Division of Nuclear Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Oude Markt 13, Bus 5005, 3000, Leuven, Belgium.
Acta Neurol Belg. 2022 Apr;122(2):325-335. doi: 10.1007/s13760-020-01569-y. Epub 2021 Feb 5.
The value of functional molecular changes outside the seizure onset zone as independent predictive factors of surgical outcome has been scarcely evaluated. The aim of this retrospective study was to evaluate relative metabolic and perfusion changes outside the seizure onset zone as predictors of postoperative outcome in patients with unifocal refractory focal epilepsy. Eighty-six unifocal epilepsy patients who underwent F-FDG PET prior to surgery were included. Ictal and interictal perfusion SPECT was available in 65 patients. Good postoperative outcome was defined as the International League against Epilepsy class 1. Using univariate statistical analysis, the predictive ability of volume-of-interest based relative metabolism/perfusion for outcome classification was quantified by AUC ROC-curve, using composite, unilateral cortical (frontal, orbitofrontal, temporal, parietal, occipital) and central volumes-of-interest. The results were cross-validated, and a false discovery rate (FDR) correction was applied. As a secondary objective, a subgroup analysis was performed on temporal lobe epilepsy patients (N = 64). Increased relative ictal perfusion in the contralateral central volume-of-interest was significantly associated with the good surgical outcome both in the total population (AUC 0.79, p = 0.009) and the temporal lobe epilepsy subgroup (AUC 0.80, p = 0.028). No other significant associations between functional molecular changes and postoperative outcome were found. Increased relative ictal perfusion in the contralateral central region significantly predicted outcome after epilepsy surgery in patients with refractory focal epilepsy. We postulate that these relative perfusion changes could be an expression of better preoperative neuronal network integration and centralization in the contralateral central structures, which is suggested to be associated with better postoperative outcome.
发作起始区外的功能分子变化作为手术结果的独立预测因子的价值尚未得到充分评估。本回顾性研究的目的是评估发作起始区外的相对代谢和灌注变化作为单灶性难治性局灶性癫痫患者术后结果的预测因子。共纳入 86 例接受手术前 F-FDG PET 的单灶性癫痫患者。65 例患者可获得发作期和发作间期灌注 SPECT。术后良好结果定义为国际抗癫痫联盟分级 1。使用单变量统计分析，通过 AUC ROC 曲线，使用复合、单侧皮质（额、眶额、颞、顶、枕）和中央体积感兴趣区，量化基于感兴趣区的相对代谢/灌注的体积预测能力。结果进行了交叉验证，并应用错误发现率（FDR）校正。作为次要目标，对颞叶癫痫患者（N=64）进行了亚组分析。在总人群（AUC 0.79，p=0.009）和颞叶癫痫亚组（AUC 0.80，p=0.028）中，对侧中央体积感兴趣区的相对发作期灌注增加与良好的手术结果显著相关。在其他功能分子变化与术后结果之间未发现其他显著相关性。在难治性局灶性癫痫患者中，对侧中央区域的相对发作期灌注增加显著预测癫痫手术后的结果。我们推测这些相对灌注变化可能是对侧中央结构中术前神经元网络整合和集中化更好的表现，这与更好的术后结果相关。
