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Performance of PET imaging for the localization of epileptogenic zone in patients with epilepsy: a meta-analysis

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Abstract

Objectives

The aim of this meta-analysis was to estimate the clinical use value of 11C-FMZ and 18F-FDG in PET for the localization of epileptogenic zone and to provide evidence for practitioners’ clinical decision-making.

Methods

We searched PubMed and Embase in a time frame from inception to May 31, 2020. Studies utilizing FMZ or FDG-PET or FDG-PET/MRI used in patients with epilepsy, with EEG or surgical outcomes as the gold standard and corresponding outcomes such as concordance rates of PET or PET/MRI scan compared with reference standard, absolute numbers of participants with true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) results in FDG or FMZ PET. Pooled concordance rates, overall sensitivity, and specificity of 11C-FMZ-PET and 18F-FDG-PET were calculated.

Results

In total, 44 studies met the inclusion criteria. The pooled concordance rates of FDG-PET, FMZ-PET, and FDG-PET/MRI coregistration compared with reference standard were 0.67 (95% CI: 0.60–0.73), 0.75 (95% CI: 0.57–0.93), and 0.93 (95% CI: 0.89–0.97), respectively. The concordance rate of 18F-FDG-PET in patients with temporal lobe epilepsy (TLE) was 0.79 (0.63; 0.92). The overall sensitivity and specificity of 18F-FDG-PET were 0.66 (95% CI: 0.58–0.73) and 0.71 (95% CI: 0.63–0.78), respectively. 11C-FMZ-PET displayed an overall sensitivity of 0.62 (95% CI: 0.49–0.73) and specificity of 0.73 (95% CI: 0.59–0.84).

Conclusions

Both 11C-FMZ PET and 18F-FDG PET are the choice of modalities for the localization of epileptogenic zone, especially when coregistered with MRI.

Key Points

• 11 C-FMZ-PET may be more helpful than 18 F-FDG-PET in the localization of epilepsy foci.

• Coregistration of FDG-PET and MRI is recommended in the localization of epileptogenic zone.

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Abbreviations

11C-FMZ:

11C-flumazenil

18F-FDG:

18F-2-fluoro-2-deoxy-D-glucose

AEDs:

Antiepileptic drugs

AMT:

a-Methyl-L-tryptophan

AUCs:

Area under the sROC curves

CIs:

Confidence intervals

EEG:

Electroencephalograph

FLE:

Frontal lobe epilepsy

FN:

False negative

FP:

False positive

LR:

Likelihood ratio

MRI:

Magnetic resonance imaging

NMDA:

N-Methyl-d-aspartate

OR:

Odds ratio

PET:

Positron emission tomography

PRISMA:

The Preferred Reporting Items for Systematic Review and Meta-analysis

QUADAS:

Quality assessment of diagnostic accuracy studies

SPECT:

Single-photon emission computed tomography

sROC:

Summarized receiver operating characteristic curves

TLE:

Temporal lobe epilepsy

TN:

True negative

TP:

True positive

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Acknowledgments

We thank the National Natural Science Foundation of China, Capital’s Funds for Health Improvement and Research (CFH), and CAMS Innovation Fund for Medical Sciences (CIFMS) for the financial support.

Funding

This work was sponsored in part by the National Natural Science Foundation of China (Grant No. 81571713), Capital’s Funds for Health Improvement and Research (CFH) (Grant No. 2016-2-40115), and CAMS Innovation Fund for Medical Sciences (CIFMS) (Grant Nos. 2016-I2M-4-003, 2017-I2M-3-001, 2018-I2M-3-001).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China

    Na Niu, Haiqun Xing, Meiqi Wu, Yanru Ma, Yimin Liu, Jiantao Ba, Shikun Zhu, Fang Li & Li Huo

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Correspondence to Li Huo.

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The scientific guarantor of this publication is Li Huo (huoli@pumch.cn).

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was not required for this study because this was a meta-analysis using the studies in published literature and did not analyze specific human subjects.

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Niu, N., Xing, H., Wu, M. et al. Performance of PET imaging for the localization of epileptogenic zone in patients with epilepsy: a meta-analysis. Eur Radiol 31, 6353–6366 (2021). https://doi.org/10.1007/s00330-020-07645-4

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