Kim Yu Kyeong, Lee Dong Soo, Lee Sang Kun, Chung Chun Kee, Chung June-Key, Lee Myung Chul
Department of Nuclear Medicine, College of Medicine, Seoul National University, Seoul, Korea.
J Nucl Med. 2002 Sep;43(9):1167-74.
The sensitivity of (18)F-FDG PET to localize epileptogenic zones in frontal lobe epilepsy was evaluated by both visual assessment and statistical parametric mapping (SPM).
Twenty-nine patients with frontal lobe epilepsy were examined. All patients showed good outcome after surgical resection (Engel class I or II). On pathologic examination, 22 patients had cortical dysplasia, 4 had tumors, 1 had cortical scars, and 2 had an old infarct. Hypometabolic lesions were found on (18)F-FDG PET images by both visual assessment and SPM analysis. On SPM analysis, the cutoff threshold was varied and sensitivity to find epileptogenic zones was compared.
MRI showed structural lesions in 15 patients and normal findings in 14. (18)F-FDG PET correctly localized the epileptogenic zones in 16 patients (55%) by visual assessment. The sensitivity of (18)F-FDG PET was 36% in patients without structural lesions on MRI and 73% in patients with structural lesions. On SPM analysis, using an uncorrected probability value of 0.005 as the threshold, the sensitivity of SPM analysis was 66%, which was not statistically different from the sensitivity of visual assessment. The sensitivity decreased according to the decrease in probability value.
(18)F-FDG PET was sensitive in localizing epileptogenic zones by revealing hypometabolic areas in nonlesional patients with frontal lobe epilepsy as well as in lesional patients. SPM analysis showed a comparable sensitivity to visual assessment and could be used as an aid in diagnosing epileptogenic zones in frontal lobe epilepsy.
通过视觉评估和统计参数映射（SPM）评估了¹⁸F-FDG PET定位额叶癫痫致痫区的敏感性。
对29例额叶癫痫患者进行了检查。所有患者在手术切除后均取得了良好的效果（Engel分级为I级或II级）。病理检查显示，22例患者有皮质发育异常，4例有肿瘤，1例有皮质瘢痕，2例有陈旧性梗死。通过视觉评估和SPM分析在¹⁸F-FDG PET图像上发现了代谢减低病变。在SPM分析中，改变截止阈值并比较发现致痫区的敏感性。
MRI显示15例患者有结构性病变，14例正常。¹⁸F-FDG PET通过视觉评估在16例患者（55%）中正确定位了致痫区。¹⁸F-FDG PET在MRI无结构性病变的患者中的敏感性为36%，在有结构性病变的患者中为73%。在SPM分析中，以未校正的概率值0.005为阈值，SPM分析的敏感性为66%，与视觉评估的敏感性无统计学差异。敏感性随概率值的降低而降低。
¹⁸F-FDG PET通过揭示额叶癫痫非病变患者以及病变患者中的代谢减低区域，在定位致痫区方面具有敏感性。SPM分析显示出与视觉评估相当的敏感性，可作为诊断额叶癫痫致痫区的辅助手段。
