Komoto Daisuke, Iida Koji, Higaki Toru, Kaichi Yoko, Takauchi Komei, Arihiro Koji, Kakita Akiyoshi, Hirokawa Yutaka, Awai Kazuo
Hiroshima J Med Sci. 2015 Dec;64(4):51-7.
To compare the diagnostic performance of 18F-FDG PET, 11C-FMZ PET, and 11C-FMZ BP imaging for the evaluation of patients with intractable partial epilepsy whose MRI findings are normal by using statistical imaging analysis. Ten patients underwent comprehensive presurgical evaluation, including PET studies, to assess the epileptic foci. The extent of cortical resection was based on the results of intracranial video-electroencephalography (IVEEG) monitoring and brain mapping under stimulation. The images of 10 patients and 30 controls were spatially normalized to templates generated in-house by non-rigid registration and the standardized images of the patients and controls were statistically compared. Epileptic focus candidates were visualized on a color map of axial images of each template and the focus site was identified in candidates for lobar location. In patients with Engel I postoperative seizure outcomes we assessed the sensitivity and specificity of the imaging methods for lobar focus localization. We also compared the concordance scores of patients with Engel I and Engel II-IV postoperative seizures. The sensitivity and specificity for lobar focus localization on 18F-FDG PET scans was 90.0% and 84.8%, respectively; it was 30.0% and 81.4% for 11C-FMZ PET, 40.0% and 66.7% for 11C-FMZ BP images, and 100.0% and 51.4% for 18F-FDG PET/11C-FMZ PET/11C-FMZ BP images. In one patient the epileptic focus not detected on 18F-FDG PET scans was shown on 11C-FMZ BP images. In patients with Engel I post-treatment seizures the concordance scores were significantly higher for 18F-FDG PET than 11C-FMZ PET and 11C-FMZ BP images (p < 0.05). With respect to sensitivity and specificity, 18F-FDG PET was superior to 11C-FMZ PET and 11C-FMZ BP imaging. However, in some patients with normal MRI results, 11C-FMZ BP studies may complement 18F-FDG PET findings in efforts to identify the epileptogenic lobar regions.
通过统计成像分析比较18F-FDG PET、11C-FMZ PET和11C-FMZ BP成像对MRI结果正常的难治性部分性癫痫患者的诊断性能。10例患者接受了包括PET研究在内的全面术前评估，以评估癫痫病灶。皮质切除术的范围基于颅内视频脑电图（IVEEG）监测和刺激下的脑图谱结果。通过非刚性配准将10例患者和30例对照的图像空间归一化到内部生成的模板，并对患者和对照的标准化图像进行统计学比较。在每个模板的轴向图像的彩色图上可视化癫痫病灶候选区域，并在叶定位的候选区域中确定病灶位置。对于术后Engel I级癫痫发作结果的患者，我们评估了成像方法对叶病灶定位的敏感性和特异性。我们还比较了术后Engel I级和Engel II-IV级癫痫发作患者的一致性评分。18F-FDG PET扫描对叶病灶定位的敏感性和特异性分别为90.0%和84.8%；11C-FMZ PET分别为30.0%和81.4%，11C-FMZ BP图像分别为40.0%和66.7%，18F-FDG PET/11C-FMZ PET/11C-FMZ BP图像分别为100.0%和51.4%。在1例患者中，18F-FDG PET扫描未检测到的癫痫病灶在11C-FMZ BP图像上显示。对于术后Engel I级癫痫发作的患者，18F-FDG PET的一致性评分显著高于11C-FMZ PET和11C-FMZ BP图像（p<0.05）。就敏感性和特异性而言，18F-FDG PET优于11C-FMZ PET和11C-FMZ BP成像。然而，在一些MRI结果正常的患者中，11C-FMZ BP研究可能有助于补充18F-FDG PET的结果，以识别致痫叶区域。
