Clinical utility of flumazenil-PET versus [18F]fluorodeoxyglucose-PET and MRI in refractory partial epilepsy -: A prospective study in 100 patients
Clinical utility of flumazenil-PET versus [18F]fluorodeoxyglucose-PET and MRI in refractory partial epilepsy -: A prospective study in 100 patients
复制标题
DOI：
10.1093/brain/121.11.2067
复制
发表时间：
1998-11-01
期刊：
影响因子：
14.5
通讯作者：
Mauguiére, F
中科院分区：
文献类型：
--
作者：
Ryvlin, P;Bouvard, S;Mauguiére, F
我们在100例接受术前评估的癫痫患者中前瞻性评估了[C-11]氟马西尼-PET（FMZ-PET）的临床效用，并确定了这种神经成像技术相对于MRI和[F-18]氟脱氧葡萄糖-PET（FDG-PET）的具体贡献。所有患者均受益于长期视频EEG监测，而40例患者进行了颅内EEG调查。我们的大多数患者（73%）表现出FMZ-PET异常;颞叶癫痫（94%）的命中率显著高于其他类型的癫痫（50%）（P < 0.001）。大多数FMZ-PET结果与MRI异常（81%）共存，包括海马萎缩（35%）和FDG-PET上的局灶性低代谢（89%），FMZ结合减少的区域通常小于葡萄糖低代谢（48%）或大于MRI异常（28%），FMZ-PET在评估发作区范围方面并不证明上级于FDG-PET，但在以下三种情况下，FMZ-PET可提供与MRT和FDG-PET互补的有用数据：（1）在伴有海马硬化MRI征象的颞叶癫痫中，当FMZ-PET异常与FDG-PET异常同延时，FMZ-PET异常可精确地描绘癫痫发作的部位;（ii）在双颞叶癫痫中，FMZ-PET有助于确认癫痫发作的双侧起源，在33%的病例中显示了双侧颞叶FMZ结合减少的特定模式;（iii）在单侧隐源性额叶癫痫患者中，FMZ-PET在55%的病例中提供了癫痫发作的侧面和部位的进一步证据。因此，FMZ-PET值得纳入这些特定类别癫痫患者的术前评估中，这些患者约占考虑进行癫痫手术的人群的一半。
We assessed the clinical utility of [C-11]flumazenil-PET (FMZ-PET) prospectively in 100 epileptic patients undergoing a pre-surgical evaluation, and defined the specific contribution of this neuro-imaging technique with respect to those of MRI and [F-18]fluorodeoxyglucose-PET (FDG-PET), All patients benefited from a long term video-EEG monitoring, whereas an intracranial EEG investigation was performed in 40 cases. Most of our patients (73%) demonstrated a FMZ-PET abnormality; this hit rate was significantly higher in temporal lobe epilepsy (94%) than in other types of epilepsy (50%) (P < 0.001). Most FMZ-PET findings coexisted with a MRI abnormality (81%), including hippocampal atrophy (35%) and focal hypometabolism on FDG-PET (89%), The area of decreased FMZ binding was often smaller than that of glucose hypometabolism (48%) or larger than that of the MRI abnormality (28%), FMZ-PET did not prove superior to FDG-PET in assessing the extent of the ictal onset zone, as defined by intracranial EEG recordings, However, it provided useful data which were complementary to those of MRT and FDG-PET in three situations: (i) in temporal lobe epilepsy associated with MRI signs of hippocampal sclerosis, FMZ-PET abnormalities delineated the site of seizure onset precisely, whenever they were coextensive with FDG-PET abnormalities; (ii) in bi-temporal epilepsy, FMZ-PET helped to confirm the bilateral origin of seizures by showing a specific pattern of decreased FMZ binding in both temporal lobes in 33% of cases; (iii) in patients with a unilateral cryptogenic frontal lobe epilepsy, FMZ-PET provided further evidence of the side and site of seizure onset in 55% of cases. Thus, FMZ-PET deserves to be included in the pre-surgical evaluation of these specific categories of epileptic patients, representing approximately half of the population considered for epilepsy surgery.