脑^(18)F-FDG PET/CT对MRI阴性难治性癫痫患者术前致痫灶定位的价值

Value of brain ^(18)F-FDG PET/CT in the preoperative localization of epileptogenic foci in refractory epilepsy patients with negative MRI

目的探讨脑^(18)F-FDG PET/CT对MRI阴性难治性癫痫患者术前致痫灶定位的价值。方法回顾性分析2014年1月至2020年6月间于暨南大学附属第一医院接受术前脑^(18)F-FDG PET/CT-MRI检查的55例[男38例、女17例,年龄(20.0±8.1)岁]MRI阴性癫痫患者的临床资料(550个脑叶)。以立体定向脑电图(SEEG)及术后随访至少1年的结果作为参考标准,分别计算^(18)F-FDG PET/CT、视频脑电图(VEEG)、PET/CT+VEEG及PET/CT-VEEG对致痫灶定位的灵敏度、特异性、准确性、阳性预测值(PPV)及阴性预测值(PPV)。使用χ^(2)检验对单脑叶、多脑叶及全部患者不同检查方式的效能进行比较。结果PET/CT对致痫灶的正确定侧率为92.6%(25/27)。PET/CT对致痫灶定位的灵敏度、特异性、准确性、PPV及NPV分别为65.1%(54/83)、77.9%(364/467)、76.0%(418/550)、34.4%(54/157)及92.6%(364/393)。PET/CT-VEEG对全部及多脑叶癫痫患者致痫灶定位的灵敏度高于单独的VEEG[75.9%(63/83)和45.8%(38/83)、68.6%(35/51)和31.4%(16/51);χ^(2)值:15.80、14.16,均P<0.001],PET/CT+VEEG对全部及单脑叶癫痫患者致痫灶定位的特异性高于单独的VEEG[97.6%(456/467)和94.6%(442/467)、97.9%(282/288)和94.1%(271/288);χ^(2)值:5.66、5.48,P值:0.017、0.019]。PET/CT-VEEG(PET/CT与VEEG一致)对致痫灶定位的灵敏度高于PET/CT+VEEG(PET/CT与VEEG不一致)[8/9和28.4%(21/74);χ^(2)=10.40,P=0.001],其特异性及准确性高于PET/CT-VEEG(PET/CT与VEEG不一致)[93.4%(57/61)和71.7%(291/406)、92.9%(65/70)和72.1%(346/480);χ^(2)值:13.23、13.96,均P<0.001]。结论^(18)F-FDG PET/CT能定位定侧MRI阴性癫痫患者的致痫灶。^(18)F-FDG PET/CT与VEEG的联合应用能提高致痫灶检出的灵敏度、特异性及准确性。^(18)F-FDG PET/CT与VEEG一致时对致痫灶检出的准确性较高。

Objective To evaluate the value of ^(18)F-FDG PET/CT for preoperative localization of epileptogenic foci in refractory epilepsy patients with negative MRI.Methods Clinical data(550 lobes)of 55 epilepsy patients(38 males,17 females,age(20.0±8.1)years)with negative MRI who underwent preoperative ^(18)F-FDG PET/CT-MRI between January 2014 and June 2020 at the First Affiliated Hospital of Jinan University were retrospectively analyzed.The sensitivity,specificity,accuracy,positive predictive value(PPV)and negative predictive value(NPV)of ^(18)F-FDG PET/CT,video electroencephalogram(VEEG),PET/CT+VEEG and PET/CT-VEEG for localizing epileptogenic foci were calculated using stereoelectroencephalography(SEEG)and the outcomes of at least 1 year of postoperative follow-up as reference standards.χ^(2) test was used to compare the efficiencies of different examination modalities for unilobar,multilobar and all patients.Results The correct lateralization rate of epileptogenic foci was 92.6%(25/27)using PET/CT.The sensitivity,specificity,accuracy,PPV and NPV of PET/CT for localization of epileptogenic foci were 65.1%(54/83),77.9%(364/467),76.0%(418/550),34.4%(54/157)and 92.6%(364/393),respectively.The sensitivities of PET/CT-VEEG for localization of epileptogenic foci in all patients and patients with multilobar epilepsy were higher than those of VEEG alone(75.9%(63/83)vs 45.8%(38/83),68.6%(35/51)vs 31.4%(16/51);χ^(2) values:15.80,14.16,both P<0.001).The specificities of PET/CT+VEEG for localization of epileptogenic foci in all patients and patients with unilobar epilepsy were higher than those of VEEG alone(97.6%(456/467)vs 94.6%(442/467),97.9%(282/288)vs 94.1%(271/288);χ^(2) values:5.66,5.48;P values:0.017,0.019).The sensitivity of PET/CT-VEEG(PET/CT and VEEG concordance)for localization of epileptogenic foci was higher than that of PET/CT+VEEG(PET/CT and VEEG discordance)(8/9 vs 28.4%(21/74);χ^(2)=10.40,P=0.001),and its specificity and accuracy were higher than those of PET/CT-VEEG(PET/CT and VEEG discordance)(93.4%(57/61)vs 71.7%(291/406),92.9%(65/70)vs 72.1%(346/480);χ^(2) values:13.23,13.96;both P<0.001).Conclusions ^(18)F-FDG PET/CT can localize and lateralize epileptogenic foci in patients with negative MRI.The combination of ^(18)F-FDG PET/CT and VEEG improves the sensitivity,specificity,and accuracy for epileptogenic foci detection.^(18)F-FDG PET/CT is more accurate in detecting epileptogenic foci when it is concordant with VEEG.