Hu Wen-Han, Liu Li-Na, Zhao Bao-Tian, Wang Xiu, Zhang Chao, Shao Xiao-Qiu, Zhang Kai, Ma Yan-Shan, Ai Lin, Li Jun-Ju, Zhang Jian-Guo
Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Pathology, Beijing Fengtai Hospital, Beijing, China.
Front Neurol. 2018 Oct 4;9:820. doi: 10.3389/fneur.2018.00820. eCollection 2018.
Magnetic resonance imaging (MRI) and positron emission tomography (PET) with F-fluorodeoxyglucose (FDG) are valuable tools for evaluating hippocampal sclerosis (HS); however, bias may arise during visual analyses. The aim of this study was to evaluate and compare MRI and PET post-processing techniques, automated quantitative hippocampal volume (Q-volume), and fluid-attenuated inversion-recovery (FLAIR) signal (Q-FLAIR) and glucose metabolism (Q-PET) analyses in patients with HS. We collected MRI and FDG-PET images from 54 patients with HS and 22 healthy controls and independently performed conventional visual analyses (CVA) of PET (CVA-PET) and MRI (CVA-MRI) images. During the subsequent quantitative analyses, the hippocampus was segmented from the 3D T1 image, and the mean volumetric, FLAIR intensity and standardized uptake value ratio (SUVR) values of the left and right hippocampus were assessed in each subject. Threshold confidence levels calculated from the mean volumetric, FLAIR intensity and SUVR values of the controls were used to identify healthy subjects or subjects with HS. The performance of the three methods was assessed using receiver operating characteristic (ROC) curves, and the detection rates of CVA-MRI, CVA-PET, Q-volume, Q-FLAIR, and Q-PET were statistically compared. The areas under the curves (AUCs) for the Q-volume, Q-FLAIR, and Q-PET ROC analyses were 0.88, 0.41, and 0.98, which suggested a diagnostic method with moderate, poor, and high accuracy, respectively. Although Q-PET had the highest detection rate among the two CVA methods and three quantitative methods, the difference between Q-volume and Q-PET did not reach statistical significance. Regarding the HS subtypes, CVA-MRI, CVA-PET, Q-volume, and Q-PET had similar detection rates for type 1 HS, and Q-PET was the most sensitive method for detecting types 2 and 3 HS. In MRI or FDG-PET images that have been visually assessed by experts, the quantification of hippocampal volume or glucose uptake can increase the detection of HS and appear to be additional valuable diagnostic tools for evaluating patients with epilepsy who are suspected of having HS.
磁共振成像（MRI）和氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）是评估海马硬化（HS）的重要工具；然而，在视觉分析过程中可能会出现偏差。本研究的目的是评估和比较HS患者的MRI和PET后处理技术、自动定量海马体积（Q体积）、液体衰减反转恢复（FLAIR）信号（Q-FLAIR）和葡萄糖代谢（Q-PET）分析。我们收集了54例HS患者和22例健康对照者的MRI和FDG-PET图像，并分别对PET（CVA-PET）和MRI（CVA-MRI）图像进行了传统视觉分析（CVA）。在随后的定量分析中，从3D T1图像中分割出海马体，并评估每个受试者左右海马体的平均体积、FLAIR强度和标准化摄取值比率（SUVR）值。根据对照组的平均体积、FLAIR强度和SUVR值计算出的阈值置信水平用于识别健康受试者或HS受试者。使用受试者操作特征（ROC）曲线评估这三种方法的性能，并对CVA-MRI、CVA-PET、Q体积、Q-FLAIR和Q-PET的检测率进行统计学比较。Q体积、Q-FLAIR和Q-PET ROC分析的曲线下面积（AUC）分别为0.88、0.41和0.98，这表明诊断方法的准确性分别为中等、较差和较高。尽管Q-PET在两种CVA方法和三种定量方法中检测率最高，但Q体积和Q-PET之间的差异未达到统计学意义。关于HS亚型，CVA-MRI、CVA-PET、Q体积和Q-PET对1型HS的检测率相似，而Q-PET是检测2型和3型HS最敏感的方法。在经过专家视觉评估的MRI或FDG-PET图像中，海马体积或葡萄糖摄取的量化可以提高HS的检测率，似乎是评估疑似HS的癫痫患者的额外有价值的诊断工具。
