Guo Kun, Hu Jie, Cui Bixiao, Wang Zhenming, Hou Yaqin, Yang Hongwei, Lu Jie
Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
Neuroradiology. 2025 Jan;67(1):89-97. doi: 10.1007/s00234-024-03446-4. Epub 2024 Aug 22.
To evaluate the (1) successful surgery proportion in patients with clear structural lesions on MRI and single abnormality on F-fluorodeoxyglucose positron emission tomography/Magnetic resonance imaging (F-FDG PET/MRI); (2) predictive value of F-FDG PET/MRI for postsurgical outcome in refractory epilepsy patients.
A retrospective study was conducted on 123 patients diagnosed with refractory epilepsy who underwent presurgical evaluation involving F-FDG PET/MRI and were followed for one-year post-surgery. Two neuroradiologists interpreted the PET/MRI images using visual analysis and an asymmetry index based on the standard uptake value. The Engel classification was used to assess surgical outcomes one-year post-surgery. Prognostic factors predicting post-surgical seizure outcomes were explored using univariate and binary logistic regression.
Definitely single lesion abnormality was observed in 35.0% (43/123) of the patients on the MRI portion of PET/MRI. The proportion increased to 74.0% (91/123) when 18 F-FDG PET portion was added. About 75% (69/91) of patients displaying a clear-cut lesion on 18 F-FDG PET/MRI were classified as Engel Class I one-year post-surgery. The proportion of Engel Class I patients was not significantly different when comparing MRI-single lesion patients with MRI-negative, PET-single lesion patients one year after surgery (81.4% vs. 70.0%, P = 0.24). Binary logistic regression analysis revealed that the detection of a clear single lesion on 18 F-FDG PET/MRI was a strong positive predictor of a favorable surgical outcome (OR 3.518, 95% CI 1.363-9.077, p = 0.009).
Single lesion detected on 18 F-FDG PET/MRI is useful to predict good surgical outcome for refractory epilepsy patients; Those patients should be considered as candidates for surgery.
评估（1）磁共振成像（MRI）显示有明确结构病变且氟脱氧葡萄糖正电子发射断层扫描/磁共振成像（F-FDG PET/MRI）有单一异常的患者的手术成功率；（2）F-FDG PET/MRI对难治性癫痫患者术后结局的预测价值。
对123例诊断为难治性癫痫的患者进行回顾性研究，这些患者接受了包括F-FDG PET/MRI的术前评估，并在术后随访一年。两名神经放射科医生使用视觉分析和基于标准摄取值的不对称指数对PET/MRI图像进行解读。采用恩格尔分类法评估术后一年的手术结局。使用单因素和二元逻辑回归探索预测术后癫痫发作结局的预后因素。
在PET/MRI的MRI部分，35.0%（43/123）的患者观察到明确的单一病变异常。当加入18F-FDG PET部分时，这一比例增至74.0%（91/123）。在18F-FDG PET/MRI上显示有明确病变的患者中，约75%（69/91）在术后一年被分类为恩格尔I级。术后一年，比较MRI单一病变患者与MRI阴性、PET单一病变患者时，恩格尔I级患者的比例无显著差异（81.4%对70.0%，P = 0.24）。二元逻辑回归分析显示，在18F-FDG PET/MRI上检测到明确的单一病变是良好手术结局的强阳性预测指标（OR 3.518，95% CI 1.363 - 9.077，p = 0.009）。
18F-FDG PET/MRI上检测到的单一病变有助于预测难治性癫痫患者的良好手术结局；这些患者应被视为手术候选者。
