Main Logo
Logo

Society for Pediatric Radiology – Poster Archive

  147
  0
  0
 
 


Final ID: Poster #: EDU-094

Pearls and Pitfalls in FDG PET Brain Imaging in Pediatric Epilepsy

Purpose or Case Report: The goal of this educational exhibit is to explore the utility of interictal FDG PET brain imaging in the evaluation of intractable, drug-resistant cases of pediatric epilepsy and to clarify its role in pre-surgical seizure focus localization. We will also explore the salient pearls and pitfalls of FDG PET brain imaging.
Methods & Materials: Retrospective review of key cases of interictal FDG PET brain imaging in pediatric epilepsy:

Normal brain FDG PET uptake in children:
- Normal distribution at different ages
- Normal variance in temporal lobes

Indications for FDG PET in epilepsy:
-When initial MRI is negative, interictal FDG PET can spotlight an area of concern and second-look MRI may uncover an inconspicuous seizure focus. (Figure 1. Initial MRI was negative except for hippocampal inversion. Hypometabolic activity was seen on FDG PET throughout the left temporal lobe, and on second look MRI, corresponding FLAIR abnormality was seen in the temporal lobe.
-Evaluation of post-operative areas difficult to assess with EEG (Figure 2. Hypometabolic activity was seen in the occipital lobe, which extended beyond the resection cavity and corresponded to areas of abnormal EEG activity).
-Isolating a target lesion when there is more than one area of abnormality (i.e. focal nodular heterotopia or tuberous sclerosis)
-Differentiate inflammation/limbic encephalitis from other seizure etiologies (i.e. focal cortical dysplasia or low grade glioma)

Utility of fusion techniques, comparison with ictal SPECT, and other hybrid imaging:
-Fusing PET with MRI enhances detection of subtle structural abnormalities
-Comparison of sensitivity with ictal SPECT
-Other hybrid imaging such as fusion with EEG or stereo grids can help localize seizure focus

Major artifacts and pitfalls in interpretation:
-metallic and motion artifact
-areas of ictal activity
-calculated attenuation difference due to skull thickness
-hyperglycemia
-drug related hypo- or hypermetabolism

The future:
-New tracers
-Utility of quantitative evaluation to confirm areas of hypometabolism
Results: This exhibit will review indications for interictal FDG-PET brain imaging and its utility in the multimodal work-up of pediatric epilepsy. Pearls and pitfalls in imaging will be discussed, including review of the normal distribution of FDG PET and major artifacts.
Conclusions: Recognizing the utility of FDG PET of the brain, as well as its shortcomings and potential pitfalls, will help radiologists and clinicians better utilize this modality in the evaluation of pediatric epilepsy.
  • Nahl, Daniel  ( Children's Hospital Los Angeles and Keck School of Medicine University of Southern California , Los Angeles , California , United States )
  • Nelson, Marvin  ( Children's Hospital Los Angeles and Keck School of Medicine University of Southern California , Los Angeles , California , United States )
  • Berkovich, Rachel  ( Children's Hospital Los Angeles and Keck School of Medicine University of Southern California , Los Angeles , California , United States )
  • Goodarzian, Fariba  ( Children's Hospital Los Angeles and Keck School of Medicine University of Southern California , Los Angeles , California , United States )
  • Lai, Lillian  ( Children's Hospital Los Angeles and Keck School of Medicine University of Southern California , Los Angeles , California , United States )
Session Info:

Posters - Educational

Nuclear Imaging/Oncology

SPR Posters - Educational

More abstracts on this topic:
Improved Pediatric fMRI Success Rates in Clinical Epilepsy Patients Using Intensive Patient Preparation Methods

Long Alexander, Buskirk Tricia, Smith Mark, Krishnamurthy Ramkumar, Hu Houchun, Halverson Mark

PET/MRI of Children with Cancer: Your Key To Success

Jayapal Praveen, Baratto Lucia, Rashidi Ali, Daldrup-link Heike

More abstracts from these authors:
Pictorial Review of Pitfalls in SPECT-CT I-123 MIBG Imaging of Neuroblastoma

Lai Lillian, Berkovich Rachel, Goodarzian Fariba

Pediatric oncologic emergencies: Must know diagnoses

Sato T Shawn, Lai Lillian, Sato Yutaka

Preview
Poster____EDU-094.pdf
You have to be authorized to contact abstract author. Please, Login or Signup.

Please note that this is a separate login, not connected with your credentials used for the SPR main website.

Not Available