between PET and SISCOM. In cases of discrepancy between PET and SISCOM, functional changes were in favor of PET in mesial and anterior temporal neocortex. Conversely, in posterior part of temporal gyrus, SISCOM abnormalities alone were more frequent. Note involvement of contralateral side in same way but to lesser extent.

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FIGURE 4. PET and SISCOM abnormalities in ipsilateral and contralateral frontal and perisylvian regions ( ${blacksquare}$ , PET and SISCOM abnormalities;

, PET abnormalities alone; ${square}$ , SISCOM abnormalities alone). (A) Orbitofrontal gyri and gyrus rectus. (B) Frontal pole and prefrontal cortex. (C) Insular gyri. (D) Cingulate gyrus. Note marked involvement of ipsilateral and contralateral orbitofrontal gyrus (A) and insular cortex (C) with high rate of concordance between PET and SISCOM. In cases of spreading functional changes, SISCOM abnormalities were more frequent (B and D).

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FIGURE 5. PET and SISCOM abnormalities in ipsilateral and contralateral central and posterior regions ( ${blacksquare}$ , PET and SISCOM abnormalities;

, PET abnormalities alone; ${square}$ , SISCOM abnormalities alone). (A) Precentral gyrus. (B) Postcentral gyrus. (C) Superior and inferior parietal gyri. (D) Temporo-parieto-occipital junction. Rate of concordance between PET and SISCOM in pre- and postcentral cortex (A and B), parietal region (C), and temporo-parieto-occipital junction (D) is similar. In cases of discrepancy between these examinations, SISCOM abnormalities were found to predominate.

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FIGURE 6. PET and SISCOM abnormalities in ipsilateral and contralateral occipital and subcortical regions ( ${blacksquare}$ , PET and SISCOM abnormalities;

, PET abnormalities alone; ${square}$ , SISCOM abnormalities alone). (A) Occipital cortex. (B) Thalamus. (C) Caudate nucleus. (D) Lenticular nucleus. SISCOM revealed mainly functional changes in basal ganglia (C and D) and thalamus (B). Such changes occurred in ipsilateral and contralateral hemispheres. SISCOM abnormalities were found to predominate in occipital regions (A).