Double match of 18F-fluorodeoxyglucose-PET and iomazenil-SPECT improves outcomes of focus resection surgery
Double match of 18F-fluorodeoxyglucose-PET and iomazenil-SPECT improves outcomes of focus resection surgery
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DOI：
10.1007/s00701-018-3573-1
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发表时间：
2018-09-01
影响因子：
2.4
通讯作者：
Enoki, Hideo
中科院分区：
文献类型：
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作者：
Fujimoto, Ayataka;Okanishi, Tohru;Enoki, Hideo
当脑电图（EEG）、磁共振成像（MRI）和癫痫符号学结果不一致或MRI上没有明显的结构性病变时，单光子发射计算机断层扫描（SPECT）和正电子发射断层扫描（PET）是检测癫痫区域偏侧或定位的重要检查方法。我们假设间期2-[F-18]氟-2-脱氧-d -葡萄糖((18)FDG)- pet和iomazenil (IMZ)- spect的一致性可以提示在MRI上有非病变表现的患者的癫痫性叶。方法59例患者行硬膜下电极植入加病灶切除手术，其中女性31例，男性28例，平均年龄29岁，中位年龄27岁，年龄范围7 ~ 56岁。所有患者均行FDG-PET、IMZ-SPECT和病灶切除手术。随访2年。我们评估了有无癫痫发作的手术结果，并分析了PET、SPECT或PET和SPECT上低摄取叶与切除叶的结果和一致性之间的相关性。我们使用单变量和多变量逻辑回归分析。结果在单变量分析中，所有三项一致性与无癫痫发作结果显著相关（PET, p = 0.017； SPECT, p = 0.030； PET和SPECT均p = 0.006）。在多变量分析中，PET和SPECT中切除和低摄取叶的一致性与无癫痫发作结果显著相关（p = 0.004）。优势比为6.0。结论间期FDG-PET和IMZ-SPECT的一致性提示，在MRI无病变表现的患者中，癫痫性叶的检查效果是单独检查的6倍。IMZ-SPECT和（18）FDG-PET是评估定位相关性癫痫的补充检查。
Background When the results of electroencephalography (EEG), magnetic resonance imaging (MRI), and seizure semiology are discordant or no structural lesion is evident on MRI, single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are important examinations for lateralization or localization of epileptic regions. We hypothesized that the concordance between interictal 2-[F-18]fluoro-2-deoxy-D-glucose ((18)FDG)-PET and iomazenil (IMZ)-SPECT could suggest the epileptogenic lobe in patients with non-lesional findings on MRI.Method Fifty-nine patients (31 females, 28 males; mean age, 29 years; median age, 27 years; range, 7-56 years) underwent subdural electrode implantation followed by focus resection. All patients underwent (18)FDG-PET, IMZ-SPECT, and focus resection surgery. Follow-up was continued for >= 2 years. We evaluated surgical outcomes as seizure-free or not and analyzed correlations between outcomes and concordances of low-uptake lobes on PET, SPECT, or both PET and SPECT to the resection lobes. We used uni- and multivariate logistic regression analyses.Results In univariate analyses, all three concordances correlated significantly with seizure-free outcomes (PET, p = 0.017; SPECT, p = 0.030; both PET and SPECT, p = 0.006). In multivariate analysis, concordance between resection and low-uptake lobes in both PET and SPECT correlated significantly with seizure-free outcomes (p = 0.004). The odds ratio was 6.0.Conclusion Concordance between interictal (18)FDG-PET and IMZ-SPECT suggested that the epileptogenic lobe is six times better than each examination alone among patients with non-lesional findings on MRI. IMZ-SPECT and (18)FDG-PET are complementary examinations in the assessment of localization-related epilepsy.