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[18F]SynVesT-1 and [18F]FDG quantitative PET imaging in the presurgical evaluation of MRI-negative children with focal cortical dysplasia type II

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

MRI-negative children with focal cortical dysplasia type II (FCD II) are one of the most challenging cases in surgical epilepsy management. We aimed to utilize quantitative positron emission tomography (QPET) analysis to complement [18F]SynVesT-1 and [18F]FDG PET imaging and facilitate the localization of epileptogenic foci in pediatric MRI-negative FCD II patients.

Methods

We prospectively enrolled 17 MRI-negative children with FCD II who underwent [18F]SynVesT-1 and [18F]FDG PET before surgical resection. The QPET scans were analyzed using statistical parametric mapping (SPM) with respect to healthy controls. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of [18F]SynVesT-1 PET, [18F]FDG PET, [18F]SynVesT-1 QPET, and [18F]FDG QPET in the localization of epileptogenic foci were assessed. Additionally, we developed a multivariate prediction model based on dual trace PET/QPET assessment.

Results

The AUC values of [18F]FDG PET and [18F]SynVesT-1 PET were 0.861 (sensitivity = 94.1%, specificity = 78.2%, PPV = 38.1%, NPV = 98.9%) and 0.908 (sensitivity = 82.4%, specificity = 99.2%, PPV = 93.3%, NPV = 97.5%), respectively. [18F]FDG QPET showed lower sensitivity (76.5%) and NPV (96.6%) but higher specificity (95.0%) and PPV (68.4%) than visual assessment, while [18F]SynVesT-1 QPET exhibited higher sensitivity (94.1%) and NPV (99.1%) but lower specificity (97.5%) and PPV (84.2%). The multivariate prediction model had the highest AUC value (AUC = 0.996, sensitivity = 100.0%, specificity = 96.6%, PPV = 81.0%, NPV = 100%).

Conclusions

The multivariate prediction model based on [18F]SynVesT-1 and [18F]FDG PET/QPET assessments holds promise in noninvasively identifying epileptogenic regions in MRI-negative children with FCD II. Furthermore, the combination of visual assessment and QPET may improve the sensitivity and specificity of diagnostic tests in localizing epileptogenic foci and achieving a preferable surgical outcome in MRI-negative FCD II.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code Availability

Not applicable.

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Acknowledgements

We extend our deepest appreciation to the research participants and their families. We are grateful to Professor Yiyun Huang from Yale University PET Center for providing the prodrug and synthesis method of [18F]SynVesT-1.

Declarations.

Funding

This study has received funding from the National Key Program of China (2022YFC2503804), the National Natural Science Foundation of China (82071461, 81801740, 91859207, 82271503, and 81771873), the National Science Foundation of Hunan Province (2020JJ5922, 2021JJ31060), Science and Technology Innovation Program of Hunan Province (2021RC4056), clinical research foundation of the National Clinical Research Center for Geriatric Diseases (XIANGYA) (2020LNJJ01), and China Postdoctoral Science Foundation (2022M23561).

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Author notes

  1. Ling Xiao and Jinhui Yang contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Ling Xiao, Jinhui Yang, Ming Zhou, Jian Li, Yongxiang Tang & Shuo Hu

  2. Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Haoyue Zhu & Li Feng

  3. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Dingyang Liu

  4. National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Li Feng & Shuo Hu

  5. Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Shuo Hu

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  1. Ling Xiao
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ling Xiao, Jinhui Yang, Yongxiang Tang, Li Feng, Haoyue Zhu, Ming Zhou and Jian Li. Dingyang Liu performed the epilepsy surgery and provided prognostic information. The first draft of the manuscript was written by Ling Xiao and Jinhui Yang. Yongxiang Tang, Li Feng, and Shuo Hu revised the work critically for important intellectual content. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yongxiang Tang, Li Feng or Shuo Hu.

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The authors have declared that no competing interest exists.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Xiangya Hospital, Central South University.

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Informed consent was obtained from all individual participants or legal guardians included in the study.

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Xiao, L., Yang, J., Zhu, H. et al. [18F]SynVesT-1 and [18F]FDG quantitative PET imaging in the presurgical evaluation of MRI-negative children with focal cortical dysplasia type II. Eur J Nucl Med Mol Imaging 51, 1651–1661 (2024). https://doi.org/10.1007/s00259-024-06593-1

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