Positron Emission Tomography (PET)

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Positron-emission tomography (PET) is a nuclear medicine imaging modality which detects gamma rays emitted by a positron-emitting radioactive tracer. The most common tracer used for neuroimaging is 2-deoxy-2 (18F) fluoro-d-glucose (FDG). It approximates for the metabolic processes in the brain providing a broad range of functional and metabolic information to help understand mechanisms of neurologic diseases and guide therapeutic approaches. Most settings have used 2-deoxy-2 (18F) fluoro-d-glucose (FDG) in the interictal state [35,47]. Ictal PET is not of much help as the half-life of radiotracer used extremely short. For patients with temporal lobe epilepsy interictal studies shows hypometabolism in epileptogenic areas. Interictal FDG-PET provides more information about epileptogenic foci compared to …show more content…

Neuroreceptor tracers show increased or decreased uptake in epileptogenic brain regions in the interictal state, unlike FDG-PET which shows decreased uptake in interictal period. Hence this type of neuroimaging is of more importance while detecting epileptogenic area in presence of multiple structural lesions, which confounds epileptogenic foci. AMT ([11C] methyl-l-tryptophan) PET effectively differentiates between epileptogenic and nonepileptogenic lesions in the interictal state in children with numerous structural lesions tuberous sclerosis. AMT PET [51] can also detect epileptic cortex in nontuberous sclerosis patient with normal MRI. FMZ PET [52,50] involves benzodiazepine labeling. 11C-flumazenil (FMZ), benzodiazepine receptor antagonist, shows reduced binding in the epileptogenic focus. Flumazenil-labeled PET studies are more specific than FDG studies, FMZ-PET image shows more restricted localization compared to FDG PET. Similarly, opiate, histamine, and N-methyl-d-aspartate receptor studies for epilepsy are under development

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