视觉雪综合征中同时出现的F-FDG PET/MR代谢和结构变化及诊断应用。
Simultaneous F-FDG PET/MR metabolic and structural changes in visual snow syndrome and diagnostic use.
作者信息
Van Laere Koen, Ceccarini Jenny, Gebruers Juanito, Goffin Karolien, Boon Elizabet
机构信息
Nuclear Medicine, University Hospitals Leuven, UZ Leuven, Campus Gasthuisberg, Nucleaire Geneeskunde, E901, Herestraat 49, 3000, Leuven, Belgium.
Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
出版信息
EJNMMI Res. 2022 Dec 30;12(1):77. doi: 10.1186/s13550-022-00949-0.
PURPOSE
Visual snow syndrome (VSS) is a recently recognized chronic neurologic condition characterized by the constant perceiving of tiny flickering dots throughout the entire visual field. Metabolic overactivity and grey matter volume increase in the lingual gyrus has been reported. We investigated this by F-FDG PET/MR in comparison to healthy controls. Aside from voxel-based characterization, the classification accuracy of volume-of-interest (VOI)-based multimodal assessment was evaluated, also in comparison with visual analysis.
METHODS
Simultaneous F-FDG PET and MR imaging was performed in 7 patients with VSS (24.6 ± 5.7 years; 5 M/2F) and 15 age-matched healthy controls (CON) (28.0 ± 5.3 years; 8 M/7F). SPM12 and voxel-based morphometric analysis was performed. A VOI-based discriminant analysis was performed with relative F-FDG uptake, MR grey matter (GM) volumes and their combination. A visual analysis was done by two blinded experienced readers.
RESULTS
Relative increased hypermetabolism was found in VSS patients in the lingual gyrus and cuneus (p < 0.05, peak change + 24%), and hypometabolism in the mesiotemporal cortex (p < 0.001, peak change - 14%). VSS patients also had increased GM volume in the limbic system and frontotemporal cortex bilaterally (p < 0.05), and in the left secondary and associative visual cortex and in the left lingual gyrus (p < 0.001). Discriminant analysis resulted in 100% correct classification accuracy for F-FDG with lingual gyrus, cuneus and lateral occipital lobe (BA 17 and BA 18) as main discriminators. Unimodal MR- and combined F-FDG + MR classification resulted in an accuracy of 91% and 95%, respectively. Visual analysis of F-FDG was highly observer dependent.
CONCLUSION
Patients with VSS have highly significant structural and metabolic abnormalities in the visual and limbic system. VOI-based discriminant analysis of F-FDG PET allows reliable individual classification versus controls, whereas visual analysis of experienced observers was highly variable. Further investigation in larger series, also in comparison to VSS mimicking disorders such as migraine, is warranted.
TRAIL REGISTRATION
Retrospectively registered at clinicaltrials.gov under NCT05569733 on Oct 5, 2022.
目的
视觉雪综合征（VSS）是一种最近才被认识的慢性神经系统疾病，其特征是在整个视野中持续感觉到微小的闪烁小点。据报道，舌回存在代谢活动亢进和灰质体积增加的情况。我们通过F-FDG PET/MR对其进行研究，并与健康对照进行比较。除了基于体素的特征描述外，还评估了基于感兴趣区（VOI）的多模态评估的分类准确性，同样与视觉分析进行了比较。
方法
对7例VSS患者（24.6±5.7岁；5男/2女）和15例年龄匹配的健康对照（CON）（28.0±5.3岁；8男/7女）进行了同步F-FDG PET和MR成像。进行了SPM12和基于体素的形态计量分析。使用相对F-FDG摄取、MR灰质（GM）体积及其组合进行了基于VOI的判别分析。由两名经验丰富的盲法阅片者进行视觉分析。
结果
VSS患者在舌回和楔叶发现相对代谢亢进增加（p<0.05，峰值变化+24%），在颞中皮质发现代谢减退（p<0.001，峰值变化-14%）。VSS患者双侧边缘系统和额颞叶皮质的GM体积也增加（p<0.05），左侧二级和联合视觉皮质以及左侧舌回的GM体积也增加（p<0.001）。判别分析结果显示，以舌回、楔叶和枕叶外侧（BA 17和BA 18）作为主要判别指标，F-FDG的分类准确率为100%。单模态MR和联合F-FDG+MR分类的准确率分别为91%和95%。F-FDG的视觉分析高度依赖观察者。
结论
VSS患者在视觉和边缘系统存在高度显著的结构和代谢异常。基于VOI的F-FDG PET判别分析能够可靠地对个体与对照进行分类，而经验丰富的观察者的视觉分析则差异很大。有必要在更大的系列中进行进一步研究，同时也与偏头痛等类似VSS的疾病进行比较。
试验注册
于2022年10月5日在clinicaltrials.gov上进行回顾性注册，注册号为NCT05569733。
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