Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
Eur Radiol. 2022 Dec;32(12):8423-8431. doi: 10.1007/s00330-022-08912-2. Epub 2022 Jun 17.
To integrate the glucose metabolism measured using [F]FDG PET/CT and anatomical features measured using MRI to forecast the post-surgical seizure outcomes of intractable temporal lobe epilepsy.
This retrospective study enrolled 63 patients with drug-resistant temporal lobe epilepsy. Z-transform of the patients' PET images based on comparison with a database of healthy controls, cortical thickness, and quantitative anisotropy (QA) of the diffusion spectrum imaging concordant/non-concordant with cortical resection was adopted to quantify their predictive values for the post-surgical seizure outcomes.
The PET hypometabolism region was concordant with the surgical field in 47 of the 63 patients. Forty-two patients were seizure-free post-surgery. The sensitivity and specificity of PET in predicting seizure freedom were 89.4% and 68.8%, respectively. Complete resection of foci with overlapped PET, cortical thickness, and QA abnormalities resulted in Engel I in 27 patients, which was a good predictor of seizure freedom with an odds ratio (OR) of 19.57 (95% CI 2.38-161.25, p = 0.006). Hypometabolism involved in multiple lobes (OR = 7.18, 95% CI 1.02-50.75, p = 0.048) and foci of hypometabolism with QA/cortical thickness abnormalities outside surgical field (OR = 14.72, 95% CI 2.13-101.56, p = 0.006) were two major predictors of Engel III/IV outcomes. ORs of QA to predict Engel I and seizure recurrence were 14.64 (95% CI 2.90-73.80, p = 0.001) and 12.01 (95% CI 2.91-49.65, p = 0.001), respectively.
Combined PET and structural pattern is helpful to predict the post-surgical seizure outcomes and worse outcomes of Engel III/IV. This might decrease unnecessary surgical injuries to patients who are potentially not amenable to surgery.
• A combined metabolic and structural pattern is helpful to predict the post-surgical seizure outcomes. • Favorable post-surgical seizure outcome was most likely reached in patients whose hypometabolism overlapped with the structural changes. • Hypometabolism in multiple lobes and QA or cortical thickness abnormalities outside the surgical field were predictors of worse seizure outcomes of Engel III/IV.
通过整合 [F]FDG PET/CT 测量的葡萄糖代谢和 MRI 测量的解剖学特征，预测难治性颞叶癫痫患者的术后癫痫发作结局。
本回顾性研究纳入了 63 例耐药性颞叶癫痫患者。基于与健康对照组数据库的比较，对患者的 PET 图像进行 Z 变换，测量皮质厚度和弥散光谱成像的各向异性（QA），并将其与皮质切除的一致性/非一致性，以此来量化这些指标对术后癫痫发作结局的预测价值。
63 例患者中有 47 例 PET 代谢低下区域与手术区域相吻合。42 例患者术后无癫痫发作。PET 预测无癫痫发作的灵敏度和特异度分别为 89.4%和 68.8%。完全切除重叠的 PET、皮质厚度和 QA 异常焦点的病灶，使 27 例患者达到了 Engel I 级，这是一个良好的无癫痫发作预测因子，优势比（OR）为 19.57（95%CI 2.38-161.25，p=0.006）。涉及多个脑叶的代谢低下（OR=7.18，95%CI 1.02-50.75，p=0.048）和手术野外代谢低下病灶伴有 QA/皮质厚度异常（OR=14.72，95%CI 2.13-101.56，p=0.006）是 Engel III/IV 结局的两个主要预测因子。QA 预测 Engel I 级和癫痫复发的 OR 分别为 14.64（95%CI 2.90-73.80，p=0.001）和 12.01（95%CI 2.91-49.65，p=0.001）。
联合 PET 和结构模式有助于预测术后癫痫发作结局和较差的 Engel III/IV 结局。这可能会减少对那些可能不适合手术的患者的不必要的手术损伤。
代谢和结构联合模式有助于预测术后癫痫发作结局。
代谢低下与结构改变重叠的患者最有可能获得良好的术后癫痫发作结局。
多脑叶代谢低下和手术野外 QA 或皮质厚度异常是 Engel III/IV 较差癫痫结局的预测因子。
