Keywords
pediatrics
epileptogenic zone
neuroimaging
How to Cite
Abstract
In press
Background. Drug-resistant epilepsy in children remains one of the most challenging problems in pediatric neurology, as the lack of seizure control after drug treatment requires early detection of the epileptogenic zone and precise preoperative planning. Integration of Positron Emission Tomography with 18F-FluoroDeoxyGlucose and Computed Tomography (18F-FDG PET/CT) and high-resolution neuroimaging opens new possibilities for a personalized approach.
Aim. To assess the diagnostic and prognostic value of an integrated approach combining positron emission tomography with 18F-fluorodeoxyglucose and computed tomography and high-resolution neuroimaging data in detecting and localizing the epileptogenic zone for personalized surgical planning in children with drug-resistant epilepsy.
Materials and Methods. A retrospective analysis of 150 outpatient charts of children aged 1 to 17 years at the Nuclear Medicine Center of the Kyiv City Clinical Oncology Center in 2021–2023 was conducted. Patients were divided into four age groups. Data from ElectroEncephaloGrams (EEG), high-resolution Magnetic Resonance Imaging (MRI), and 18F-FDG PET/CT were compared.
Research Ethics. The study was conducted with the written consent of the children's parents, in compliance with the provisions of the World Medical Association Declaration of Helsinki (1964–2024).
Results. Structural changes in the brain by MRI were detected in 43.3 % of the examined, and metabolic disorders by PET/CT were detected in 68.7 % of the children, including cases with negative MRI results. Quantitative analysis using the CortexID 3.2 software complex (GE Healthcare, USA) proved to be an effective tool for objectifying the results of PET/CT. This increases the reproducibility of the results and contributes to the personalized choice of surgical tactics. Correlation analysis showed a reliable relationship between the zones of hypometabolism by PET/CT and focal epileptic activity by EEG (r=+0.577; p<0.05), as well as between the localization of hypometabolism and structural changes by MRI (r=+0.251; p<0.05), which confirms the complementary nature of the methods in the diagnosis of the epileptogenic zone.
Conclusions. The obtained data confirm that PET/CT with 18F-FDG is a highly sensitive method for detecting epileptogenic foci in children, in particular in cases of "MRI-negative" epilepsy and is a key stage in personalized planning of neurosurgical interventions in children with drug-resistant epilepsy.
Keywords: medical radiology, pediatrics, epileptogenic zone, neuroimaging.
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