Flaus Anthime, Mellerio Charles, Rodrigo Sebastian, Brulon Vincent, Lebon Vincent, Chassoux Francine
Université Paris-Saclay, CEA, CNRS, Inserm, Biomaps, Service Hospitalier Frédéric Joliot, 4 place du général Leclerc, 91401 ORSAY France; Department of Nuclear Medicine, East Group Hospital, Hospices Civils de Lyon, Lyon, France.
Department of Nuclear Medicine, East Group Hospital, Hospices Civils de Lyon, Lyon, France; Department of Neuroradiology, Groupe Hospitalier Universitaire Psychiatrie et Neurosciences, Sainte-Anne Hospital, 75014 Paris, France; Department of Radiology, Centre d'imagerie du Nord, Saint-Denis, France; Department of Radiology, Ramsay-Générale de Santé, Clinique du Landy, Saint-Ouen, France.
Epilepsy Res. 2021 Dec;178:106819. doi: 10.1016/j.eplepsyres.2021.106819. Epub 2021 Nov 20.
Hybrid PET/MR is a promising tool in focal drug-resistant epilepsy, however the additional value for the detection of epileptogenic lesions and surgical decision-making remains to be established.
We retrospectively compared F-FDG PET/MR images with those obtained by a previous F-FDG PET co-registered with MRI (PET+MR) in 25 consecutive patients (16 females, 13-60 years) investigated for focal drug-resistant epilepsy. Visual analysis was performed by two readers blinded from imaging modalities, asked to assess the technical characteristics (co-registration, quality of images), the confidence in results, the location of PET abnormalities and the presence of a structural lesion on MRI. Clinical impact on surgical strategy and outcome was assessed independently.
The location of epileptic focus was temporal in 9 patients and extra-temporal in 16 others. MRI was initially considered negative in 21 patients. PET stand-alone demonstrated metabolic abnormalities in 19 cases (76%), and the co-registration with MRI allowed the detection of 4 additional structural lesions. Compared to PET+MR, the PET/MR sensitivity was increased by 13% and new structural lesions (mainly focal cortical dysplasias) were detected in 6 patients (24%). Change of surgical decision-making was substantial for 10 patients (40%), consisting in avoiding invasive monitoring in 6 patients and modifying the planning in 4 others. Seizure-free outcome (follow-up>1 year) was obtained in 12/14 patients who underwent a cortical resection.
Hybrid PET/MR may improve the detection of epileptogenic lesions, allowing to optimize the presurgical work-up and to increase the proportion of successful surgery even in the more complex cases.
在局灶性耐药性癫痫治疗中，PET/MR混合成像技术是一种很有前景的工具，然而其在检测致痫性病变及手术决策方面的附加价值仍有待确定。
我们回顾性比较了25例连续接受局灶性耐药性癫痫检查的患者（16名女性，年龄13 - 60岁）的F-FDG PET/MR图像与先前F-FDG PET与MRI联合登记（PET+MR）所获得的图像。由两名对成像方式不知情的阅片者进行视觉分析，要求他们评估技术特征（联合登记、图像质量）、对结果的信心、PET异常的位置以及MRI上结构病变的存在情况。独立评估对手术策略和结果的临床影响。
癫痫病灶位于颞叶的有9例，位于颞叶外的有16例。最初21例患者的MRI被认为是阴性的。单独的PET显示19例（76%）有代谢异常，与MRI联合登记可检测到另外4个结构病变。与PET+MR相比，PET/MR的敏感性提高了13%，6例患者（24%）检测到新的结构病变（主要是局灶性皮质发育不良）。10例患者（40%）的手术决策有重大改变，其中6例避免了侵入性监测，4例修改了手术计划。14例接受皮质切除术的患者中有12例（随访>1年）获得无癫痫发作的结果。
PET/MR混合成像技术可能会改善致痫性病变的检测，即使在更复杂的病例中也能优化术前检查并提高成功手术的比例。
