Hu Daoyan, Yu Congcong, Zhang Xiaohui, Zhong Yan, Zhu Yuankai, Tian Mei, Zhang Hong
College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310014, Zhejiang, China.
Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
Eur J Nucl Med Mol Imaging. 2025 Jan;52(2):564-573. doi: 10.1007/s00259-024-06933-1. Epub 2024 Oct 7.
This study aimed to investigate [F]fluorodeoxyglucose positron emission tomography ([F]FDG PET) mapping for cerebral glucose metabolism in drug-sensitive and drug-resistant pediatric epilepsy patients.
This retrospective study enrolled 40 patients and 25 controls. Patients were categorized into drug-sensitive epilepsy (n = 22) and drug-resistant epilepsy (n = 18) according to the seizure frequency at follow-up. All patients underwent two [F]FDG PET scans separated by a minimum of one year. Absolute asymmetry index (|AI|) was calculated for assessing metabolic differences and changes in epileptic foci. Statistical Parametric Mapping (SPM) was utilized to reveal voxel-wise metabolic characteristics and alterations throughout the brain. Network analysis based on graph theory was used to investigate network-level differences between the two patient groups.
The drug-sensitive group showed a lower |AI| at both baseline (P = 0.038) and follow-up (P = 0.003) PET scans than the drug-resistant group. |AI| decreased in the drug-sensitive group and increased in the drug-resistant group across scans, but these trends were not statistically significant (P = 0.240 and P = 0.450, respectively). Both groups exhibited hypometabolism at baseline. The drug-sensitive group showed less hypometabolic brain regions than the drug-resistant group. The drug-sensitive maintained stable level of hypometabolism between the two scans, whereas the drug-resistant group showed an increasing hypometabolism. Network analysis demonstrated that the drug-sensitive group had a higher global efficiency, average degree, and clustering, along with a shorter characteristic path length compared to the drug-resistant group.
For the first time, this study revealed in vivo cerebral glucose metabolic pattern of nonsurgical pediatric epilepsy patients treated by antiepileptic drugs. Especially, drug-resistant epilepsy patients represented significantly extensive and progressive hypometabolism with inefficient brain network connectivity compared with drug-sensitive epilepsy. [F]FDG PET imaging may be a potential visual approach for theranostics of epilepsy patients.
本研究旨在探讨[F]氟脱氧葡萄糖正电子发射断层扫描（[F]FDG PET）对药物敏感和耐药儿童癫痫患者脑葡萄糖代谢的成像情况。
本回顾性研究纳入了40例患者和25例对照。根据随访时的癫痫发作频率，将患者分为药物敏感型癫痫（n = 22）和药物耐药型癫痫（n = 18）。所有患者均接受了两次[F]FDG PET扫描，间隔至少一年。计算绝对不对称指数（|AI|）以评估代谢差异和癫痫病灶的变化。采用统计参数映射（SPM）来揭示全脑体素水平的代谢特征和改变。基于图论的网络分析用于研究两组患者在网络水平上的差异。
在基线（P = 0.038）和随访（P = 0.003）PET扫描中，药物敏感组的|AI|均低于药物耐药组。在两次扫描中，药物敏感组的|AI|降低，药物耐药组的|AI|升高，但这些趋势无统计学意义（分别为P = 0.240和P = 0.450）。两组在基线时均表现为代谢减低。药物敏感组代谢减低的脑区比药物耐药组少。药物敏感组在两次扫描之间代谢减低水平保持稳定，而药物耐药组的代谢减低则呈增加趋势。网络分析表明，与药物耐药组相比，药物敏感组具有更高的全局效率、平均度和聚类系数，以及更短的特征路径长度。
本研究首次揭示了接受抗癫痫药物治疗的非手术儿童癫痫患者的活体脑葡萄糖代谢模式。特别是，与药物敏感型癫痫相比，药物耐药型癫痫患者表现出明显更广泛且进行性的代谢减低以及脑网络连接效率低下。[F]FDG PET成像可能是癫痫患者诊疗的一种潜在可视化方法。
