^(11)C-胆碱PET/CT动态脑显像对海马硬化所致难治性癫癎致癎灶的定位研究

Localization of epileptic foci in intractable epilepsy induced by hippocampal sclerosis by^(11)C-choline PET/CT dynamic brain imaging

目的:评价^(11)C-胆碱PET/CT动态脑显像对海马硬化难治性颞叶癫癎(HS-RTLE)致癎灶的定位诊断价值,并与^(18)F-FDG、^(11)C-氟马西尼(FMZ)PET/CT进行对比。方法:回顾性分析2017年3月至2020年6月间北部战区总医院经病理证实为海马硬化(HS)的62例患者[男39例、女23例,年龄(30.3±11.2)岁],术前均行多核素(^(18)F-FDG、^(11)C-FMZ、^(11)C-胆碱)PET/CT脑显像。^(11)C-胆碱PET显像采用动态连续扫描技术,绘制^(11)C-胆碱在双侧海马区域的时间-放射性曲线(TAC)。以术后病理为"金标准",比较3种显像剂对HS致灶的阳性检出率及定位准确率。另对2019年5月至2020年8月间该院46例临床可疑HS-RTLE患者[男27例、女19例,年龄(32.9±11.9)岁]行前瞻性研究,检查方法同回顾性研究,以颅内植入电极或术后病理为"金标准",验证^(11)C-胆碱TAC对致灶的定位诊断效能,应用ROC曲线评价3种显像剂定位致灶的诊断效能。采用χ^(2)检验及Fisher确切概率法和Delong检验分析数据。结果:回顾性研究示^(18)F-FDG PET/CT对致灶的阳性检出率高于^(11)C-胆碱PET/CT[100%(62/62)与85.48%(53/62);P=0.003],^(11)C-胆碱及^(11)C-FMZ PET/CT对致灶的定位准确率高于^(18)F-FDG PET/CT[100%(53/53)、96.61%(57/59)与33.87%(21/62);均P<0.001]。前瞻性研究的46例患者中,25例为HS-RTLE,21例为非HS所致癫。^(11)C-胆碱PET/CT诊断HS致灶的特异性为100%(21/21),^(11)C-FMZ和^(18)F-FDG PET/CT分别为90.48%(19/21)和33.33%(7/21)。^(11)C-胆碱及^(11)C-FMZ PET/CT的AUC高于^(18)F-FDG(0.920、0.912与0.627;z值:4.93、5.16,均P<0.01)。结论:^(11)C-胆碱PET/CT可用于癫致癎灶的术前定位。相比于^(18)F-FDG、^(11)C-FMZ PET/CT,^(11)C-胆碱PET/CT特异性高,阴性显像患者更有排除意义。

Objective To evaluate the diagnostic value of^(11)C-choline PET/CT brain imaging for localization of epileptogenic foci in hippocampal sclerosis-refractory temporal lobe epilepsy(HS-RTLE),and compare it with ^(18)F-FDG and ^(11)C-flumazeni(FMZ)PET/CT.Methods From March 2017 and June 2020,a total of 62 patients(39 males,23 females,age(30.3±11.2)years)with pathologically confirmed HS-RTLE in General Hospital of Northern Theater Command were retrospectively analyzed.All patients were preoperatively treated with multiple radionuclide(18F-FDG,^(11)C-FMZ,^(11)C-choline)PET/CT brain imaging.^(11)C-choline PET imaging was used to acquire dynamic imaging data and time-activity curve(TAC)of^(11)C-choline in bilateral hippocampal regions were drawn.With postoperative pathology as the"gold standard",the positive detection rates and localization diagnostic efficacies of three radionuclide imaging agents for epileptogenic foci were analyzed.Then a prospective study including 46 patients(27 males,19 females;age(32.9±11.9)years;between May 2019 and August 2020;General Hospital of Northern Theater Command)with drug-refractory epilepsy caused by clinically suspected hippocampal sclerosis was performed.The examination method was the same as that of retrospective study.Using intracranial electrode implantation or postoperative pathology as"gold standard",the diagnostic efficacy of^(11)C-choline TAC for localization of epileptogenic foci was verified,and ROC curve was drawn to evaluate the diagnostic value of three imaging agents for HS-RTLE epileptogenic foci.χ^(2)test and Fisher exact probability method,Delong test were used to analyze the data.Results In the retrospective study,the positive detection rate of^(18)F-FDG PET/CT was higher than that of^(11)C-choline PET/CT(100%(62/62)vs 85.48%(53/62);P=0.003),and the localization accuracies of^(11)C-choline and^(11)C-FMZ PET/CT were both higher than that of^(18)F-FDG PET/CT(100%(53/53),96.61%(57/59)vs 33.87%(21/62);both P<0.001).In the prospective study,25 of 46 patients were diagnosed as HS-RTLE and 21 were non-HS induced epilepsy.The specificities of^(11)C-choline,^(11)C-FMZ and^(18)F-FDG PET/CT were 100%(21/21),90.48%(19/21),33.33%(7/21),respectively.The AUCs of^(11)C-choline and^(11)C-FMZ PET/CT were significantly higher than that of^(18)F-FDG PET/CT(0.920,0.912,0.627;z values:4.93,5.16,both P<0.01).Conclusions^(11)C-choline PET/CT can be used in the preoperative localization of epileptic foci.Compared with^(18)F-FDG and^(11)C-FMZ PET/CT,the specificity of^(11)C-choline PET/CT is higher,and the negative imaging of^(11)C-choline is more significant for exclusion.