Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Zhejiang University Medical PET Center, Hangzhou, China.
J Nucl Med. 2017 Aug;58(8):1293-1299. doi: 10.2967/jnumed.116.187492. Epub 2017 Jan 19.
PET with F-FDG has been used for presurgical localization of epileptogenic foci; however, in nonsurgical patients, the correlation between cerebral glucose metabolism and clinical severity has not been fully understood. The aim of this study was to evaluate the glucose metabolic profile using F-FDG PET/CT imaging in patients with epilepsy. One hundred pediatric epilepsy patients who underwent F-FDG PET/CT, MRI, and electroencephalography examinations were included. Fifteen age-matched controls were also included. F-FDG PET images were analyzed by visual assessment combined with statistical parametric mapping (SPM) analysis. The absolute asymmetry index (|AI|) was calculated in patients with regional abnormal glucose metabolism. Visual assessment combined with SPM analysis of F-FDG PET images detected more patients with abnormal glucose metabolism than visual assessment only. The |AI| significantly positively correlated with seizure frequency ( < 0.01) but negatively correlated with the time since last seizure ( < 0.01) in patients with abnormal glucose metabolism. The only significant contributing variable to the |AI| was the time since last seizure, in patients both with hypometabolism ( = 0.001) and with hypermetabolism ( = 0.005). For patients with either hypometabolism ( < 0.01) or hypermetabolism ( = 0.209), higher |AI| values were found in those with drug resistance than with seizure remission. In the post-1-y follow-up PET studies, a significant change of |AI| (%) was found in patients with clinical improvement compared with those with persistence or progression ( < 0.01). F-FDG PET imaging with visual assessment combined with SPM analysis could provide cerebral glucose metabolic profiles in nonsurgical epilepsy patients. |AI| might be used for evaluation of clinical severity and progress in these patients. Patients with a prolonged period of seizure freedom may have more subtle (or no) metabolic abnormalities on PET. The clinical value of PET might be enhanced by timing the scan closer to clinical seizures.
正电子发射断层扫描（PET）与 F-FDG 已用于致痫灶的术前定位；然而，在非手术患者中，脑葡萄糖代谢与临床严重程度之间的相关性尚未完全明确。本研究旨在评估癫痫患者使用 F-FDG PET/CT 成像的葡萄糖代谢谱。
纳入了 100 名接受 F-FDG PET/CT、MRI 和脑电图检查的儿科癫痫患者，还纳入了 15 名年龄匹配的对照者。通过视觉评估结合统计参数图（SPM）分析对 F-FDG PET 图像进行分析。在有局部葡萄糖代谢异常的患者中计算绝对不对称指数（|AI|）。
视觉评估结合 SPM 分析 F-FDG PET 图像比仅视觉评估检测到更多葡萄糖代谢异常的患者。在葡萄糖代谢异常的患者中，|AI|与发作频率显著正相关（<0.01），与末次发作后时间显著负相关（<0.01）。末次发作后时间是导致 |AI|的唯一显著因素，无论是在代谢低下的患者中（=0.001）还是代谢亢进的患者中（=0.005）。对于代谢低下（<0.01）或代谢亢进（=0.209）的患者，药物抵抗患者的 |AI|值高于发作缓解患者。在 1 年的随访 PET 研究中，与病情持续或进展的患者相比，临床改善的患者 |AI|（%）有显著变化（<0.01）。视觉评估结合 SPM 分析的 F-FDG PET 成像可提供非手术性癫痫患者的脑葡萄糖代谢谱。|AI|可用于评估这些患者的临床严重程度和进展。发作无拘束时间较长的患者可能在 PET 上有更细微（或无）的代谢异常。通过更接近临床发作的时间进行扫描，可以增强 PET 的临床价值。
