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Presynaptic dopaminergic PET imaging is a useful method for the diagnosis of parkinsonism. Based on the expert consensus on operation and clinical application of dopamine transporter brain PET imaging technology published in 2020, this paper further recommends the relevant elements of result interpretation of presynaptic dopaminergic PET imaging.
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Due to the availability of 18F-FDG in PET centers, this article aims to advocate and promote the standardization of 18F-FDG PET brain imaging in dementia in order to improve the reliability, repeatability and comparison of the imaging process and results. It is also provided to guide the PET imaging operation standard and to give suggestions on image interpretation.
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Objective:To analyze 18F-FDG PET/CT imaging features of non-functional pancreatic neuroendocrine neoplasms (NF-pNENs) and investigate its correlation with pathology and prognosis. Methods:A total of 35 cases (17 males, 18 females; age (51±12) years) of pathologically confirmed NF-pNENs who underwent pretherapeutic 18F-FDG PET/CT from January 2011 to July 2017 in Peking Union Medical College Hospital were retrospectively enrolled. Clinical data were collected and patients were followed up. PET/CT parameters including number and maximum diameter of lesions, SUV max and pancreatic tumor-to-liver ratio (T/L) were measured. Mann-Whitney U test and Kruskal-Wallis rank sum test, Spearman correlation analysis were used to analyze the data. Results:Among the included 35 NF-pNENs patients (G1, n=6; G2, n=21; G3, n=8) with maximum diameter of 3.0(2.1, 6.1) cm and SUV max of 5.5(4.0, 8.9), 32 were positive in PET/CT. There were 1 patient with cystic, 2 with calcification and 3 with dilatation of pancreaticobiliary duct. Among 10 patients with metastases, 8 revealed multiple liver metastases. There was statistical difference of T/L among G1-G3 tumor (1.23(0.60, 2.00), 3.05(1.80, 4.00), 3.90(1.90, 7.60); H=8.29, P=0.016), but there were no statistical differences of SUV max or maximum diameter among G1-G3 tumor ( H values: 4.34, 3.37, P values: 0.114, 0.186). There was a significant correlation between T/L (2.78(1.48, 3.94)) and Ki-67 index (8.0(3.0, 20.0); rs=0.631, P<0.001). Among 27 patients with available follow-up results, T/L in patients with complete remission or stable disease ( n=20) was statistically lower than that in patients with progressive disease or death ( n=7) (2.1(1.2, 3.2) vs 7.5(3.4, 13.4); z=-3.37, P=0.001). Conclusions:18F-FDG PET/CT can detect primary and metastatic lesions of NF-pNENs. T/L can better reflect the proliferative activity based on Ki-67 index than SUV max and it may be favorable on prognostic value.
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Objective To evaluate the clinical and paraclinical features of Chinese patients with anti- LGI1 encephalitis. Methods Patients with memory deficits, psychiatric symptoms, seizures or altered level of consciousness, suspicious of encephalitis, at presentation to Peking Union Medical College Hospital were recruited between July 2013 and January 2018, and tested for anti-LGI1 antibodies in their serum and/or cerebrospinal fluid(CSF) samples. Patients with anti-LGI1 antibodies were enrolled. The demographic characteristics, clinical manifestations, laboratory examination results, neuroimaging features, immunotherapy, follow-up practices and outcomes for included patients were registered and analyzed. Results The study enrolled 120 patients, of whom 66.7% were male. The median age was 61 years (interquartile range [IQR]: 49-66 years). Seizures(65.0%) were the most common initial symptoms. Most patients developed seizures (95.0%), including faciobrachial dystonic seizures (54.2%), memory deficits (92.5%), and psychiatric symptoms (69.1%). Brain MRI and 18F-FDG PET / CT showed that the lesions were mainly located in unilateral or bilateral medial temporal lobes, and (or) basal ganglia. Of the patients, 95.0% received intravenous immunoglobulin (IVIg) or corticosteroids, 47.5% received mycophenolate mofetil as long-term immunotherapy, and no one received second-line immunotherapy. The median follow-up was 34.2 months(IQR: 22.0-45.6 months). 91.2% had a good outcome (modified Rankin Scale score≤2 points). Residual mild memory deficits were present in 47.8% of the patients. Nine deaths were documented. Relapses occurred in 24.8% of the patients in the first year. In total, 24 (20%)cases were young patients(onset age ≤45 years).There were fewer males among the younger patients(37.5% vs. 74.0%, P < 0.01). Besides, there were fewer younger patients with psychiatric symptoms(50.0% vs. 74.0%, P=0.02), hyponatremia(33.3% vs. 68.8%, P < 0.01), and abnormalities on brain 18F-FDG PET/CT(20.8% vs. 47.9%, P=0.02). The relapse-free survival rate was significantly higher in the young patients. Conclusions Elderly males were predominant in patients with anti-LGI1 encephalitis. Most patients developed symptoms of limbic encephalitis and/or FDBS during the disease course. Several patients were young adults and lacked typical symptoms. Neuroimaging features were consistent with the involvement of limbic system or basal ganglia. Patients with anti-LGI1 encephalitis respond well to immunotherapy, irrespective of the age.
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Objective To analyze the clinical and histology characteristics of a patient with frontal lobe epilepsy diagnosed with mild malformation of cortical development with oligodendroglial hyperplasia, and to recognize the new neuropathological entity. Methods Clinical history, seizure types, neuroimaging, electroencephalography as well as macroscope, histology and immunohistochemistry characteristics were collected from a frontal lobe epilepsy patient and were compared with cases from literature. Results It was a female patient aged 16 years with 12 years history of epilepsy. The seizures manifested as episodes of conscious loss with automatism including grope and voice lasting for seconds. About 10 episodes a day were found and sometimes with secondary generalized tonic-clonic seizures. MRI showed blurring of grey-white matter interface in left orbital frontal cortex. Video-encephalography revealed left frontal lobe origin of seizures. So left prefrontal lobe was removed. Histology showed almost normal cortex neuropil and neurons. Blurring of grey-white interface in some area with patches of proliferation of oligodendrocytes in the corresponding sub-cortical white matter was found. The density of oligodendrocytes was significantly higher in sub-cortical than in deep white matter both shown in HE and Oligo-2 staining. Obvious oligodendrocytes increase and satellite phenomenon in deep cortical layer as well as increased ectopic neurons in sub-cortical white matter were found in the lesion. In proliferation area, there were some nuclei stained with Ki-67, but not as high as tumor. Subsequent follow up for two years proved the operation efficacy and benign prognosis. Conclusions There are special and undiscovered histopathological entities in epilepsy etiology. Although known as grey matter disease, white matter pathology plays an important role in epilepsy pathophysiology which needs further research.
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Objective To explore the correlation between extratemporal hypometabolism on preoperative 18F-FDG PET imaging and the outcome after temporal lobectomy in temporal lobe epilepsy (TLE)patients.Methods A total of 96 patients with intractable TLE who underwent temporal lobectomy were recruited.The outcome was evaluated according to International League Against Epilepsy (ILAE) 2001 outcome classification (OC) criteria:OC 1-3 was considered as good outcome and OC4-6 as poor outcome.The follow-up period was more than 2 years.The 18F-FDG PET brain images were retrospectively analyzed.The preoperative extratemporal cortical hypometabolism and extratemporal subcortical hypometabolism occurred in basal ganglia and thalamus were taken as independent exposure factors of poor outcome and the odds ratios (OR) were calculated respectively.Results Thirteen of 96 cases had poor outcome.Extratemporal cortical hypometabolism was found in 12 of 83(14.5％) cases with good outcome and in 11 of 13 cases with poor outcome.Extratemporal subcortical hypometabolism was found in 25 of 83 (30.1％) cases with good outcome and in 10 of 13 cases with poor outcome.The occurrence of extratemporal hypometabolism was significantly higher in poor outcome group than that in good surgical outcome group (cortical:x2 =26.63 ;subcortical:x2 =8.70; both P＜0.05).The OR of extratemporal cortical hypometabolism was 32.54,with 95％ CI of 6.40-165.44,and that of extratemporal subcortical hypometabolism was 7.73,with 95％ CI of 1.96-30.52.Conclusion Extratemporal cortical hypometabolism and subcortical hypometabolism in TLE patients are associated with poor outcome of temporal lobectomy in TLE patients.
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Objective To identify the clinical profile and neuro-imaging findings of the right temporal lobe variant of semantic dementia (RTLV),and to understand the relationship between anatomic and function by comparison to the left temporal lobe atrophy.Methods Of 70 patients with diagnosis of frontotemporal dementia in our memory clinic,three patients with right temporal lobe atrophy were identified based on the MRI scans.We obtained the profile of cognitive function,behavior and personality changes in these 3 patients and compared them with those in 5 semantic dementia (SD) patients with predominant leftsided temporal lobe atrophy.We also underwent 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) with statistical parametric mapping analysis in these 3 patients.Results In RTLV patients,the most prominent cognitive deficits were impairment of prosopagnosia,and getting lost.Variety behavioral symptoms including apathy,social disinhibition,stereotypy,compulsive behaviors were more prevalent in early course for patients with RTLV,which were different from SD patients with semantic loss began with anomia or single-word comprehension.18F-FDG-PET scan showed decreased metabolism mainly in right temporal lobe and in other brain regions with varying degrees.Conclusions The RTLV is clinical heterogeneous.Prosopagnosia,behavioral changes and getting lost are the main features in the early course.It therefore,might be proposed a separate clinical entity.
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@#ObjectiveTo study the values of EEG and [18F]2-deoxyglucose(FDG) positron emission tomography in localizing the epiletogenic cortex,and evaluate their relation.MethodsVideo-EEG(VEEG) and FDG-PET scans were performed in 44 patients with refractory epilepsy.Electrocorticography(ECoG) in surgery and patholopy were performed in 38 patients who had undergone neurosurgical therapy.Congruence among them were studied.Results43 patients(98%) had FDG-PET hypometabolism.42 patients(95%) had epileptiform wave.There were 22 patients(50%) whose PET and EEG were in complete congruence,whereas 10 patients(23%) in part congruence.12 patients who had undergone operation had controversial results in PET and EEG,8 cases had agreement between ECoG and PET,and 2 cases had agreement between ECoG and VEEG. ConclusionFDG-PET is a effective,sensitive and non-invasive investigation.It can provide valuable supplemental data in patients with unlocalized surface EEG.