成人颞叶癫痫患者发作间期18F-FDG PET/CT脑代谢显像与术后疗效的关系

The relationship between interictal 18F-FDG PET/CT image pattern and prognosis of adult patients with temporal lobe epilepsy

目的:探讨成人颞叶癫痫患者发作间期18F-FDG PET/CT脑代谢显像与术后疗效的关系。方法:回顾性分析2013年8月-2018年3月于北部战区总医院接受发作间期18F-FDG PET/CT脑代谢显像,且颞叶均为阳性表现,并于我院神经外科接受手术治疗的颞叶癫痫患者62例,其中女22例,男40例,年龄范围18~58岁,平均(31.48±10.48)岁,按照病灶的数目(单发/多发)、侧别(单侧大脑半球/双侧大脑半球)将PET/CT图像分为单侧单发低代谢病灶组(病灶仅存在于单侧大脑半球颞叶中)、单侧多发低代谢病灶组(病灶存在于颞叶及其他同侧非颞叶中)、双侧多发低代谢病灶组(病灶分布于双侧颞叶或一侧颞叶与对侧非颞叶中),术后随访12~55(30.50±13.42)月,中位随访时间28.5月,根据Engel分级分为疗效满意组(EngelⅠ)45例和疗效不满意组(EngelⅡ+EngelⅢ+EngelⅣ)17例,对两组患者PET/CT图像中病灶的数目、侧别进行单因素分析,并对有统计学意义的因素进行Logistic回归分析,总结出18F-FDG PET/CT图像的代谢改变图型与成人颞叶癫痫患者术后预后的关系。结果:18F-FDG PET/CT脑代谢显像显示病灶的数目、侧别单因素分析结果均具有统计学意义,P值分别为0.001、0.02,进而进行Logistic回归分析,结果显示病变的数目与预后具有很强的相关性(OR=7.219,95%CI:0.339~8.676,P=0.008),而病变的侧别与预后不具有相关性(OR=1.714,95%CI:1.691~30.809,P=0.515)。结论:18F-FDG PET/CT脑代谢显像可用于预测成人颞叶癫痫患者的术后疗效,单发低代谢病灶的患者手术疗效较好,低代谢病灶的数目是手术预后疗效的独立预测因素。

Objective:To investigate the relationship between interictal 18F-FDG PET/CT image pattern and prognosis of adult patients with adult temporal lobe epilepsy.Methods:A retrospective analysis from August 2013 to March 2018 was made for patients undertaking interictal brain 18F-FDG PET/CT.There were 62 cases in total,including 22 cases(35.48%)of women and 40 cases(64.52%)of men,age range 18~58(31.48±10.48)years.According to the number of lesions(single/multiple),side(ipsilateral/bilateral),PET/CT image could be divided into one single low metabolic lesion group,low unilateral multiple metabolic lesions on the same side and double side.According to Engel grading,the patients were divided into 45 cases(72.58%)in the satisfactory efficacy group(EngelⅠ)and 17 cases(27.42%)in the unsatisfactory efficacy group(EngelⅡ+EngelⅢ+EngelⅣ).Univariate analysis was performed on the number and side of lesions on PET/CT,and Logistic regression analysis was performed on the factors with statistical significance,to summarize the relationship between the metabolic change pattern of 18F-FDG PET/CT and the postoperative prognosis of adult patients with temporal lobe epilepsy.Result:The results of univariate analysis showed that the number and side of lesions were statistically significant(P values were 0.001 and 0.02,respectively).Logistic regression analysis showed that the number of lesions was strongly correlated with the prognosis(OR=7.219,95%CI:0.339~8.676,P=0.008),while the number of lesions was not correlated with the prognosis(OR=1.714,95%CI:1.691~30.809,P=0.515).Conclusion:18F-FDG PET/CT brain metabolism imaging can be used to predict the postoperative efficacy of adult patients with temporal lobe epilepsy.Patients with single low-metabolism lesions have better surgical efficacy,and the number of low-metabolism lesions is an independent predictor of surgical prognosis.