PET/MRI融合结合头皮脑电图间期放电在MRI阴性FCDⅡ型药物难治性癫痫术前评估中的定位价值

Role of PET/MRI combined with scalp interictal EEG discharges in presurgical lesion localization in MRI-negative FCD typeⅡdrug-refractory epilepsy

目的:探讨PET/MRI融合与头皮脑电图间期放电(IEDs)在MRI阴性局灶性皮质发育不良(FCD)Ⅱ型难治性癫痫中对病灶定位的一致性及两者结合优势。方法:回顾性分析45例行手术治疗且病理证实为MRI阴性FCDⅡ型难治性癫痫患者的术前IEDs和头皮脑电图发作期放电(IDs)、PET、MRI和其它临床资料,将PET与MRI进行图像融合,分析IEDs、IDs和PET/MRI融合对FCDⅡ型病灶定位,比较IEDs和IDs分别与PET/MRI融合对FCDⅡ型病灶定位的一致性。结果:PET/MRI融合定位34例(75.6%);IEDs定位40例(88.9%),IDs定位35例(77.8%),PET/MRI融合结合IEDs和IDs使定位分别提高到39例(86.7%)和37例(82.2%)。PET/MRI融合与IEDs定位有高度一致性(k=0.90),PET/MRI融合与IDs定位一致性较差(k=0.25)。结论:PET/MRI融合与IEDs对FCDⅡ型病灶定位有高度一致性,两者结合可以改善对MRI阴性FCDⅡ型病灶的定位,作为非侵袭性技术手段在MRI阴性FCDⅡ型患者术前评估中有重要价值。

Objective To assess the concordance of PET/MRI and scalp interictal EEG discharges(IEDs)in localizing lesions of MRI-negative focal cortical dysplasia(FCD)typeⅡdrug-refractory epilepsy,and to explore the benefit of combining the two.Methods A retrospective study was carried out on 45 patients who had undergone surgery and pathologically confirmed as MRI-negative FCD typeⅡdrug-refractory epilepsy.The presurgical IEDs,scalp ictal EEG discharges(IDs),PET,MRI and other clinical data were collected,and the PET and MRI images were coregistered.The result of lesion localization by PET/MRI or IEDs or IDs was analyzed,and the concordance between IEDs or IDs with PET/MRI in localizing FCD typeⅡlesions was compared.Results The lesions were successfully localized in 34,40 and 35 cases using PET/MRI,IEDs and IDs,respectively,accounting for 75.6%,88.9%and 77.8%of the enrolled cases.The number of successful lesion localization cases increased to 39(86.7%)and 37(82.2%)after combining PET/MRI with IEDs and IDs.There was a high degree of concordance between IEDs and PET/MRI(k=0.90),but a poor concordance between IDs and PET/MRI(k=0.25).Conclusion IEDs and PET/MRI have a high degree of concordance in localizing FCD typeⅡlesions,and the combination of the two which can improve the precise lesion localization is of great significance in presurgical evaluation of MRI negative FCD typeⅡas a noninvasive technique.