Akman Cigdem Inan, Provenzano Frank, Wang Dong, Engelstad Kristin, Hinton Veronica, Yu Julia, Tikofsky Ronald, Ichese Masonari, De Vivo Darryl C
Department of Neurology, Division of Pediatric Neurology, Colleen Giblin Research Laboratory, Columbia University College of Physician & Surgeons, United States; Department of Neurology, Comprehensive Epilepsy Center, Columbia University College of Physician & Surgeons, United States.
Department of Radiology, Kreitchman PET Center, Columbia University College of Physician & Surgeons, United States.
Epilepsy Res. 2015 Feb;110:206-15. doi: 10.1016/j.eplepsyres.2014.11.007. Epub 2014 Dec 11.
(18)F fluorodeoxyglucose positron emission tomography ((18)F FDG-PET) facilitates examination of glucose metabolism. Previously, we described regional cerebral glucose hypometabolism using (18)F FDG-PET in patients with Glucose transporter 1 Deficiency Syndrome (Glut1 DS). We now expand this observation in Glut1 DS using quantitative image analysis to identify the epileptic network based on the regional distribution of glucose hypometabolism.
(18)F FDG-PET scans of 16 Glut1 DS patients and 7 healthy participants were examined using Statistical parametric Mapping (SPM). Summed images were preprocessed for statistical analysis using MATLAB 7.1 and SPM 2 software. Region of interest (ROI) analysis was performed to validate SPM results.
Visual analysis of the (18)F FDG-PET images demonstrated prominent regional glucose hypometabolism in the thalamus, neocortical regions and cerebellum bilaterally. Group comparison using SPM analysis confirmed that the regional distribution of glucose hypo-metabolism was present in thalamus, cerebellum, temporal cortex and central lobule. Two mildly affected patients without epilepsy had hypometabolism in cerebellum, inferior frontal cortex, and temporal lobe, but not thalamus. Glucose hypometabolism did not correlate with age at the time of PET imaging, head circumference, CSF glucose concentration at the time of diagnosis, RBC glucose uptake, or CNS score.
Quantitative analysis of (18)F FDG-PET imaging in Glut1 DS patients confirmed that hypometabolism was present symmetrically in thalamus, cerebellum, frontal and temporal cortex. The hypometabolism in thalamus correlated with the clinical history of epilepsy.
（18）F氟脱氧葡萄糖正电子发射断层扫描（（18）F FDG-PET）有助于检查葡萄糖代谢。此前，我们曾描述过葡萄糖转运体1缺乏综合征（Glut1 DS）患者使用（18）F FDG-PET检测到的局部脑葡萄糖代谢减低情况。现在，我们利用定量图像分析对Glut1 DS患者进行进一步观察，以基于葡萄糖代谢减低的区域分布识别癫痫网络。
使用统计参数映射（SPM）对16例Glut1 DS患者和7名健康参与者的（18）F FDG-PET扫描图像进行检查。使用MATLAB 7.1和SPM 2软件对叠加图像进行预处理以进行统计分析。进行感兴趣区域（ROI）分析以验证SPM结果。
对（18）F FDG-PET图像的视觉分析显示，双侧丘脑、新皮质区域和小脑存在明显的局部葡萄糖代谢减低。使用SPM分析进行的组间比较证实，葡萄糖代谢减低的区域分布见于丘脑、小脑、颞叶皮质和中央小叶。两名无癫痫发作的轻度受累患者在小脑、额下回皮质和颞叶存在代谢减低，但丘脑无此表现。葡萄糖代谢减低与PET成像时的年龄、头围、诊断时的脑脊液葡萄糖浓度、红细胞葡萄糖摄取或中枢神经系统评分均无相关性。
对Glut1 DS患者的（18）F FDG-PET成像进行定量分析证实，丘脑、小脑、额叶和颞叶皮质对称存在代谢减低。丘脑中的代谢减低与癫痫临床病史相关。
