Guo Kun, Wang Jingjuan, Cui Bixiao, Wang Yihe, Hou Yaqin, Zhao Guoguang, Lu Jie
Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Eur Radiol. 2022 May;32(5):3024-3034. doi: 10.1007/s00330-021-08336-4. Epub 2021 Oct 14.
To evaluate the clinical value of the combination of [F]FDG PET/MRI and magnetoencephalography (MEG) ([F]FDG PET/MRI/MEG) in localizing the epileptogenic zone (EZ) in temporal lobe epilepsy (TLE) patients.
Seventy-three patients with localization-related TLE who underwent [F]FDG PET/MRI and MEG were enrolled retrospectively. PET/MRI images were interpreted by two radiologists; the focal hypometabolism on PET was identified using statistical parametric mapping (SPM). MEG spike sources were co-registered onto T1-weighted sequence and analyzed by Neuromag software. The clinical value of [F]FDG PET/MRI, MEG, and PET/MRI/MEG in locating the EZ was assessed using cortical resection and surgical outcomes as criteria. The correlations between surgical outcomes and modalities concordant or non-concordant with cortical resection were analyzed.
For 46.6% (34/73) of patients, MRI showed definitely structural abnormality concordant with surgical resection. SPM results of [F]FDG PET showed focal temporal lobe hypometabolism concordant with surgical resection in 67.1% (49/73) of patients, while the concordant cases increased to 82.2% (60/73) patients with simultaneous MRI co-registration. MEG was concordant with surgical resection in 71.2% (52/73) of patients. The lobar localization was defined in 94.5% (69/73) of patients by the [F]FDG PET/MRI/MEG. The results of PET/MRI/MEG concordance with surgical resection were significantly higher than that of PET/MRI or MEG (χ = 13.948, p < 0.001; χ = 5.393, p = 0.020). The results of PET/MRI/MEG cortical resection concordance with surgical outcome were shown to be better than PET/MRI or MEG (χ = 6.695, p = 0.012; χ = 16.991, p < 0.0001).
Presurgical evaluation by [F]FDG PET/MRI/MEG could improve the identification of the EZ in TLE and may further guide surgical decision-making.
• Lobar localization was defined in 94.5% of patients by the [F]FDG PET/MRI/MEG. • The results of PET/MRI/MEG concordance with surgical resection were significantly higher than that of PET/MRI or MEG alone. • The results of PET/MRI/MEG cortical resection concordance with surgical outcome were shown to be better than that of PET/MRI or MEG alone.
评估[F]氟代脱氧葡萄糖正电子发射断层显像/磁共振成像（[F]FDG PET/MRI）与脑磁图（MEG）（[F]FDG PET/MRI/MEG）联合应用在颞叶癫痫（TLE）患者致痫区（EZ）定位中的临床价值。
回顾性纳入73例接受[F]FDG PET/MRI及MEG检查的定位相关TLE患者。PET/MRI图像由两名放射科医生解读；使用统计参数映射（SPM）识别PET上的局灶性代谢减低。MEG棘波源与T1加权序列进行配准，并通过Neuromag软件分析。以皮质切除术及手术结果为标准，评估[F]FDG PET/MRI、MEG以及PET/MRI/MEG在EZ定位中的临床价值。分析手术结果与与皮质切除术一致或不一致的检查方法之间的相关性。
46.6%（34/73）的患者MRI显示出与手术切除一致的明确结构异常。[F]FDG PET的SPM结果显示，67.1%（49/73）的患者颞叶存在与手术切除一致的局灶性代谢减低，而同时进行MRI配准的患者中，一致病例增加至82.2%（60/73）。71.2%（52/73）的患者MEG与手术切除一致。[F]FDG PET/MRI/MEG确定了94.5%（69/73）患者的脑叶定位。PET/MRI/MEG与手术切除的一致性结果显著高于PET/MRI或MEG（χ = 13.948，p < 0.001；χ = 5.393，p = 0.020）。PET/MRI/MEG与手术结果的皮质切除一致性结果显示优于PET/MRI或MEG（χ = 6.695，p = 0.012；χ = 16.991，p < 0.0001）。
[F]FDG PET/MRI/MEG术前评估可提高TLE中EZ的识别率，并可能进一步指导手术决策。
• [F]FDG PET/MRI/MEG确定了94.5%患者的脑叶定位。• PET/MRI/MEG与手术切除的一致性结果显著高于单独的PET/MRI或MEG。• PET/MRI/MEG与手术结果的皮质切除一致性结果显示优于单独的PET/MRI或MEG。
