Utility of 18F-fluorodeoxyglucose positron emission tomography in presurgical evaluation of patients with epilepsy: A multicenter study
Utility of 18F-fluorodeoxyglucose positron emission tomography in presurgical evaluation of patients with epilepsy: A multicenter study
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DOI：
10.1111/epi.17194
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发表时间：
2022-02-15
期刊：
影响因子：
5.6
通讯作者：
Ilyas-Feldmann, Maria
中科院分区：
文献类型：
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作者：
Steinbrenner, Mirja;Duncan, John S.;Ilyas-Feldmann, Maria
如果磁共振成像 (MRI) 和头皮脑电图 (EEG) 无法定位癫痫发作区域或不一致，则 18F-氟脱氧葡萄糖正电子发射断层扫描 (FDG-PET) 广泛用于耐药局灶性癫痫 (DRE) 患者的术前评估。方法 在这项多中心、回顾性观察队列研究中，我们纳入了连续接受 FDG-PET 作为术前检查一部分的 DRE 患者。我们评估了 FDG-PET 的效用，其定义为有助于决策过程，以参考切除或颅内脑电图 (iEEG) 或得出手术不可行的结论。结果 本研究纳入了 951 名患者； 479 例患有颞叶癫痫 (TLE)，219 例患有颞叶外癫痫 (ETLE)，253 例患有不确定脑叶起源的癫痫。 FDG-PET 在 62% 的患者中显示出明显的代谢减退，并且在 TLE 中 74% 的患者和 ETLE 中的 56% 的患者中与发作期脑电图一致 (p < .001)。 FDG-PET 对 396 名患者 (47%) 的术前决策有用，与 ETLE 相比，TLE 最有益（58% vs. 44%，p = .001）。总体而言，FDG-PET 有助于建议切除 78 例 (20%)，iEEG 有助于建议切除 187 例 (47%)；在 131 名患者 (33%) 中，FDG-PET 得出的结论是切除不可行。在 TLE 中，MRI 和 EEG-PET 一致性为阴性的患者 (n = 30, 65%) 与 MRI 和 EEG 一致性为阳性的患者 (n = 46, 68%) 术后 1 年无癫痫发作没有显着差异 (p = .48)。在 ETLE 中，一半 MRI 和 EEG-PET 一致性为阴性的患者以及四分之三的 MRI 和 EEG 一致性为阳性的患者术后无癫痫发作（n = 5 vs. n = 6，p = .28）。意义 这是报告的最大的接受术前 FDG-PET 的 DRE 患者队列，表明 FDG-PET 是一种有用的诊断工具。 FDG-PET 结果（脑电图或 MRI）一致的 MRI 阴性和 MRI 阳性病例在手术后具有相似的结果。这些发现证实了 FDG-PET 在术前癫痫诊断中的重要性。
Objective 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in presurgical assessment in patients with drug-resistant focal epilepsy (DRE) if magnetic resonance imaging (MRI) and scalp electroencephalography (EEG) do not localize the seizure onset zone or are discordant. Methods In this multicenter, retrospective observational cohort study, we included consecutive patients with DRE who had undergone FDG-PET as part of their presurgical workup. We assessed the utility of FDG-PET, which was defined as contributing to the decision-making process to refer for resection or intracranial EEG (iEEG) or to conclude surgery was not feasible. Results We included 951 patients in this study; 479 had temporal lobe epilepsy (TLE), 219 extratemporal epilepsy (ETLE), and 253 epilepsy of uncertain lobar origin. FDG-PET showed a distinct hypometabolism in 62% and was concordant with ictal EEG in 74% in TLE and in 56% in ETLE (p < .001). FDG-PET was useful in presurgical decision-making in 396 patients (47%) and most beneficial in TLE compared to ETLE (58% vs. 44%, p = .001). Overall, FDG-PET contributed to recommending resection in 78 cases (20%) and iEEG in 187 cases (47%); in 131 patients (33%), FDG-PET resulted in a conclusion that resection was not feasible. In TLE, seizure-freedom 1 year after surgery did not differ significantly (p = .48) between patients with negative MRI and EEG-PET concordance (n = 30, 65%) and those with positive MRI and concordant EEG (n = 46, 68%). In ETLE, half of patients with negative MRI and EEG-PET concordance and three quarters with positive MRI and concordant EEG were seizure-free postsurgery (n = 5 vs. n = 6, p = .28). Significance This is the largest reported cohort of patients with DRE who received presurgical FDG-PET, showing that FDG-PET is a useful diagnostic tool. MRI-negative and MRI-positive cases with concordant FDG-PET results (with either EEG or MRI) had a comparable outcome after surgery. These findings confirm the significance of FDG-PET in presurgical epilepsy diagnostics.