Functional imaging: II. Prediction of epilepsy surgery outcome
Functional imaging: II. Prediction of epilepsy surgery outcome
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DOI：
10.1002/ana.21419
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发表时间：
2008-07-01
影响因子：
11.2
通讯作者：
Kuzniecky, Ruben
中科院分区：
文献类型：
--
作者：
Knowlton, Robert C.;Elgavish, Rotem A.;Kuzniecky, Ruben
目的：获得磁源成像（MSI）、2-[18 F]氟-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）和发作期单光子发射计算机断层扫描（SPECT）的价值信息，以预测需要颅内脑电图（ICEEG）的癫痫患者手术后的无癫痫结局。这项工作是一项前瞻性观察研究的一部分，癫痫手术的候选人没有充分定位与头皮脑电图和MRI。在160例患者中，62例完成ICEEG和随后的手术切除。61%的患者在至少1年的随访（平均= 3.4年）中获得了无Engel I型糖尿病结局。敏感性，特异性和预测值计算每一种方式。多变量逻辑回归用于确定预测的手术结果的影像学test.Results：MSI的敏感性为55%，阳性预测值为78%。排除非诊断性MSI病例（记录期间未捕获尖峰），校正后的阴性预测值为64%。可用的比较亚组FDG-PET和发作SPECT值与MSI相似。MSI预测无癫痫结局的OR（根据癫痫和MRI分类调整）为4.4（p =0.01）。在PET和MSI同时存在的病例中，PET的校正OR为7.1（p < 0.01），MSI的校正OR为6.4（p = 0.01）。在所有三种测试的情况下（n = 27），发作SPECT具有最高的OR为9.1（p = 0.05）。解释：MSI，FDG-PET和发作SPECT在预测通常需要ICEEG的癫痫手术候选人的无癫痫手术结果方面具有临床价值。
Objective: To gain information on the value of magnetic source imaging (MSI), 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), and ictal single photon emission computed tomography (SPECT) to predict seizure-free outcome following epilepsy surgery in patients who require intracranial electroencephalography (ICEEG).Methods: This work was part of a prospective observation study of epilepsy surgery candidates not sufficiently localized with scalp EEG and MRI. Of 160 patients enrolled 62 completed ICEEG and subsequent surgical resection. Sixty-one percent resulted in an Engel I seizure-free outcome at a minimum of one-year follow-up (mean = 3.4 years). Sensitivity, specificity, and predictive values were computed for each modality. Multivariate logistical regression was used to identify prediction of surgical outcome by imaging test.Results: MSI sensitivity for a conclusively localized study was 55% with a positive predictive value of 78%. Eliminating non-diagnostic MSI cases (no spikes captured during recording) yielded a corrected negative predictive value of 64%. With available comparison subgroups FDG-PET and ictal SPECT values were similar to MSI. The OR (adjusted for epilepsy and MRI classification) for MSI prediction of seizure-free outcome was 4.4 (p =0.01). In cases with both PET and MSI, the adjusted OR for PET was 7.1 (p < 0.01) and for MSI was 6.4 (p = 0.01). In the cases with all three tests (n = 27), ictal SPECT had the highest OR of 9.1 (p = 0.05).Interpretation: MSI, FDG-PET, and ictal SPECT each have clinical value in predicting seizure-free surgical outcome in epilepsy surgery candidates who typically require ICEEG.