Role of concordance between ictal-subtracted SPECT and PET in predicting long-term outcomes after epilepsy surgery
Role of concordance between ictal-subtracted SPECT and PET in predicting long-term outcomes after epilepsy surgery
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DOI：
10.1016/j.eplepsyres.2014.09.024
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发表时间：
2014-12-01
影响因子：
2.2
通讯作者：
Tripathi, Manjari
中科院分区：
文献类型：
--
作者：
Chandra, P. S.;Vaghania, Gaurang;Tripathi, Manjari
目的：F-18F-脱氧葡萄糖正电子发射断层扫描(FDG-PET)和ICT减影单光子发射断层扫描(ISPECT)对癫痫灶的定位具有重要意义。下面的研究分析了FDG-PET和iSPECT的相关性在预测癫痫手术后长期结果中的作用。方法：我们前瞻性地评估了(2003年1月至2008年1月)因颞叶或颞外药物难治性癫痫(DRE)而接受手术的患者，他们至少有5年的随访。对MRI和视频EEG(VEEG)符合癫痫灶的患者进行了iSPECT和FDG-PET检查。结果：123例癫痫患者(男性74例)，手术时平均年龄18.9±10.41岁。癫痫发作的平均年龄为9.87±8.37岁。最常见的符号学是复杂部分(45%)。当FDG-PET和iSPECT相互一致时，这转化为(5年时I级Engel)颞外癫痫62%的结果(前提是它们也与MRI和vEEG所定义的病变一致)。与所有其他情况(FDG-PET/iSPECT与MRI/vEEG不一致，只有PET或iSPECT与MRI/vEEG一致)相比，这一比例显著(p<；0.01)。对于颞叶癫痫则没有发现这种相关性，因为MRI和vEEG是最重要的预后参数。在颞叶和颞外癫痫中，iSPECT/FDG-PET与MRI/vEEG的符合率与较好的5年预后相关(颞叶：70%比25%；颞外：62%比33%；p<；0.05)。意义：iSPECT和FDG-PET之间的非侵入性检查的一致性是颞外癫痫手术结果的重要预测因素。(C)2014爱思唯尔B.V.保留所有权利。
Objective: F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and ictally subtracted single photon emission tomography (iSPECT) are important for localizing the epileptogenic focus. The following study analyzes the role of inter-concordance between FDG-PET and iSPECT in predicting long-term outcomes after epilepsy surgery.Methods: We prospectively evaluated (January 2003-January 2008) patients undergoing surgery for temporal or extratemporal drug refractory epilepsy (DRE) who had at least a 5 years follow up. Patients with MRI and video EEG (vEEG) concordance for the seizure focus underwent iSPECT and FDG-PET. Concordance of the iSPECT and FDG-PET with each other and with the substrate (defined by MRI and vEEG) for temporal and extra-temporal epilepsies was evaluated and correlated with outcomes.Results: One hundred twenty-three patients (74 males) were included in the study (mean age at time of surgery: 18.9 +/- 10.41 years). The mean age of onset of seizures was 9.87 +/- 8.37 years. The most common semiology was complex partial (45%). When both FDG-PET and iSPECT were concordant with each other, this translated into a (class I Engel at 5 years) outcome of 62% for extra-temporal epilepsies (provided they were also concordant with the lesion, as defined by MRI and vEEG). This percentage was significant (p < 0.01) compared with all other situations (both FDG-PET/iSPECT not concordant to MRI/vEEG, only PET or iSPECT concordant with MRI/vEEG). This correlation was not found for the temporal epilepsies, where the MRI and vEEG were the most important prognostic parameters. In both temporal and extratemporal epilepsies the concordance of the iSPECT/FDG-PET with the MRI/vEEG correlated with a better 5-year outcome (temporal: 70% vs 25%; extra-temporal: 62% vs 33%; p < 0.05).Significance: Concordance between non-invasive investigations iSPECT and FDG-PET is an important predictive factor for surgical outcomes in extra-temporal epilepsy. (C) 2014 Elsevier B.V. All rights reserved.