Bottom-of-sulcus dysplasia: the role of (18)F-FDG PET in identifying a focal surgically remedial epileptic lesion

PURPOSE: Bottom-of-sulcus dysplasia (BOSD) is a type of focal cortical dysplasia and an important cause of intractable epilepsy. While the MRI features of BOSD have been well documented, the contribution of PET to the identification of these small lesions has not been widely explored. The aim of this study was to investigate the role of F-18 fluorodeoxyglucose ((18)F-FDG) PET in the identification of BOSD. METHODS: Twenty patients with BOSD underwent both (18)F-FDG PET and structural MRI scans as part of preoperative planning for surgery. Visual PET analysis was performed, and patients were classified as positive if they exhibited a focal or regional hypometabolic abnormality, or negative in the absence of a hypometabolic abnormality. MRI data were reviewed to determine if any structural abnormality characteristic of BOSD were observed before and after co-registration with PET findings. RESULTS: PET detected hypometabolic abnormalities consistent with the seizure focus location in 95% (19/20) of cases. Focal abnormalities were detected on (18)F-FDG PET in 12/20 (60%) patients, while regional hypometabolism was evident in 7/20 (35%). BOSD lesions were missed in 20% (4/20) of cases upon initial review of MRI scans. Co-registration of (18)F-FDG PET with MRI enabled detection of the BOSD in all four cases where the lesion was initially missed. CONCLUSION: Our findings show that (18)F-FDG PET provides additional clinical value in the localisation and detection of BOSD lesions, when used in conjunction with MRI.