Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China.
Eur Radiol. 2021 Aug;31(8):6353-6366. doi: 10.1007/s00330-020-07645-4. Epub 2021 Feb 1.
The aim of this meta-analysis was to estimate the clinical use value of C-FMZ and F-FDG in PET for the localization of epileptogenic zone and to provide evidence for practitioners' clinical decision-making.
We searched PubMed and Embase in a time frame from inception to May 31, 2020. Studies utilizing FMZ or FDG-PET or FDG-PET/MRI used in patients with epilepsy, with EEG or surgical outcomes as the gold standard and corresponding outcomes such as concordance rates of PET or PET/MRI scan compared with reference standard, absolute numbers of participants with true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) results in FDG or FMZ PET. Pooled concordance rates, overall sensitivity, and specificity of C-FMZ-PET and F-FDG-PET were calculated.
In total, 44 studies met the inclusion criteria. The pooled concordance rates of FDG-PET, FMZ-PET, and FDG-PET/MRI coregistration compared with reference standard were 0.67 (95% CI: 0.60-0.73), 0.75 (95% CI: 0.57-0.93), and 0.93 (95% CI: 0.89-0.97), respectively. The concordance rate of F-FDG-PET in patients with temporal lobe epilepsy (TLE) was 0.79 (0.63; 0.92). The overall sensitivity and specificity of F-FDG-PET were 0.66 (95% CI: 0.58-0.73) and 0.71 (95% CI: 0.63-0.78), respectively. C-FMZ-PET displayed an overall sensitivity of 0.62 (95% CI: 0.49-0.73) and specificity of 0.73 (95% CI: 0.59-0.84).
Both C-FMZ PET and F-FDG PET are the choice of modalities for the localization of epileptogenic zone, especially when coregistered with MRI.
• C-FMZ-PET may be more helpful than F-FDG-PET in the localization of epilepsy foci. • Coregistration of FDG-PET and MRI is recommended in the localization of epileptogenic zone.
本荟萃分析旨在评估 C-FMZ 和 F-FDG 在正电子发射断层扫描（PET）中定位致痫区的临床应用价值，并为临床医生的临床决策提供依据。
我们在时间范围内从 1990 年 1 月 1 日至 2020 年 5 月 31 日检索了 PubMed 和 Embase。研究对象为应用 FMZ 或 FDG-PET 或 FDG-PET/MRI 的癫痫患者，以脑电图（EEG）或手术结果为金标准，并比较了 PET 或 PET/MRI 扫描与参考标准的一致性率、FDG 或 FMZ PET 中真阳性（TP）、假阳性（FP）、真阴性（TN）和假阴性（FN）结果的参与者绝对数量。计算了 C-FMZ-PET 和 F-FDG-PET 的总体一致性率、总灵敏度和特异性。
共有 44 项研究符合纳入标准。FDG-PET、FMZ-PET 和 FDG-PET/MRI 与参考标准的一致性率分别为 0.67（95%置信区间：0.60-0.73）、0.75（95%置信区间：0.57-0.93）和 0.93（95%置信区间：0.89-0.97）。FDG-PET 在颞叶癫痫（TLE）患者中的一致性率为 0.79（0.63；0.92）。FDG-PET 的总灵敏度和特异性分别为 0.66（95%置信区间：0.58-0.73）和 0.71（95%置信区间：0.63-0.78）。C-FMZ-PET 的总灵敏度为 0.62（95%置信区间：0.49-0.73），特异性为 0.73（95%置信区间：0.59-0.84）。
C-FMZ-PET 和 F-FDG-PET 均是致痫区定位的模态选择，尤其是与 MRI 联合应用时。
C-FMZ-PET 可能比 F-FDG-PET 更有助于癫痫灶的定位。
建议在致痫区定位时将 FDG-PET 与 MRI 进行配准。
