Department of Neurology and Experimental Neurology, Epilepsy Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK.
Epilepsia. 2022 May;63(5):1238-1252. doi: 10.1111/epi.17194. Epub 2022 Feb 15.
18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in presurgical assessment in patients with drug-resistant focal epilepsy (DRE) if magnetic resonance imaging (MRI) and scalp electroencephalography (EEG) do not localize the seizure onset zone or are discordant.
In this multicenter, retrospective observational cohort study, we included consecutive patients with DRE who had undergone FDG-PET as part of their presurgical workup. We assessed the utility of FDG-PET, which was defined as contributing to the decision-making process to refer for resection or intracranial EEG (iEEG) or to conclude surgery was not feasible.
We included 951 patients in this study; 479 had temporal lobe epilepsy (TLE), 219 extratemporal epilepsy (ETLE), and 253 epilepsy of uncertain lobar origin. FDG-PET showed a distinct hypometabolism in 62% and was concordant with ictal EEG in 74% in TLE and in 56% in ETLE (p < .001). FDG-PET was useful in presurgical decision-making in 396 patients (47%) and most beneficial in TLE compared to ETLE (58% vs. 44%, p = .001). Overall, FDG-PET contributed to recommending resection in 78 cases (20%) and iEEG in 187 cases (47%); in 131 patients (33%), FDG-PET resulted in a conclusion that resection was not feasible. In TLE, seizure-freedom 1 year after surgery did not differ significantly (p = .48) between patients with negative MRI and EEG-PET concordance (n = 30, 65%) and those with positive MRI and concordant EEG (n = 46, 68%). In ETLE, half of patients with negative MRI and EEG-PET concordance and three quarters with positive MRI and concordant EEG were seizure-free postsurgery (n = 5 vs. n = 6, p = .28).
This is the largest reported cohort of patients with DRE who received presurgical FDG-PET, showing that FDG-PET is a useful diagnostic tool. MRI-negative and MRI-positive cases with concordant FDG-PET results (with either EEG or MRI) had a comparable outcome after surgery. These findings confirm the significance of FDG-PET in presurgical epilepsy diagnostics.
18F-氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）在耐药性局灶性癫痫（DRE）患者的术前评估中广泛应用，如果磁共振成像（MRI）和头皮脑电图（EEG）不能定位发作起始区或存在不一致。
在这项多中心、回顾性观察队列研究中，我们纳入了接受 FDG-PET 作为术前评估一部分的 DRE 连续患者。我们评估了 FDG-PET 的效用，其定义为有助于决定是否进行切除或颅内脑电图（iEEG）或得出手术不可行的结论。
本研究共纳入 951 例患者；479 例为颞叶癫痫（TLE），219 例为颞外癫痫（ETLE），253 例癫痫起源部位不明。FDG-PET 在 TLE 中显示出 62%的明显代谢低下，在 74%的 TLE 和 56%的 ETLE 中与致痫性 EEG 一致（p<0.001）。FDG-PET 在 396 例患者（47%）的术前决策中具有有用性，并且在 TLE 中比 ETLE 更有益（58%比 44%，p=0.001）。总体而言，FDG-PET 有助于推荐 78 例（20%）进行切除和 187 例（47%）进行 iEEG；在 131 例患者（33%）中，FDG-PET 得出结论认为切除不可行。在 TLE 中，术后 1 年无癫痫发作的患者在 MRI 和 EEG-PET 一致的阴性患者（n=30，65%）和 MRI 和 EEG 一致的阳性患者（n=46，68%）之间无显著差异（p=0.48）。在 ETLE 中，MRI 和 EEG-PET 一致的阴性患者中有一半（n=5）和 MRI 和 EEG 一致的阳性患者中有四分之三（n=6）术后无癫痫发作（p=0.28）。
这是最大的报道的接受术前 FDG-PET 的 DRE 患者队列，表明 FDG-PET 是一种有用的诊断工具。MRI 阴性和 MRI 阳性病例与 FDG-PET 结果一致（无论 EEG 或 MRI），术后结果相似。这些发现证实了 FDG-PET 在术前癫痫诊断中的重要性。
