PT - JOURNAL ARTICLE AU - William H. Theodore AU - Ashley R. Martinez AU - Omar I. Khan AU - Clarissa J. Liew AU - Sungyoung Auh AU - Irene M. Dustin AU - John Heiss AU - Susumu Sato TI - PET of Serotonin 1A Receptors and Cerebral Glucose Metabolism for Temporal Lobectomy AID - 10.2967/jnumed.112.103093 DP - 2012 Sep 01 TA - Journal of Nuclear Medicine PG - 1375--1382 VI - 53 IP - 9 4099 - http://jnm.snmjournals.org/content/53/9/1375.short 4100 - http://jnm.snmjournals.org/content/53/9/1375.full SO - J Nucl Med2012 Sep 01; 53 AB - The objective of this study was to compare 5-hydroxytryptamine receptor 1A (5-HT1A) PET with cerebral metabolic rate of glucose (CMRglc) PET for temporal lobectomy planning. Methods: We estimated 5-HT1A receptor binding preoperatively with 18F-trans-4-fluoro-N-2-[4-(2-methoxyphenyl) piperazin-1-yl]ethyl-N-(2-pyridyl) cyclohexane carboxamide (18F-FCWAY) PET and CMRglc measurement with 18F-FDG in regions drawn on coregistered MRI after partial-volume correction in 41 patients who had anterior temporal lobectomy with at least a 1-y follow-up. Surgery was tailored to individual preresection evaluations and intraoperative electrocorticography. Mean regional asymmetry values and the number of regions with asymmetry exceeding 2 SDs in 16 healthy volunteers were compared between seizure-free and non–seizure-free patients. 18F-FCWAY but not 18F-FDG and MRI data were masked for surgical decisions and outcome assessment. Results: Twenty-six of 41 (63%) patients seizure-free since surgery had significantly different mesial temporal asymmetries, compared with 15 non–seizure-free patients for both 18F-FCWAY (F1,39 = 5.87; P = 0.02) and 18F-FDG PET (F1,38 = 5.79; P = 0.021). The probability of being seizure-free was explained by both 18F-FDG and 18F-FCWAY PET, but not MRI, with a significant additional 18F-FCWAY effect (χ22 = 9.8796; P = 0.0072) after the probability of being seizure-free was explained by 18F-FDG. Although MRI alone was not predictive, any combination of 2 lateralizing imaging studies was highly predictive of seizure freedom. Conclusion: Our study provides class III evidence that both 5-HT1A receptor PET and CMRglc PET can contribute to temporal lobectomy planning. Additional studies should explore the potential for temporal lobectomy based on interictal electroencephalography and minimally invasive imaging studies.