O'Brien Terence J, Miles Ken, Ware Robert, Cook Mark J, Binns David S, Hicks Rodney J
Department of Medicine, Surgery, and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
J Nucl Med. 2008 Jun;49(6):931-7. doi: 10.2967/jnumed.107.048207. Epub 2008 May 15.
This study applied decision tree analysis to evaluate the sensitivity, specificity, and cost-effectiveness of clinical algorithms that incorporate 18F-FDG PET.
A cohort of 176 patients was studied. The localization rate, accuracy, therapeutic impact on the presurgical decision-making process, and correlation with the postsurgical outcome were assessed for the tests commonly performed for seizure localization. Decision tree sensitivity analysis compared 3 imaging strategies with a baseline strategy of medical therapy for all: video-electroencephalography monitoring (VEM)/MRI strategy, in which patients underwent VEM and brain MRI only, and +SPECT and +PET strategies, in which patients with an indeterminate VEM/MRI result underwent ictal SPECT or interictal 18F-FDG PET, respectively.
The localization rates for VEM, MRI, 18F-FDG PET, ictal SPECT, and intracranial electroencephalography (EEG) were 62.2%, 35.8%, 75.0%, 60.0%, and 93.8%. The VEM/MRI strategy had the lowest cost per class I/II outcome, but the additional costs per class I/II outcome for the +PET and +SPECT strategies were always below the minimum reported cost savings for a class I/II outcome. There were no valid conditions in which the +SPECT strategy had a lower cost per class I/II outcome than the +PET strategy. Within the range of cost savings estimated to be associated with a class I/II outcome, all decision strategies produced net cost savings; however, these were significantly higher for the +PET and the +SPECT strategies.
18F-FDG PET is cost-effective in the presurgical evaluation, particularly when used in patients with a nonlocalizing or nonconcordant VEM or MRI result.
本研究应用决策树分析来评估纳入18F-FDG PET的临床算法的敏感性、特异性和成本效益。
对176例患者进行了队列研究。评估了常用于癫痫灶定位的检查的定位率、准确性、对术前决策过程的治疗影响以及与术后结果的相关性。决策树敏感性分析将3种成像策略与对所有患者进行药物治疗的基线策略进行了比较：视频脑电图监测（VEM）/MRI策略，即患者仅接受VEM和脑部MRI检查；+SPECT和+PET策略，即VEM/MRI结果不确定的患者分别接受发作期SPECT或发作间期18F-FDG PET检查。
VEM、MRI、18F-FDG PET、发作期SPECT和颅内脑电图（EEG）的定位率分别为62.2%、35.8%、75.0%、60.0%和93.8%。VEM/MRI策略的I/II级结果的单位成本最低，但+PET和+SPECT策略的I/II级结果的额外单位成本始终低于报道的I/II级结果的最低成本节约值。不存在+SPECT策略的I/II级结果单位成本低于+PET策略的有效情况。在估计与I/II级结果相关的成本节约范围内，所有决策策略均产生了净成本节约；然而，+PET和+SPECT策略的净成本节约显著更高。
18F-FDG PET在术前评估中具有成本效益，特别是用于VEM或MRI结果无定位或不一致的患者时。
