Departments of Neurosurgery, Centre Hospitalier Sainte-Anne, Paris, France.
Neurology. 2010 Dec 14;75(24):2168-75. doi: 10.1212/WNL.0b013e31820203a9.
To determine the diagnostic accuracy and prognostic value of ¹⁸FDG-PET in a recent series of patients operated for intractable partial epilepsy associated with histologically proven Taylor-type focal cortical dysplasia (TTFCD) and negative MRI.
Of 23 consecutive patients (12 male, 7-38 years old) with negative 1.5-Tesla MRI, 10 exhibited subtle nonspecific abnormalities (e.g., unusual sulcus depth or gyral pattern) and the 13 others had strictly normal MRI. FDG-PET was analyzed both visually after coregistration on MRI and using SPM5 software. Metabolic data were compared with the epileptogenic zone (EZ) determined by stereo-EEG (SEEG) and surgical outcome.
Visual PET analysis disclosed a focal or regional hypometabolism in 18 cases (78%) corresponding to a single gyrus (n = 9) or a larger cortical region (n = 9). PET/MRI coregistration detected a partially hypometabolic gyrus in 4 additional cases. SPM5 PET analysis (n = 18) was concordant with visual analysis in 13 cases. Location of PET abnormalities was extratemporal in all cases, involving eloquent cortex in 15 (65%). Correlations between SEEG, PET/MRI, and histologic findings (n = 20) demonstrated that single hypometabolic gyri (n = 11) corresponded to EZ and TTFCD, which was localized at the bottom of the sulcus. Larger hypometabolic areas (n = 9) also included the EZ and the dysplastic cortex but were more extensive. Following limited cortical resection (mean follow-up 4 years), seizure freedom without permanent motor deficit was obtained in 20/23 patients (87%).
¹⁸FDG-PET coregistered with MRI is highly sensitive to detect TTFCD and greatly improves diagnosis and surgical prognosis of patients with negative MRI.
在一系列最近接受手术治疗的、与组织学证实的 Taylor 型局灶性皮质发育不良（TTFCD）相关的、MRI 结果阴性的、药物难治性部分性癫痫患者中，确定 ¹⁸FDG-PET 的诊断准确性和预后价值。
在 23 例连续的 MRI 阴性患者（男 12 例，年龄 7-38 岁）中，10 例存在轻微的非特异性异常（例如，不寻常的脑沟深度或脑回模式），13 例存在严格的正常 MRI。FDG-PET 通过与 MRI 配准后的视觉分析和 SPM5 软件进行分析。代谢数据与立体脑电图（SEEG）确定的致痫区（EZ）和手术结果进行比较。
视觉 PET 分析显示 18 例（78%）存在局灶或区域性低代谢，对应于单个脑回（n=9）或较大的皮质区域（n=9）。PET/MRI 配准在另外 4 例中检测到部分低代谢脑回。SPM5 PET 分析（n=18）在 13 例中与视觉分析一致。所有病例的 PET 异常部位均为颞外，涉及 15 例（65%）的语言皮质。SEEG、PET/MRI 和组织学发现（n=20）之间的相关性研究表明，单个低代谢脑回（n=11）与 EZ 和 TTFCD 相对应，TTFCD 定位于脑沟底部。较大的低代谢区域（n=9）也包括 EZ 和发育不良皮质，但范围更广。在接受有限的皮质切除（平均随访 4 年）后，23 例患者中有 20 例（87%）获得无永久性运动障碍的无癫痫发作。
与 MRI 配准的 ¹⁸FDG-PET 对检测 TTFCD 具有高度敏感性，并大大改善了 MRI 阴性患者的诊断和手术预后。
