The use of positron emission tomography and computed tomography with 18F-fluorodeoxyglucose as a selection criterion for surgical treatment in children with drug-resistant epilepsy (literature review)

Abstract

Background. In the contemporary context, the management of paediatric patients afflicted with drug-resistant epilepsy continues to represent a significant challenge for specialists in the field of paediatric neurology. This persistent predicament underscores the imperative for the development of precise and non-biased criteria to facilitate the selection of candidates for surgical intervention. The integration of Positron Emission Tomography with Computed Tomography with 18F-FluoroDeoxyGlucose (18F-FDG PET/CT) and high-resolution neuroimaging has the potential to facilitate a personalised approach and to identify candidates for surgical treatment.

Aim. To ascertain the diagnostic and prognostic role of positron emission tomography with 18F-fluorodeoxyglucose in combination with computed tomography in the selection of paediatric patients with drug-resistant epilepsy for surgical treatment.

Materials and Methods. The work employed a range of methodological approaches, encompassing theoretical generalisation, analysis and synthesis of results. The search for relevant works was conducted in the scientometric Scopus, Web of Science, PubMed, Google Scholar databases. The research was conducted as a private initiative of the authors, did not receive funding from grant programs, and the research topic was not officially registered in the state register.

Research Ethics. During work, studies were selected whose authors demonstrated adherence to ethical standards.

Results. The sensitivity of 18F-FDG PET/CT in localising the epileptogenic focus was found to range from 80.0% to 89.0%, with the specificity of 78.0%. The combination of PET with magnetic resonance imaging has been shown to enhance the accuracy of identifying the affected area to 85.0%. Quantitative assessment of hypometabolism using automated analysis programs (CortexID, Morphometric Analysis) has significant prognostic value for predicting postoperative outcomes. The utilisation of digital systems and algorithms of quantitative analysis serves to enhance the reliability of the results, while the absence of uniform standards continues to represent a significant limitation.

Conclusions. 18F-FDG PET/CT is a highly effective method of preoperative diagnosis, which improves the quality of selection of children for surgical treatment of drug-resistant epilepsy. Integration of PET/CT with other neuroimaging technologies, quantitative assessment of metabolism and further standardisation of protocols are promising avenues for the development of personalised diagnostics in paediatric neurology.

Keywords: medical radiology, paediatrics, treatment effectiveness, epileptogenic focus, metabolic activity.