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Neuroradiology

E2391. Comparative Analysis of FDG-PET/MRI Coregistration with MRI and PET for Cortical Dysplasia

Alle N1,  Huang J2,  Park J.1,2 1. University of California, Los Angeles, Los Angeles, CA; 2. West Los Angeles Veteran Affairs Medical Center, Los Angeles, CA

Address correspondence to N. Alle (nishaalle@mednet.ucla.edu)

Objective: Patients with cortical dysplasia (CD) present a challenge to diagnosis and treat because the abnormal area is sometimes not detected on MRI. FDG PET/MRI coregistration has emerged as an imaging tool for enhancing lesion identification and facilitates successful surgical management of patients with CD. Our study follows up a previous report on this technique from our center an explores potential pitfalls.

Materials and Methods: Fifty-four patients with 56 total resected lesions over a 6-year period in whom FDG PET/MRI coregistration was performed during presurgical evaluation for epilepsy were retrospectively reviewed. Imaging results were compared with MRI and FDG PET for patients with International League Against Epilepsy (ILAE) type I, type II, type III, and mixed CD.

Results: MRI identified patients with CD in 71% of type I, 95% of type II, and 91% of type III; FDG-PET identified CD in 71% of type I, 73% of type II, and 81% of type III. FDG PET/MRI coregistration identified 94% of type I, 80% of type II, and 91% of type III. FDG PET/MRI coregistration demonstrated significantly increased detection rates for type I CD compared to other modalities (p = 0.037). In all cases of type II CD with false-negative FDG PET/MRI coregistration, MRI demonstrated positive findings. All modalities identified 100% of mixed CD cases.

Conclusion: FDG PET/MRI coregistration enhances CD detection, particularly type I cases with false-negative MRI and FDG PET. In contrast, for type II CD, patients may have negative FDG PET/MRI coregistration studies despite positive MRI. Although benefits of coregistration technique are proven, awareness of this potential shortcoming is important.