Salamon N, Kung J, Shaw S J, Koo J, Koh S, Wu J Y, Lerner J T, Sankar R, Shields W D, Engel J, Fried I, Miyata H, Yong W H, Vinters H V, Mathern G W
Reed Neurological Research Center, 710 Westwood Plaza, Room 2123, Los Angeles, CA 90095-1769, USA.
Neurology. 2008 Nov 11;71(20):1594-601. doi: 10.1212/01.wnl.0000334752.41807.2f.
Patients with cortical dysplasia (CD) are difficult to treat because the MRI abnormality may be undetectable. This study determined whether fluorodeoxyglucose (FDG)-PET/MRI coregistration enhanced the recognition of CD in epilepsy surgery patients.
Patients from 2004-2007 in whom FDG-PET/MRI coregistration was a component of the presurgical evaluation were compared with patients from 2000-2003 without this technique. For the 2004-2007 cohort, neuroimaging and clinical variables were compared between patients with mild Palmini type I and severe Palmini type II CD.
Compared with the 2000-2003 cohort, from 2004-2007 more CD patients were detected, most had type I CD, and fewer cases required intracranial electrodes. From 2004-2007, 85% of type I CD cases had normal non-University of California, Los Angeles (UCLA) MRI scans. UCLA MRI identified CD in 78% of patients, and 37% of type I CD cases had normal UCLA scans. EEG and neuroimaging findings were concordant in 52% of type I CD patients, compared with 89% of type II CD patients. FDG-PET scans were positive in 71% of CD cases, and type I CD patients had less hypometabolism compared with type II CD patients. Postoperative seizure freedom occurred in 82% of patients, without differences between type I and type II CD cases.
Incorporating fluorodeoxyglucose-PET/MRI coregistration into the multimodality presurgical evaluation enhanced the noninvasive identification and successful surgical treatment of patients with cortical dysplasia (CD), especially for the 33% of patients with nonconcordant findings and those with normal MRI scans from mild type I CD.
皮质发育异常（CD）患者难以治疗，因为磁共振成像（MRI）异常可能无法检测到。本研究确定氟脱氧葡萄糖（FDG）-正电子发射断层扫描/磁共振成像（PET/MRI）配准是否能提高癫痫手术患者中CD的识别率。
将2004年至2007年期间FDG-PET/MRI配准作为术前评估一部分的患者与2000年至2003年期间未采用该技术的患者进行比较。对于2004年至2007年队列，比较轻度帕尔米尼I型和重度帕尔米尼II型CD患者的神经影像学和临床变量。
与2000年至2003年队列相比，2004年至2007年检测到更多的CD患者，大多数为I型CD，需要颅内电极的病例更少。2004年至2007年，85%的I型CD病例未进行加利福尼亚大学洛杉矶分校（UCLA）MRI扫描。UCLA MRI在78%的患者中识别出CD，37%的I型CD病例UCLA扫描正常。52%的I型CD患者脑电图和神经影像学结果一致，而II型CD患者为89%。71%的CD病例FDG-PET扫描呈阳性，I型CD患者代谢减低程度低于II型CD患者。82%的患者术后无癫痫发作，I型和II型CD病例之间无差异。
将氟脱氧葡萄糖-PET/MRI配准纳入多模态术前评估可提高皮质发育异常（CD）患者的无创识别率和手术成功率，特别是对于33%检查结果不一致的患者以及轻度I型CD且MRI扫描正常的患者。
