From the Departments of Clinical Neurophysiology (L.D., H.T., P.O.H., A.F.-F., S.B.) and Neurology (P.S.), Aarhus University Hospital; Departments of Neurology (A.S., L.H.P.), Clinical Neurophysiology (M.F., G. Rásonyi), Pediatrics, Child Neurology (P.U.), Neurosurgery (B.J., J.B.), and Clinical Physiology, Nuclear Medicine and PET (O.M.H.), Copenhagen University Hospital Rigshospitalet; Danish Epilepsy Centre (G. Rubboli, B.P., S.B.), Dianalund; and Department of Diagnostic Radiology (A.-M.L.), Hvidovre Hospital, Denmark.
Neurology. 2019 Feb 5;92(6):e576-e586. doi: 10.1212/WNL.0000000000006877. Epub 2019 Jan 4.
To determine the diagnostic accuracy and clinical utility of electromagnetic source imaging (EMSI) in presurgical evaluation of patients with epilepsy.
We prospectively recorded magnetoencephalography (MEG) simultaneously with EEG and performed EMSI, comprising electric source imaging, magnetic source imaging, and analysis of combined MEG-EEG datasets, using 2 different software packages. As reference standard for irritative zone (IZ) and seizure onset zone (SOZ), we used intracranial recordings and for localization accuracy, outcome 1 year after operation.
We included 141 consecutive patients. EMSI showed localized epileptiform discharges in 94 patients (67%). Most of the epileptiform discharge clusters (72%) were identified by both modalities, 15% only by EEG, and 14% only by MEG. Agreement was substantial between inverse solutions and moderate between software packages. EMSI provided new information that changed the management plan in 34% of the patients, and these changes were useful in 80%. Depending on the method, EMSI had a concordance of 53% to 89% with IZ and 35% to 73% with SOZ. Localization accuracy of EMSI was between 44% and 57%, which was not significantly different from MRI (49%-76%) and PET (54%-85%). Combined EMSI achieved significantly higher odds ratio compared to electric source imaging and magnetic source imaging.
EMSI has accuracy similar to established imaging methods and provides clinically useful, new information in 34% of the patients.
This study provides Class IV evidence that EMSI had a concordance of 53%-89% and 35%-73% (depending on analysis) for the localization of epileptic focus as compared with intracranial recordings-IZ and SOZ, respectively.
确定电磁源成像（EMSI）在癫痫患者术前评估中的诊断准确性和临床实用性。
我们前瞻性地同时记录脑磁图（MEG）和脑电图（EEG），并使用 2 种不同的软件包进行电磁源成像，包括电源成像、磁源成像以及对 MEG-EEG 数据集的联合分析。以颅内记录作为致痫区（IZ）和起始区（SOZ）的参考标准，以术后 1 年的结果作为定位准确性的参考标准。
我们纳入了 141 例连续患者。EMSI 在 94 例患者（67%）中显示出局灶性癫痫样放电。大多数癫痫样放电簇（72%）通过两种模态都可以识别，15%仅通过 EEG 识别，14%仅通过 MEG 识别。逆解之间的一致性是实质性的，而软件包之间的一致性是中等的。EMSI 提供了新的信息，改变了 34%患者的治疗计划，其中 80%的改变是有用的。根据方法的不同，EMSI 与 IZ 的一致性为 53%至 89%，与 SOZ 的一致性为 35%至 73%。EMSI 的定位准确性在 44%至 57%之间，与 MRI（49%-76%）和 PET（54%-85%）相比没有显著差异。联合 EMSI 与单独的电源成像和磁源成像相比，具有显著更高的优势比。
EMSI 的准确性与已建立的成像方法相似，在 34%的患者中提供了具有临床意义的新信息。
这项研究提供了 IV 级证据，表明与颅内记录的 IZ 和 SOZ 相比，EMSI 对癫痫灶的定位具有 53%-89%和 35%-73%（取决于分析）的一致性。
