18F-FDG PET and high-resolution MRI co-registration for pre-surgical evaluation of patients with conventional MRI-negative refractory extra-temporal lobe epilepsy
18F-FDG PET and high-resolution MRI co-registration for pre-surgical evaluation of patients with conventional MRI-negative refractory extra-temporal lobe epilepsy
复制标题
F-18-FDG PET 和高分辨率 MRI 联合配准用于常规 MRI 阴性难治性颞叶外癫痫患者的术前评估
DOI：
10.1007/s00259-018-4017-0
复制
发表时间：
2018-07-01
影响因子：
9.1
通讯作者：
Tian, Mei
中科院分区：
文献类型：
--
作者：
Ding, Yao;Zhu, Yuankai;Tian, Mei
起源于颞叶以外的癫痫可能是外科治疗中最具挑战性的问题，特别是对于常规磁共振成像(MRI)阴性的难治性颞叶外癫痫(ETLE)患者。本研究旨在评价常规MRI阴性难治性ETLE患者术前F-18-脱氧葡萄糖正电子发射断层扫描(F-18-FDG PET)和高分辨率磁共振成像(HR-MRI)联合检查的临床价值，并比较其手术结果。在F-18-FDGPET和HR-MRI联合配准的指导下，重新读取HR-MRI图像。根据首次读数到复读图像结果的变化，将患者分为3组：Change-1组(复读时可发现微小异常的病变)、Change-2组(首次读数时报告的非特异性异常被认为是HR-MRI复读时的病变)和无改变组。术后随访59个月，F-18-FDGPET目测分析显示局灶性或区域性异常46例(68.6%)，联合登记异常率增至94.0%(P<；0.05)。在67例患者中，经联合登记和HR-MRI复查后，46.3%的患者被确定为Change-1，11.9%的患者被确定为Change-2。Change-1和Change-2的患者更有可能被建议接受手术切除(P<；0.001)。在17例术后患者中，88%的患者预后良好，11.7%的患者预后不佳。通过F-18-FDGPET和HR-MRI的联合注册，术前评估可以提高对致痫起始区(EOZ)的识别，并可能进一步指导手术决策，改善常规MRI正常的难治性ETLE的预后，因此，应推荐将其作为这些患者的术前评估的标准程序。
Epilepsy that originates outside of the temporal lobe can present some of the most challenging problems for surgical therapy, especially for patients with conventional magnetic resonance imaging (MRI)-negative refractory extra-temporal lobe epilepsy (ETLE). This study aimed to evaluate the clinical value of pre-surgical F-18-fluoro-deoxy-glucose positron emission tomography (F-18-FDG PET) and high-resolution MRI (HR-MRI) co-registration in patients with conventional MRI-negative refractory ETLE, and compare their surgical outcomes.Sixty-seven patients with conventional MRI-negative refractory ETLE were prospectively included for pre-surgical F-18-FDG PET and HR-MRI examinations. Under the guidance of F-18-FDG PET and HR-MRI co-registration, HR-MRI images were re-read. Based on the image result changes from first reading to re-reading, patients were divided into three groups: Change-1 (lesions of subtle abnormality could be identified in re-read), Change-2 (non-specific abnormalities reported in the first reading were considered as lesions on HR-MRI re-read) and No-change. Post-surgical follow-ups were conducted for up to 59 months.Visual analysis of F-18-FDG PET showed focal or regional abnormality in 46 patients (68.6%), while the abnormal rate increased to 94.0% (P < 0.05) by co-registration. Of the 67 patients, 46.3% of them were identified as Change-1, and 11.9% as Change-2 after co-registration and HR-MRI re-read. Patients with Change-1 and -2 were more likely to be recommended to receive surgical resection (P < 0.001). In the 17 post-surgical patients, 88% had good outcomes, whereas 11.7% had poor outcomes during our study period.Pre-surgical evaluation by co-registration of F-18-FDG PET and HR-MRI could improve the identification of the epileptogenic onset zone (EOZ), and may further guide the surgical decision-making and improve the outcome of the refractory ETLE with normal conventional MRI; therefore, it should be recommended as a standard procedure for pre-surgical evaluation of these patients.