[11C] Flumazenil PET in temporal lobe epilepsy:: do we need an arterial input function or kinetic modeling?
[11C] Flumazenil PET in temporal lobe epilepsy:: do we need an arterial input function or kinetic modeling?
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DOI：
10.1038/sj.jcbfm.9600515
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发表时间：
2008-01-01
影响因子：
6.3
通讯作者：
Koepp, Matthias J.
中科院分区：
文献类型：
--
作者：
Hammers, Alexander;Panagoda, Prasan;Koepp, Matthias J.
[（11）C]]氟马西尼（FMZ）正电子发射断层扫描（PET）信号降低与致痫灶有关。FMZ结合的参数和非参数图像之间的个体内线性相关性已经被证明，并且已经使用了各种方法，而没有比较诊断有用性。使用海马硬化（HS）作为测试案例，我们正式比较了参数图像的诊断率，无论是与父示踪剂动脉血浆输入函数还是频谱分析（产生分布容积（VD）图像），或者利用基于图像的输入函数和简化的参考组织模型（结合电位图像，BP-SRTM）与10至20或20至40分钟的半定量积分（ADD）图像的诊断产率（ADD 1020和ADD 2040）。动态90分钟[（11）C] FMZ PET数据集和动脉血浆输入功能可用于15例难治性内侧颞叶癫痫（TLE）和组织学证实的单侧HS患者以及13例对照受试者。SPM 2用于分析。ADD 1020和ADD 2040图像显示，13/15例病例的致癫痫海马同侧FMZ摄取减少; 6/13例病例在ADD 1020分析中双侧减少，5/13例病例在ADD 2040分析中双侧减少。BP-SRTM图像检测到12/15例同侧降低，3例双侧降低。相比之下，VD图像显示所有15例患者的同侧海马减少，3例患者双侧减少。ADD图像中的双侧减少倾向于更对称，在一个病例中对侧更明显。理想情况下，应在FMZ PET评价中使用图像独立输入的完全量化;至少在TLE中，受试者内相关性不能预测等同的临床有用性。
Reduced signal on [(11)C]] flumazenil (FMZ) positron emission tomography (PET) is associated with epileptogenic foci. Linear correlations within individuals between parametric and nonparametric images of FMZ binding have been shown, and various methods have been used, without comparison of diagnostic usefulness. Using hippocampal sclerosis (HS) as a test case, we formally compare the diagnostic yield of parametric images obtained either with a parent tracer arterial plasma input function and spectral analysis (yielding volume-of-distribution (VD) images), or with an image-based input function and the simplified reference tissue model (binding potential images, BP-SRTM) with the diagnostic yield of semiquantitative-integrated (ADD) images from 10 to 20 or 20 to 40 mins (ADD1020 and ADD2040). Dynamic 90-min [(11)C] FMZ PET datasets and arterial plasma input functions were available for 15 patients with medically refractory medial temporal lobe epilepsy (TLE) and histologically verified unilateral HS and for 13 control subjects. SPM2 was used for analysis. ADD1020 and ADD2040 images showed decreased FMZ uptake ipsilateral to the epileptogenic hippocampus in 13/15 cases; 6/13 had bilateral decreases in the ADD1020 analysis and 5/13 in the ADD2040 analysis. BP-SRTM images detected ipsilateral decreases in 12/15 cases, with bilateral decreases in three. In contrast, VD images showed ipsilateral hippocampal decreases in all 15 patients, with bilateral decreases in three patients. Bilateral decreases in the ADD images tended to be more symmetrical and in one case were more marked contralaterally. Full quantification with an image-independent input should ideally be used in the evaluation of FMZ PET; at least in TLE, intrasubject correlations do not predict equivalent clinical usefulness.