From the Université Paris-Saclay (M.C., C.L., M.B., N.T.); BioMAPS (S.R., F.C., F.L.B.); Bicetre University Hospital (D.T., A.M.P.), Paris; and Imagerie Moléculaire In Vivo (V.B.), SHFJ, CEA, Orsay, France.
Neurology. 2023 Nov 7;101(19):e1893-e1904. doi: 10.1212/WNL.0000000000207811. Epub 2023 Sep 25.
Translocator protein 18 kDa (TSPO) PET imaging is used to monitor glial activation. Recent studies have proposed TSPO PET as a marker of the epileptogenic zone (EZ) in drug-resistant focal epilepsy (DRFE). This study aims to assess the contributions of TSPO imaging using [F]DPA-714 PET and [F]FDG PET for localizing the EZ during presurgical assessment of DRFE, when phase 1 presurgical assessment does not provide enough information.
We compared [F]FDG and [F]DPA-714 PET images of 23 patients who had undergone a phase 1 presurgical assessment, using qualitative visual analysis and quantitative analysis, at both the voxel and the regional levels. PET abnormalities (increase in binding for [F]DPA-714 vs decrease in binding for [F]FDG) were compared with clinical hypotheses concerning the localization of the EZ based on phase 1 presurgical assessment. The additional value of [F]DPA-714 PET imaging to [F]FDG for refining the localization of the EZ was assessed. To strengthen the visual analysis, [F]DPA-714 PET imaging was also reviewed by 2 experienced clinicians blind to the EZ location.
The study included 23 patients. Visual analysis of [F]DPA-714 PET was significantly more accurate than [F]FDG PET to both, show anomalies (95.7% vs 56.5%, = 0.022), and provide additional information to refine the EZ localization (65.2% vs 17.4%, = 0.019). All 10 patients with normal [F]FDG PET had anomalies when using [F]DPA-714 PET. The additional value of [F]DPA-714 PET seemed to be greater in patients with normal brain MRI or with neocortical EZ (especially if insula is involved). Regional analysis of [F]DPA-714 and [F]FDG PET provided similar results. However, using voxel-wise analysis, [F]DPA-714 was more effective than [F]FDG for unveiling clusters whose localization was more often consistent with the EZ hypothesis (87.0% vs 39.1%, = 0.019). Nonrelevant bindings were seen in 14 of 23 patients in visual analysis and 9 patients of 23 patients in voxel-wise analysis.
[F]DPA-714 PET imaging provides valuable information for presurgical assessments of patients with DRFE. TSPO PET could become an additional tool to help to the localization of the EZ, especially in patients with negative [F]FDG PET.
Eudract 2017-003381-27. Inclusion of the first patient: September 24, 2018.
This study provides Class IV evidence on the utility of [F]DPA-714 PET compared with [F]FDG PET in identifying the epileptic zone in patients undergoing phase 1 presurgical evaluation for intractable epilepsy.
转位蛋白 18 kDa（TSPO）PET 成像用于监测神经胶质细胞的激活。最近的研究提出 TSPO PET 作为耐药性局灶性癫痫（DRFE）中致痫区（EZ）的标志物。本研究旨在评估使用 [F]DPA-714 PET 和 [F]FDG PET 进行 TSPO 成像，以在 DRFE 的术前评估 1 期不能提供足够信息时定位 EZ。
我们比较了 23 例接受 1 期术前评估的患者的 [F]FDG 和 [F]DPA-714 PET 图像，使用定性视觉分析和基于体素和区域水平的定量分析。将 PET 异常（[F]DPA-714 结合增加与 [F]FDG 结合减少）与基于 1 期术前评估的 EZ 定位的临床假说进行比较。评估 [F]DPA-714 PET 成像对 [F]FDG 定位 EZ 的补充价值。为了加强视觉分析，还由 2 名经验丰富的临床医生对 [F]DPA-714 PET 成像进行了盲法评估，这些医生对 EZ 的位置并不知情。
研究纳入了 23 例患者。[F]DPA-714 PET 的视觉分析明显比 [F]FDG PET 更准确地显示异常（95.7%比 56.5%， = 0.022），并提供了更精细的 EZ 定位的额外信息（65.2%比 17.4%， = 0.019）。所有 10 例 [F]FDG PET 正常的患者在使用 [F]DPA-714 PET 时均存在异常。[F]DPA-714 PET 的附加价值在 MRI 正常或新皮层 EZ 的患者中似乎更大（尤其是当岛叶受累时）。[F]DPA-714 和 [F]FDG PET 的区域分析提供了相似的结果。然而，使用体素分析，[F]DPA-714 比 [F]FDG 更有效地揭示出其定位更常与 EZ 假说一致的聚类（87.0%比 39.1%， = 0.019）。在视觉分析中，23 例患者中有 14 例和在体素分析中有 9 例患者出现了非相关的结合。
[F]DPA-714 PET 成像为 DRFE 患者的术前评估提供了有价值的信息。TSPO PET 可能成为帮助定位 EZ 的附加工具，尤其是在 [F]FDG PET 阴性的患者中。
本研究提供了 4 级证据，证明与 [F]FDG PET 相比，[F]DPA-714 PET 在识别进行耐药性癫痫 1 期术前评估的患者中的癫痫区方面具有优势。
