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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

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Front. Med.    2021, Vol. 15 Issue (6) : 913-921    https://doi.org/10.1007/s11684-021-0874-1
RESEARCH ARTICLE
18F-FDG-PET glucose hypometabolism pattern in patients with epileptogenic hypothalamic hamartoma
Chao Lu1,2, Kailiang Wang1,2, Fei Meng1,2, Yihe Wang1,2, Yongzhi Shan1,2(), Penghu Wei1,2(), Guoguang Zhao1,2,3()
1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
2. China International Neuroscience Institute (CHINA-INI), Beijing 100053, China
3. Center of Epilepsy, Beijing Institute for Brain Disorder, Beijing 100069, China
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Abstract

Epileptogenic hypothalamic hamartoma is characterized by intractable gelastic seizures. A systematic analysis of the overall brain metabolic pattern in patients with hypothalamic hamartoma (HH) could facilitate the understanding of the epileptic brain network and the associated brain damage effects of HH. In this study, we retrospectively evaluated 27 patients with epileptogenic HH (8 female patients; age, 2–33 years) by using 18F-fluorodeoxyglucose-positron emission tomography. The correlations among tomography result, seizure type, sex, and structural magnetic resonance imaging were assessed. Whole metabolic patterns and voxel-based morphometry findings were assessed by group analysis with healthy controls. Assessment of the whole metabolic pattern in patients with HH revealed several regional metabolic reductions in the cerebrum and an overall metabolic reduction in the cerebellum. In addition, areas showing hypometabolism in the neocortex were more widely distributed ipsilaterally than contralaterally to the HH. Reductions in glucose metabolism and gray matter volume in the neocortex were predominant ipsilateral to the HH. In conclusion, the glucose hypometabolism pattern in patients with epileptogenic HH involved the neocortex, subcortical regions, and cerebellum. The characteristics of glucose hypometabolism differed across seizure type and sex. Reductions in glucose metabolism and structural changes may be based on different mechanisms, but both are likely to occur ipsilateral to the HH in the neocortex. We hypothesized that the dentato-rubro-thalamic tract and cerebro-ponto-cerebellar tract, which are responsible for intercommunication between the cerebral cortex, subcortical regions, and cerebellar regions, may be involved in a pathway related to seizure propagation, particularly gelastic seizures, in patients with HH.
Keywords hypothalamic hamartoma      gelastic seizure      fluorodeoxyglucose-positron emission tomography      voxel-based morphometry     
Corresponding Author(s): Yongzhi Shan,Penghu Wei,Guoguang Zhao   
Just Accepted Date: 29 October 2021   Online First Date: 23 November 2021    Issue Date: 27 December 2021
 Cite this article:   
Chao Lu,Kailiang Wang,Fei Meng, et al. 18F-FDG-PET glucose hypometabolism pattern in patients with epileptogenic hypothalamic hamartoma[J]. Front. Med., 2021, 15(6): 913-921.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-021-0874-1
https://academic.hep.com.cn/fmd/EN/Y2021/V15/I6/913
HH ?patients Healthy controls ?(PET group) Healthy controls ?(VBM group)
Total number 27 25 31
Age ?(year (mean±SD)) 3–33 ?(12±11) 31–68 ?(44±16) 18–29 ?(24±3)
Sex (n)
?Male 19 10 10
?Female 8 15 21
Seizure type (n)
?GS 26 − −
?FBTCS 15 − −
?FIAS 4 − −
?TBS 8 − −
Tab.1  Demographic data
Fig.1  Differences in whole brain metabolic patterns between patients with hypothalamic hamartoma (HH) and healthy controls (P<0.01; two-sample t-test). The red-yellow color indicates a decrease in the metabolism. (A) three-dimensional (3-D) surface view of metabolic maps. Hypometabolism is mainly distributed in the right hemisphere ipsilateral to the HH, involving the frontal lobe, temporal lobe, parietal lobe, and occipital lobe. Meanwhile, hypometabolism is seen in small parts of the contralateral temporal and parietal lobes. Moreover, hypometabolism is seen in the bilateral cerebellum. (B) Axial view maps are more detailed than the 3-D surface view maps. Apart from the surface, bilateral regions, such as the thalamus, red nucleus, and globus pallidus, are also involved in the hypometabolic pattern. (C) Sagittal view maps show distinct involvement of the bilateral cingulum, an essential part of the default mode network, the thalamus, and the cerebellum, which are connected by the dentato-rubro-thalamic tract. (D) Coronal view maps. L, left; R, right.
Cluster Region MNI coordinate (mm)? T value
X Y Z
(1) Cingulum_Post_L 2 –42 30 12.54
Cingulum_Post_R 4.39 –40 30 11.79
(2) Frontal_Mid_R 32 6 50 7.82
Supp_Motor_Area_R 8 15.65 48 7.19
Precentral_R 34.64 1.99 50 6.5
(3) Angular_R 36.59 –66.28 40 8.3
Angular_L –39.52 –70.18 30 6.87
Occipital_Mid_L –38 –74 32 7.82
(4) Temporal_Mid_L –54 –32 –12 6.97
Temporal_Mid_R 55.13 –32 –14 8.14
(5) Hippocampus_R 28.78 –9.17 –24 7.6
Hippocampus_L –20 –6 –26 7.36
(6) ParaHippocampal_R 24.88 –10.69 –28 8.62
ParaHippocampal_L –21.95 –10 –30 6.78
(7) Amygdala_L –22.93 –3.86 –26 6.75
Amygdala_R 27.81 –2.88 –24 6.47
(8) Thalamus_L –3.42 –12.84 –2 8.67
Thalamus_R 8.29 –8.73 –2 8.71
(9) Mid_brain _L –2.44 –20.44 –6 8.6
Mid_brain _R 7.32 –17.51 –8 7.92
Brianstem –0.49 –32.14 –16 6.88
(10) Cerebellum_L –33.66 –60 –46.82 7.79
Cerebellum_R 36.59 –64 –45.84 9.45
Tab.2  Brain regions showing significant metabolic differences between patients and healthy controls
Fig.2  Metabolic differences according to seizure type and sex (P<0.01). The red-yellow color indicates the decrease in metabolism, and the blue-green color indicates the increase in metabolism. (A) Metabolic difference between the different seizure types. HH patients with focal to bilateral tonic?clonic seizure (FBTCS) show significant hypometabolism on both sides of the precentral gyrus and insular lobe ipsilateral to the HH and hypermetabolism in the right cerebellum compared with the non-FBTCS patients. (B) Metabolic difference between sexes. Female patients show significant hypometabolism in the bilateral frontal lobes and parietal lobes, right temporal lobe, and left cingulate gyrus and hypermetabolism in the bilateral superior parietal lobes and left precentral gyrus compared with the male patients. L, left; R, right.
Fig.3  Voxel-based morphometry (VBM) results of HH patients and healthy controls (P<0.01, two-sample t-test). Gray matter volume (GMV) decrease is shown in blue-green, and GMV increase is shown in red-yellow. (A) 3-D surface view of VBM results. HH patients show significant GMV decrease in the hemisphere ipsilateral to HH and GMV increase in the hemisphere contralateral to HH, especially in the regions of the frontal and temporal lobes. Overall, the GMV in the cerebellum increases. (B) Axial view maps showing more details than 3-D surface view maps. L, left; R, right.
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