Fernández S, Donaire A, Serès E, Setoain X, Bargalló N, Falcón C, Sanmartí F, Maestro I, Rumià J, Pintor L, Boget T, Aparicio J, Carreño M
Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Neurology Unit, Medical Division, Hospital Plató, Barcelona, Spain.
Epilepsy Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain.
Epilepsy Res. 2015 Mar;111:1-9. doi: 10.1016/j.eplepsyres.2014.12.011. Epub 2015 Jan 3.
We aimed to investigate the usefulness of coregistration of positron emission tomography (PET) and magnetic resonance imaging (MRI) findings (PET/MRI) and of coregistration of PET/MRI with subtraction ictal single-photon emission computed tomography (SPECT) coregistered to MRI (SISCOM) (PET/MRI/SISCOM) in localizing the potential epileptogenic zone in patients with drug-resistant epilepsy. We prospectively included 35 consecutive patients with refractory focal epilepsy whose presurgical evaluation included a PET study. Separately acquired PET and structural MRI images were coregistered for each patient. When possible, ictal SPECT and SISCOM were obtained and coregistered with PET/MRI. The potential location of the epileptogenic zone determined by neuroimaging was compared with the seizure onset zone determined by long-term video-EEG monitoring and with invasive EEG studies in patients who were implanted. Structural MRI showed no lesions in 15 patients. In these patients, PET/MRI coregistration showed a hypometabolic area in 12 (80%) patients that was concordant with seizure onset zone on EEG in 9. In 7 patients without MRI lesions, PET/MRI detected a hypometabolism that was undetected on PET alone. SISCOM, obtained in 25 patients, showed an area of hyperperfusion concordant with the seizure onset zone on EEG in 7 (58%) of the 12 of these patients who had normal MRI findings. SISCOM hyperperfusion was less extensive than PET hypometabolism. A total of 19 patients underwent surgery; 11 of these underwent invasive-EEG monitoring and the seizure onset zone was concordant with PET/MRI in all cases. PET/MRI/SISCOM coregistration, performed in 4 of these patients, was concordant in 3 (75%). After epilepsy surgery, 13 (68%) patients are seizure-free after a mean follow-up of 4.5 years. PET/MRI and PET/MRI/SISCOM coregistration are useful for determining the potential epileptogenic zone and thus for planning invasive EEG studies and surgery more precisely, especially in patients without lesions on MRI.
我们旨在研究正电子发射断层扫描（PET）与磁共振成像（MRI）结果的联合登记（PET/MRI）以及PET/MRI与减法发作期单光子发射计算机断层扫描（SPECT）联合登记到MRI（SISCOM）（PET/MRI/SISCOM）在定位耐药性癫痫患者潜在致痫区方面的实用性。我们前瞻性纳入了35例连续的难治性局灶性癫痫患者，其术前评估包括PET检查。为每位患者分别采集的PET和结构MRI图像进行联合登记。若可能，获取发作期SPECT和SISCOM并与PET/MRI联合登记。将神经影像学确定的致痫区潜在位置与长期视频脑电图监测确定的癫痫发作起始区以及植入患者的侵入性脑电图研究结果进行比较。结构MRI显示15例患者无病变。在这些患者中，PET/MRI联合登记显示12例（80%）患者存在代谢减低区，其中9例与脑电图上的癫痫发作起始区一致。在7例无MRI病变的患者中，PET/MRI检测到单独PET未发现的代谢减低。25例患者进行了SISCOM检查，在这些MRI结果正常的12例患者中，7例（58%）显示与脑电图上癫痫发作起始区一致的灌注增加区。SISCOM的灌注增加范围小于PET的代谢减低范围。共有19例患者接受了手术；其中11例接受了侵入性脑电图监测，所有病例的癫痫发作起始区均与PET/MRI一致。4例患者进行了PET/MRI/SISCOM联合登记，3例（75%）结果一致。癫痫手术后，平均随访4.5年，13例（68%）患者无癫痫发作。PET/MRI和PET/MRI/SISCOM联合登记有助于确定潜在致痫区，从而更精确地规划侵入性脑电图研究和手术，尤其是在MRI无病变的患者中。
