Rheims Sylvain, Jung Julien, Ryvlin Philippe
Department of Functional Neurology and Epileptology, Institute of Epilepsies (IDEE), Hospices Civils de Lyon , Lyon , France ; INSERM U1028/CNRS UMR5292, Lyon Neuroscience Research Center , Lyon , France.
Front Neurol. 2013 Nov 21;4:188. doi: 10.3389/fneur.2013.00188.
Despite major advances in neuroimaging, no lesion is visualized on MRI in up to a quarter of patients with drug-resistant focal epilepsy presenting for presurgical evaluation. These patients demonstrate poorer surgical outcomes than those with lesion seen on MRI. Accurate localization of the seizure onset zone (SOZ) is more difficult in MRI-negative patients and often requires invasive EEG recordings. Positron emission tomography (PET) and magnetoencephalography (MEG) have been proposed as clinically relevant tools to localize the SOZ prior to intracranial EEG recordings. However, there is no consensus regarding the optimal gold standard that should be used for assessing the performance of these presurgical investigations. Here, we review the current knowledge concerning the usefulness of PET and MEG for presurgical assessment of MRI-negative epilepsy. Beyond the individual diagnostic performance of MEG and of different PET tracers, including [(18)F]-fluorodeoxyglucose, [(11)C]flumazenil, and markers of 5-HT1A receptors, recent data suggest that the combination of PET and MEG might provide greater sensitivity and specificity than that of each of the two individual tests in patients with normal MRI.
尽管神经影像学取得了重大进展，但在接受术前评估的耐药性局灶性癫痫患者中，高达四分之一的患者在磁共振成像（MRI）上未发现病变。这些患者的手术效果比MRI上有病变的患者更差。在MRI阴性的患者中，癫痫发作起始区（SOZ）的准确定位更加困难，通常需要进行侵入性脑电图记录。正电子发射断层扫描（PET）和脑磁图（MEG）已被提议作为在颅内脑电图记录之前定位SOZ的临床相关工具。然而，对于评估这些术前检查性能应使用的最佳金标准尚无共识。在此，我们综述了有关PET和MEG在MRI阴性癫痫术前评估中的有用性的现有知识。除了MEG和不同PET示踪剂（包括[（18）F] - 氟脱氧葡萄糖、[（11）C]氟马西尼和5-HT1A受体标记物）的个体诊断性能外，最近的数据表明，在MRI正常的患者中，PET和MEG的联合应用可能比两种单独检查中的任何一种具有更高的敏感性和特异性。
