Exploring the Role of TSPO-PET Imaging Among MRI-Negative Patients with Temporal Lobe Epilepsy: From the Perspective of Heterogeneity.

Background/

Objectives

This study explored the heterogeneous distribution pattern of translocator protein 18kDa (TSPO)-PET/MRI using radioligand [18F] DPA-714 in temporal lobe epilepsy patients and identified clinical factors influencing imaging outcomes.

Methods

The TSPO imaging in individual patient was evaluated with both visual reading and quantitative assessment using an asymmetry index based on cerebellum-normalized standardized uptake values. The association between clinical factors and TSPO imaging outcomes was assessed. Pathological evaluation was conducted in three patients.

Results

Twenty-nine TLE patients and ten healthy controls were enrolled. Visual evaluation revealed increased [18F] DPA-714 uptake in twenty patients as compared to controls, predominantly in a unilateral regional brain, while the remaining nine patients showed visually undetectable uptake of [18F] DPA-714. Consistently, quantitative analysis revealed that 69% (20/29) patients exhibited at least one brain area with significant asymmetry index, notably in the temporal lobe (85%, 17/20). A high asymmetry index could also be observed in the parietal (13.8%, 4/29) and occipital lobe (17.2%, 5/29). Significant associations were identified between the asymmetry index and seizure frequency (p = 0.045, OR = 7.994), and the interval from last seizure to PET scan (p = 0.033, OR = 6.712). Moreover, we confirmed the pathology in three patients via immunohistochemistry, which underscored the potential of TSPO-PET in detecting minor lesion.

Conclusions

TSPO-PET reveals patient-specific and network-level neuroinflammatory heterogeneity in MRI-negative TLE, supporting its potential role as a complementary tool for presurgical evaluation.