Epilepsy Lesion Localization is not Predicted by Developmental Venous Anomaly Location or its FDG‐PET Metabolic Activity

• Published in: Journal of neuroimaging Vol. 30; no. 4; pp. 544 - 550
• Main Authors: Lazor, Jillian W., Stein, Joel M., Schmitt, James Eric, Davis, Kathryn A., Nabavizadeh, Seyed Ali
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-07-2020
• Subjects: Adult; Anomalies; Brain - diagnostic imaging; Brain - metabolism; Convulsions & seizures; Correlation analysis; Developmental venous anomaly; Diagnostic systems; EEG; Electroencephalography - methods; Electronic health records; Electronic medical records; Epilepsy; Epilepsy - diagnostic imaging; Epilepsy - metabolism; FDG‐PET; Female; Fluorine isotopes; Fluorodeoxyglucose F18; Humans; Hypometabolism; Localization; Magnetic Resonance Imaging; Male; Metabolism; Middle Aged; Neuroimaging; Patients; Positron emission; Positron emission tomography; Positron-Emission Tomography - methods; Retrospective Studies; seizure; Seizures; Statistical analysis; Surgery; Territory; Tomography; FDG-PET; epilepsy; seizure; Developmental venous anomaly
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/jon.12722

ABSTRACT
BACKGROUND AND PURPOSE
This study's purpose is to correlate location and metabolic activity of developmental venous anomalies (DVAs) in epilepsy patients to the seizure focus as determined by ictal/interictal encephaloelectrogram (EEG).
METHODS
A retrospective search was performed for epilepsy patients with DVAs who underwent brain 18F‐fluorodeoxyglucose positron emission tomography (18F‐FDG‐PET) and magnetic resonance imaging (MRI). MRI exams were analyzed to characterize DVA location and associated structural findings. MRI and PET images were co‐registered and assessment of 18F‐FDG uptake in the DVA territory was performed. The electronic medical record was reviewed for each subject to determine seizure semiology and site of seizure focus by ictal/interictal EEG.
RESULTS
Twenty‐eight DVAs in 25 patients were included. Twelve DVAs demonstrated regional metabolic abnormality on 18F‐FDG‐PET. There was no significant correlation between DVA site and seizure focus on EEG. DVA location was concordant with EEG seizure focus in three subjects, and all three demonstrated hypometabolism on 18F‐FDG‐PET. This significance remains indeterminate, as one of these DVAs was associated with cavernoma, which could serve as the true seizure focus, and one of the patients underwent resection of the DVA without decrease in seizure frequency. Furthermore, there was no statistically significant relationship between DVA metabolic activity and DVA‐EEG lobar or laterality concordance.
CONCLUSIONS
In this sample, there is no significant correlation between location of DVA and seizure focus, and hypometabolism within the DVA territory is not predictive of EEG/DVA co‐localization. As use of 18F‐FDG‐PET for evaluation of epilepsy increases, knowledge of this poor correlation is important to avoid diagnostic confusion and potentially unnecessary surgery in epilepsy patients.