Clinical Investigations
18F-FDG PET/CT imaging in temporal lobe epilepsy and extratemporal lobe epilepsy caused by focal cortical dysplasia
Hou Yaqin, Guo Kun, Shang Kun, Wang Jingjuan, Wang Zhenming, Zhang Haiqin, Su Yusheng, Lu Jie
Published 2021-10-25
Cite as Chin J Nucl Med Mol Imaging, 2021, 41(10): 607-612. DOI: 10.3760/cma.j.cn321828-20200511-00187
Abstract
ObjectiveTo analyze the differences in 18F-fluorodeoxyglucose (FDG) PET/CT imaging and preoperative localization between patients with temporal lobe epilepsy (TLE) and extratemporal epilepsy (ETLE) caused by focal cortical dysplasia (FCD).
MethodsFrom April 2015 to August 2018, a total of 71 patients (45 males, 26 females, age (24.3±9.1) years) with refractory epilepsy who underwent 18F-FDG PET/CT imaging before surgery and confirmed as FCD by pathology in Xuanwu Hospital were retrospectively analyzed. Patients were divided into TLE and ETLE groups based on pathological results. 18F-FDG PET/CT images were analyzed qualitatively and compared with the operation result, then region of interest (ROI) was used to calculate the asymmetry index (AI), and evaluated the hypometabolism of every cerebral region by |AI| semi-quantitatively. Engle classification were followed-up after surgery. Independent-sample t test and χ2 test were used to analyze data.
ResultsOf 71 FCD patients, 35 were TLE and 36 were ETLE. The onset age of ETLE patients were younger than TLE patients ((10.1±6.5) vs (14.9±9.7) years; t=2.48, P=0.02). In TLE group, 54.29%(19/35) were completely consistent with the operation results, and 42.86%(15/35) showed hypometabolized brain regions in extratemporal lobe. In ETLE group, 27.78%(10/36) were completely consistent with the operation results, and 47.22%(17/36) showed hypometabolized brain regions in temporal lobe. There were significant differences in the lateral accuracy and positioning accuracy of 18F-FDG PET/CT between TLE and ETLE patients (97.14%(34/35) vs 75.00%(27/36), 54.29%(19/35) vs 27.78%(10/36); χ2 values: 7.19, 6.27, both P<0.05). There was no significant difference in |AI| values between the brain regions of TLE and ETLE patients (z values: from -1.25 to -0.06, all P>0.05).
ConclusionThe lateral accuracy and positioning accuracy of 18F-FDG PET/CT in TLE patients are better than that in ETLE patients.
Key words:
Epilepsy, temporal lobe; Malformations of cortical development; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose
Contributor Information
Hou Yaqin
Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Guo Kun
Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Shang Kun
Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Wang Jingjuan
Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Wang Zhenming
Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Zhang Haiqin
Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Su Yusheng
Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Lu Jie
Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
及颞叶外癫
的18F-FDG PET/CT影像分析
(TLE)及颞叶外癫
(ETLE)患者影像表现及术前定位的差异。
患者71例[男45例，女26例，年龄(24.3±9.1)岁]。依据手术结果将患者分为TLE及ETLE 2组。18F-FDG PET/CT图像先行定性分析，并与手术结果进行比较；然后利用感兴趣区(ROI)计算每个脑区的不对称指数(AI)，用|AI|半定量评估每个脑区的代谢减低程度。术后行Engle分级随访。采用两独立样本t检验、χ2检验分析数据。
是常见的神经系统慢性疾病之一，根据致
灶所在脑区分为颞叶癫
(temporal lobe epilepsy, TLE)及颞叶外癫
(extratemporal lobe epilepsy, ETLE)，大约1/3的患者属于药物难治性癫
[1]。局灶性皮质发育不良(focal cortical dysplasia, FCD)、海马硬化、肿瘤、脑炎等是难治性癫
常见的组织病理学类型，其中以FCD最常见，约占83.94%[2]。手术治疗是控制癫
不发作的有效手段，手术切除是首选方法，对于无法手术切除的深部各脑区病灶，常采取神经调控技术治疗[3]。大约50%~80%的患者手术切除术后可达到无癫
发作状态；迷走神经电刺激可以使大约1/3的患者发作频率减少50%或者更多[4]。ETLE的手术效果较TLE差，手术疗效与组织学类型、致
灶的位置等诸多因素有关，并不是所有患者都能从手术治疗中获益，术前对致
灶的评估尤为重要。
