Fujian Medical University, Fuzhou, China.
Department of Neurosurgery, Tsinghua University Yuquan Hospital, Fuzhou, China.
Seizure. 2024 Apr;117:275-283. doi: 10.1016/j.seizure.2024.03.011. Epub 2024 Mar 28.
Accurate detection of focal cortical dysplasia (FCD) through magnetic resonance imaging (MRI) plays a pivotal role in the preoperative assessment of epilepsy. The integration of multimodal imaging has demonstrated substantial value in both diagnosing FCD and devising effective surgical strategies. This study aimed to enhance MRI post-processing by incorporating positron emission tomography (PET) analysis. We sought to compare the diagnostic efficacy of diverse image post-processing methodologies in patients presenting MRI-negative FCD.
In this retrospective investigation, we assembled a cohort of patients with negative preoperative MRI results. T1-weighted volumetric sequences were subjected to morphometric analysis program (MAP) and composite parametric map (CPM) post-processing techniques. We independently co-registered images derived from various methods with PET scans. The alignment was subsequently evaluated, and its correlation was correlated with postoperative seizure outcomes.
A total of 41 patients were enrolled in the study. In the PET-MAP(p = 0.0189) and PET-CPM(p = 0.00041) groups, compared with the non-overlap group, the overlap group significantly associated with better postoperative outcomes. In PET(p = 0.234), CPM(p = 0.686) and MAP(p = 0.672), there is no statistical significance between overlap and seizure-free outcomes. The sensitivity of using the CPM alone outperformed the MAP (0.65 vs 0.46). The use of PET-CPM demonstrated superior sensitivity (0.96), positive predictive value (0.83), and negative predictive value (0.91), whereas the MAP displayed superior specificity (0.71).
Our findings suggested a superiority in sensitivity of CPM in detecting potential FCD lesions compared to MAP, especially when it is used in combination with PET for diagnosis of MRI-negative epilepsy patients. Moreover, we confirmed the superiority of synergizing metabolic imaging (PET) with quantitative maps derived from structural imaging (MAP or CPM) to enhance the identification of subtle epileptogenic zones (EZs). This study serves to illuminate the potential of integrated multimodal techniques in advancing our capability to pinpoint elusive pathological features in epilepsy cases.
磁共振成像（MRI）对病灶性皮质发育不良（FCD）的准确检测在癫痫术前评估中起着关键作用。多模态成像的整合在 FCD 的诊断和制定有效手术策略方面都具有重要价值。本研究旨在通过正电子发射断层扫描（PET）分析来增强 MRI 后处理。我们旨在比较不同图像后处理方法在 MRI 阴性 FCD 患者中的诊断效果。
在这项回顾性研究中，我们收集了一组术前 MRI 结果阴性的患者。对 T1 加权容积序列进行形态计量分析程序（MAP）和复合参数图（CPM）后处理技术。我们独立地将来自不同方法的图像与 PET 扫描进行配准。随后评估配准结果，并将其与术后癫痫发作结果相关联。
共纳入 41 例患者。在 PET-MAP（p = 0.0189）和 PET-CPM（p = 0.00041）组中，与非重叠组相比，重叠组与更好的术后结果显著相关。在 PET（p = 0.234）、CPM（p = 0.686）和 MAP（p = 0.672）中，重叠与无癫痫发作结果之间没有统计学意义。单独使用 CPM 的灵敏度优于 MAP（0.65 对 0.46）。PET-CPM 的使用显示出较高的灵敏度（0.96）、阳性预测值（0.83）和阴性预测值（0.91），而 MAP 显示出较高的特异性（0.71）。
我们的研究结果表明，CPM 在检测潜在的 FCD 病变方面的灵敏度优于 MAP，尤其是当它与 PET 联合用于诊断 MRI 阴性癫痫患者时。此外，我们证实了代谢成像（PET）与结构成像（MAP 或 CPM）衍生的定量图谱相结合，以增强对细微致痫区（EZ）的识别的优越性。这项研究阐明了集成多模态技术在提高我们识别癫痫病例中难以捉摸的病理特征的能力方面的潜力。
