Page 162 - MEGIN Book Of Abstracts - 2023

PET/MRI or MEG (χ[2] = 13.948, p < 0.001; χ[2] = 5.393, Montreal Neurological Institute, McGill University; Division
p = 0.020). The results of PET/MRI/MEG cortical resec- of Neurology and Department of Clinical Neurophysiology,
tion concordance with surgical outcome were shown to Montreal Children's Hospital; Pediatric Radiology, Montreal
be better than PET/MRI or MEG (χ[2] = 6.695, p = 0.012; Children's Hospital, McGill University; Division of Nuclear
χ[2] = 16.991, p < 0.0001). Medicine, Medical Imaging, CHU Ste-Justine and Montreal
Children's Hospital; and; Neuroimaging of Epilepsy Labo-
CONCLUSIONS Presurgical evaluation by [[18]F]FDG ratory, Montreal Neurological Institute, McGill University,
PET/MRI/MEG could improve the identification of the Montreal, Quebec, Canada
EZ in TLE and may further guide surgical decision-
making. OBJECTIVE In an attempt to improve postsurgical
seizure outcomes for poorly defined cases (PDCs) of
KEY POINTS • Lobar localization was defined in 94.5% pediatric focal epilepsy (i.e., those that are not visible
of patients by the [[18]F]FDG PET/MRI/MEG. • The re- or well defined on 3T MRI), the authors modified their
sults of PET/MRI/MEG concordance with surgical resec- presurgical evaluation strategy. Instead of relying on
tion were significantly higher than that of PET/MRI or concordance between video-electroencephalography
MEG alone. • The results of PET/MRI/MEG cortical resec- and 3T MRI and using functional imaging and intracra-
tion concordance with surgical outcome were shown to nial recording in select cases, the authors systematically
be better than that of PET/MRI or MEG alone. used a multimodal, 3-tiered investigation protocol that
also involved new collaborations between their hospi-
Keywords: Epilepsy, Magnetic resonance imaging, Mag- tal, the Montreal Children's Hospital, and the Montreal
netoencephalography, Positron emission tomography, Neurological Institute. In this study, the authors exam-
Surgery ined how their new strategy has impacted postsurgical
outcomes. They hypothesized that it would improve
European radiology (2022), Vol. 32, No. 5 (34651211) (4 postsurgical seizure outcomes, with the added benefit
citations) of identifying a subset of tests contributing the most.

METHODS Chart review was performed for children
New interinstitutional, multimodal presurgical with PDCs who underwent resection following the new
evaluation protocol associated with improved strategy (i.e., new protocol [NP]), and for the same num-
seizure freedom for poorly defined cases of focal ber who underwent treatment previously (i.e., preprot-
epilepsy in children (2022) ocol [PP]); ≥ 1-year follow-up was required for inclusion.
Well-defined, multifocal, and diffuse hemispheric cases
Schur, Solon; Moreau, Jeremy T; Khoo, Hui Ming; were excluded. Preoperative demographics and clinical
Koupparis, Andreas; Simard Tremblay, Elisabeth; Myers, characteristics, resection volumes, and pathology, as
Kenneth A; Osterman, Bradley; Rosenblatt, Bernard; well as seizure outcomes (Engel class Ia vs > Ia) at 1 year
Farmer, Jean-Pierre; Saint-Martin, Christine; Turpin, postsurgery and last follow-up were reviewed.
Sophie; Hall, Jeff; Olivier, Andre; Bernasconi, Andrea;
Bernasconi, Neda; Baillet, Sylvain; Dubeau, Francois; RESULTS Twenty-two consecutive NP patients were
Gotman, Jean; Dudley, Roy W R compared with 22 PP patients. There was no difference
between the two groups for resection volumes, pathol-
Montreal Neurological Institute and Hospital, McGill Univer- ogy, or preoperative characteristics, except that the NP
sity Health Center, Department of Neurology and Neuro- group underwent more presurgical evaluation tests (p
surgery, McGill University; Department of Pediatric Surgery, < 0.001). At 1 year postsurgery, 20 of 22 NP patients and
Division of Neurosurgery, Montreal Children's Hospital, 10 of 22 PP patients were seizure free (OR 11.81, 95% CI
Montreal, Quebec, Canada; Department of Neurosurgery, 2.00-69.68; p = 0.006). Magnetoencephalography and
Osaka University Graduate School of Medicine, Suita, Japan; PET/MRI were associated with improved postsurgical

 ontents  Index 141
C