Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex

E. Asano, Diane C. Chugani, O. Muzik, C. Shen, C. Juhász, J. Janisse, J. Ager, A. Canady, J. R. Shah, A. K. Shah, Craig Watson, H. T. Chugani

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

Objective: Using interictal α-[11C]methyl-L-tryptophan ([11C]AMT) PET scan, the authors have undertaken a quantitative analysis of all tubers visible on MRI or 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) PET, to determine the relationship between [11C]AMT uptake and epileptic activity on EEG. Background: Tuberous sclerosis complex (TSC is an autosomal dominant disorder, often associated with cortical tubers and intractable epilepsy. The authors have shown previously that [11C]AMT PET scans show high tracer uptake in some epileptogenic tubers and low uptake in the remaining tubers. Methods: Eighteen children, age 7 months to 16 years, were studied. Patients underwent video-EEG monitoring, PET scans of [11C]AMT and [18F]FDG, and T2-weighted or fluid-attenuated inversion recovery (FLAIR) MRI. [11C]AMT uptake values were measured in 258 cortical tubers delineated with coregistered MRI or [18F]FDG scans. Uptake ratios were calculated between the [11C]AMT uptake in tubers and those for normal cortex (tuber/normal cortex. Using the region of epileptiform activity, the authors performed receiver operator characteristics (ROC) analysis and determined the optimal uptake ratio for detecting presumed epileptogenic tubers. Results: Tuber uptake ratios ranged from 0.6 to 2.0. Tuber uptake ratios in the epileptic lobes were higher than those in the nonepileptic lobes (p < 0.0001). All 15 patients with focal seizure activity showed one or more lesions with uptake ratio above 0.98 in the epileptic lobe. ROC analysis showed that a tuber uptake ratio of 0.98 resulted in a specificity of 0.91. Conclusions: Cortical tubers with [11C]AMT uptake greater than or equal to normal cortex are significantly related to epileptiform activity in that lobe. Together, interictal [11C]AMT PET and FLAIR MRI improve the detection of potentially epileptogenic tubers in patients with TSC being evaluated for epilepsy surgery.

Original languageEnglish (US)
Pages (from-to)1976-1984
Number of pages9
JournalNeurology
Volume54
Issue number10
StatePublished - May 23 2000
Externally publishedYes

Fingerprint

Tuberous Sclerosis
Fluorodeoxyglucose F18
Positron-Emission Tomography
Electroencephalography
Tryptophan
Epilepsy
Seizures

Keywords

  • α-[C]methyl-L- tryptophan
  • Epilepsy surgery
  • Neuroimaging
  • PET
  • Quinolinic acid
  • Serotonin
  • Tuberous sclerosis complex

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Asano, E., Chugani, D. C., Muzik, O., Shen, C., Juhász, C., Janisse, J., ... Chugani, H. T. (2000). Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex. Neurology, 54(10), 1976-1984.

Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex. / Asano, E.; Chugani, Diane C.; Muzik, O.; Shen, C.; Juhász, C.; Janisse, J.; Ager, J.; Canady, A.; Shah, J. R.; Shah, A. K.; Watson, Craig; Chugani, H. T.

In: Neurology, Vol. 54, No. 10, 23.05.2000, p. 1976-1984.

Research output: Contribution to journalArticle

Asano, E, Chugani, DC, Muzik, O, Shen, C, Juhász, C, Janisse, J, Ager, J, Canady, A, Shah, JR, Shah, AK, Watson, C & Chugani, HT 2000, 'Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex', Neurology, vol. 54, no. 10, pp. 1976-1984.
Asano E, Chugani DC, Muzik O, Shen C, Juhász C, Janisse J et al. Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex. Neurology. 2000 May 23;54(10):1976-1984.
Asano, E. ; Chugani, Diane C. ; Muzik, O. ; Shen, C. ; Juhász, C. ; Janisse, J. ; Ager, J. ; Canady, A. ; Shah, J. R. ; Shah, A. K. ; Watson, Craig ; Chugani, H. T. / Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex. In: Neurology. 2000 ; Vol. 54, No. 10. pp. 1976-1984.
@article{8e0369008c104b6988432893f938315d,
title = "Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex",
abstract = "Objective: Using interictal α-[11C]methyl-L-tryptophan ([11C]AMT) PET scan, the authors have undertaken a quantitative analysis of all tubers visible on MRI or 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) PET, to determine the relationship between [11C]AMT uptake and epileptic activity on EEG. Background: Tuberous sclerosis complex (TSC is an autosomal dominant disorder, often associated with cortical tubers and intractable epilepsy. The authors have shown previously that [11C]AMT PET scans show high tracer uptake in some epileptogenic tubers and low uptake in the remaining tubers. Methods: Eighteen children, age 7 months to 16 years, were studied. Patients underwent video-EEG monitoring, PET scans of [11C]AMT and [18F]FDG, and T2-weighted or fluid-attenuated inversion recovery (FLAIR) MRI. [11C]AMT uptake values were measured in 258 cortical tubers delineated with coregistered MRI or [18F]FDG scans. Uptake ratios were calculated between the [11C]AMT uptake in tubers and those for normal cortex (tuber/normal cortex. Using the region of epileptiform activity, the authors performed receiver operator characteristics (ROC) analysis and determined the optimal uptake ratio for detecting presumed epileptogenic tubers. Results: Tuber uptake ratios ranged from 0.6 to 2.0. Tuber uptake ratios in the epileptic lobes were higher than those in the nonepileptic lobes (p < 0.0001). All 15 patients with focal seizure activity showed one or more lesions with uptake ratio above 0.98 in the epileptic lobe. ROC analysis showed that a tuber uptake ratio of 0.98 resulted in a specificity of 0.91. Conclusions: Cortical tubers with [11C]AMT uptake greater than or equal to normal cortex are significantly related to epileptiform activity in that lobe. Together, interictal [11C]AMT PET and FLAIR MRI improve the detection of potentially epileptogenic tubers in patients with TSC being evaluated for epilepsy surgery.",
keywords = "α-[C]methyl-L- tryptophan, Epilepsy surgery, Neuroimaging, PET, Quinolinic acid, Serotonin, Tuberous sclerosis complex",
author = "E. Asano and Chugani, {Diane C.} and O. Muzik and C. Shen and C. Juh{\'a}sz and J. Janisse and J. Ager and A. Canady and Shah, {J. R.} and Shah, {A. K.} and Craig Watson and Chugani, {H. T.}",
year = "2000",
month = "5",
day = "23",
language = "English (US)",
volume = "54",
pages = "1976--1984",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex

AU - Asano, E.

AU - Chugani, Diane C.

AU - Muzik, O.

AU - Shen, C.

AU - Juhász, C.

AU - Janisse, J.

AU - Ager, J.

AU - Canady, A.

AU - Shah, J. R.

AU - Shah, A. K.

AU - Watson, Craig

AU - Chugani, H. T.

PY - 2000/5/23

Y1 - 2000/5/23

N2 - Objective: Using interictal α-[11C]methyl-L-tryptophan ([11C]AMT) PET scan, the authors have undertaken a quantitative analysis of all tubers visible on MRI or 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) PET, to determine the relationship between [11C]AMT uptake and epileptic activity on EEG. Background: Tuberous sclerosis complex (TSC is an autosomal dominant disorder, often associated with cortical tubers and intractable epilepsy. The authors have shown previously that [11C]AMT PET scans show high tracer uptake in some epileptogenic tubers and low uptake in the remaining tubers. Methods: Eighteen children, age 7 months to 16 years, were studied. Patients underwent video-EEG monitoring, PET scans of [11C]AMT and [18F]FDG, and T2-weighted or fluid-attenuated inversion recovery (FLAIR) MRI. [11C]AMT uptake values were measured in 258 cortical tubers delineated with coregistered MRI or [18F]FDG scans. Uptake ratios were calculated between the [11C]AMT uptake in tubers and those for normal cortex (tuber/normal cortex. Using the region of epileptiform activity, the authors performed receiver operator characteristics (ROC) analysis and determined the optimal uptake ratio for detecting presumed epileptogenic tubers. Results: Tuber uptake ratios ranged from 0.6 to 2.0. Tuber uptake ratios in the epileptic lobes were higher than those in the nonepileptic lobes (p < 0.0001). All 15 patients with focal seizure activity showed one or more lesions with uptake ratio above 0.98 in the epileptic lobe. ROC analysis showed that a tuber uptake ratio of 0.98 resulted in a specificity of 0.91. Conclusions: Cortical tubers with [11C]AMT uptake greater than or equal to normal cortex are significantly related to epileptiform activity in that lobe. Together, interictal [11C]AMT PET and FLAIR MRI improve the detection of potentially epileptogenic tubers in patients with TSC being evaluated for epilepsy surgery.

AB - Objective: Using interictal α-[11C]methyl-L-tryptophan ([11C]AMT) PET scan, the authors have undertaken a quantitative analysis of all tubers visible on MRI or 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) PET, to determine the relationship between [11C]AMT uptake and epileptic activity on EEG. Background: Tuberous sclerosis complex (TSC is an autosomal dominant disorder, often associated with cortical tubers and intractable epilepsy. The authors have shown previously that [11C]AMT PET scans show high tracer uptake in some epileptogenic tubers and low uptake in the remaining tubers. Methods: Eighteen children, age 7 months to 16 years, were studied. Patients underwent video-EEG monitoring, PET scans of [11C]AMT and [18F]FDG, and T2-weighted or fluid-attenuated inversion recovery (FLAIR) MRI. [11C]AMT uptake values were measured in 258 cortical tubers delineated with coregistered MRI or [18F]FDG scans. Uptake ratios were calculated between the [11C]AMT uptake in tubers and those for normal cortex (tuber/normal cortex. Using the region of epileptiform activity, the authors performed receiver operator characteristics (ROC) analysis and determined the optimal uptake ratio for detecting presumed epileptogenic tubers. Results: Tuber uptake ratios ranged from 0.6 to 2.0. Tuber uptake ratios in the epileptic lobes were higher than those in the nonepileptic lobes (p < 0.0001). All 15 patients with focal seizure activity showed one or more lesions with uptake ratio above 0.98 in the epileptic lobe. ROC analysis showed that a tuber uptake ratio of 0.98 resulted in a specificity of 0.91. Conclusions: Cortical tubers with [11C]AMT uptake greater than or equal to normal cortex are significantly related to epileptiform activity in that lobe. Together, interictal [11C]AMT PET and FLAIR MRI improve the detection of potentially epileptogenic tubers in patients with TSC being evaluated for epilepsy surgery.

KW - α-[C]methyl-L- tryptophan

KW - Epilepsy surgery

KW - Neuroimaging

KW - PET

KW - Quinolinic acid

KW - Serotonin

KW - Tuberous sclerosis complex

UR - http://www.scopus.com/inward/record.url?scp=0034705014&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034705014&partnerID=8YFLogxK

M3 - Article

C2 - 10822440

AN - SCOPUS:0034705014

VL - 54

SP - 1976

EP - 1984

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 10

ER -