From the Departments of Neurology (T.S., A.F.S.) and Radiology (A.J., L.T.H.), University of Wisconsin-Madison; and Department of Neurology (A.J.C., M.B.W., E.R.), Massachusetts General Hospital, Harvard Medical School, Boston.
Neurology. 2019 Feb 12;92(7):e670-e674. doi: 10.1212/WNL.0000000000006903. Epub 2019 Jan 11.
To investigate the correlation between characteristics of lateralized periodic discharges (LPDs) and glucose metabolism measured by F-fluorodeoxyglucose (FDG)-PET.
We retrospectively reviewed medical records to identify patients who underwent FDG-PET during EEG monitoring with LPDs present during the FDG uptake period. Two blinded board-certified neurophysiologists independently interpreted EEGs. FDG uptake was measured using standardized uptake value (SUV). Structural images were fused with PET images to aid with localization of SUV. Two PET readers independently measured maximum SUV. Relative SUV values were obtained by normalization of the maximum SUV to the SUV of pons (SUVRpons). LPD frequency was analyzed both as a categorical variable and as a continuous measure. Other secondary variables included duration, amplitude, presence of structural lesion, and "plus" EEG features such as rhythmic or fast sharp activity.
Nine patients were identified and 7 had a structural etiology for LPDs. Analysis using frequency as a categorical variable and continuous variable showed an association between increased LPD frequency and increased ipsilateral SUVRpons ( = 0.02). Metabolism associated with LPDs (0.5 Hz as a baseline) increased by a median of 100% at 1 Hz and for frequencies >1 Hz increased by a median of 309%. There were no statistically significant differences in SUVRpons for other factors including duration ( = 0.10), amplitude ( = 0.80), structural etiology ( = 0.55), or "plus" features such as rhythmic or fast sharp activity ( = 0.84).
Metabolic activity increases monotonically with LPD frequency. LPD frequency should be a measure of interest when developing neuroprotection strategies in critical neurologic illness.
研究侧向周期性放电（LPD）的特征与 F-氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）测量的葡萄糖代谢之间的相关性。
我们回顾性地查阅了病历，以确定在 FDG 摄取期间进行 EEG 监测并存在 LPD 的患者。两名经过认证的神经生理学家对 EEG 进行了独立的盲法解读。使用标准化摄取值（SUV）测量 FDG 摄取。结构图像与 PET 图像融合以帮助定位 SUV。两名 PET 读者独立测量最大 SUV。通过将最大 SUV 与脑桥 SUV（SUVRpons）归一化来获得相对 SUV 值。LPD 频率既作为分类变量又作为连续变量进行分析。其他次要变量包括持续时间、振幅、结构性病变的存在以及 EEG 的“附加”特征，如节律性或快速锐波活动。
确定了 9 名患者，其中 7 名患者的 LPD 具有结构性病因。使用频率作为分类变量和连续变量进行分析，显示增加的 LPD 频率与增加的同侧 SUVRpons 之间存在关联（ = 0.02）。LPD 相关的代谢（以 0.5 Hz 为基线）在 1 Hz 时增加了中位数 100%，在频率>1 Hz 时增加了中位数 309%。SUVpons 与其他因素（包括持续时间[ = 0.10]、振幅[ = 0.80]、结构性病因[ = 0.55]或节律性或快速锐波活动等“附加”特征[ = 0.84]）之间没有统计学显著差异。
代谢活性随 LPD 频率单调增加。在开发危重神经疾病的神经保护策略时，LPD 频率应作为感兴趣的测量指标。
