A comparative study of 18F-FDG PET and MRI in the localization of intractable temporal lobe epilepsy
Department of Medical Imaging, Affiliated Fuzhou General Hospital of Nanjing Military Command, Fuzhou Clinical Medical College of the Second Military Medical University, Fuzhou 350025, China
Abstract：Objective: To evaluate the value of 18F-FDG PET and MRI in the localization of temporal lobe epileptic focus. Methods: Seventy-eight patients diagnosed as TLE underwent conventional MRI, MRS and 18F-FDG PET brain imaging. With the pathological results as the gold standard, the accuracies of these three methods and combined application of these three methods were analyzed to evaluate the value of the methods mentioned above. Results: After statistical analysis, the values of NAA/(Cho+Cr) and SUVmean in the affected side were lower than that of the healthy side. The accuracy rates of these three kinds examinations and combined application of these three methods in localization of temporal lobe epileptic focus were 33.33%(26/78), 58.97%(46/78), 85.89%(67/78) and 89.74%(70/78) respectively. After the chi-square test, there was statistically significant difference(χ2=73.090, P<0.001). Using the chi-square decomposition to further pairwise comparison with the P value corrected to 0.008 as the standard, the differences between conventional MRI and MRS, 18F-FDG PET imaging, combined application were statistically significant(χ2 was 10.317, 44.758, 52.433, respectively and P=0.001, P<0.001, P<0.001, respectively).The differences between MRS and 18F-FDG PET, combined application were statistically significant(χ2 was 14.158, 19.366, respectively and P values are both less than 0.01). The difference between the 18F-FDG PET and the combined application was statistically significant(χ2=0.539, P=0.463). Conclusion: MRI can be used in the clinical diagnosis of epilepsy, but the conventional MRI and MRS examination should be carried out at the same time, because the accuracy of MRS was significantly higher than that of conventional MRI. Patients should be examined by 18F-FDG PET imaging if the patients were still unable to be diagnosed by the above examination and were willing to accept the examination. The combination of the three methods in localization of temporal lobe epileptic focus can significantly improve the diagnostic accuracy of intractable temporal lobe epilepsy.
赵春雷，陈自谦，钱根年，杨忠东，王楷堂. 18F-FDG PET与MRI在难治性颞叶癫痫定侧诊断中的价值研究[J]. 中国临床医学影像杂志, 2016, 27(5): 305-308.
ZHAO Chun-lei, CHEN Zi-qian, QIAN Gen-nian, YANG Zhong-dong, WANG Kai-tang. A comparative study of 18F-FDG PET and MRI in the localization of intractable temporal lobe epilepsy. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(5): 305-308.
[1]Fisher RS, Van Emde Boas W, Blume W, et al． Epileptic seizures and Epilpsy: definitions proposed by the International League Against Epilepsy(ILAE) and the International Bureau for Epilepsy(IBE)[J]． Epilepsia, 2005, 46(4): 470-472．
[2]Robert D, Elwes C． Surgery for temporal lobe epilepsy[J]． BMJ, 2002, 324(2): 496-497．
[3]Hany TF, Steinert HC, Goerres GW, et al. PET diagnostic accuracy: improvement with in-line PET-CT system: initial results[J]． Radiology, 2002, 225(2): 575-581．
[4]Goncalves PPM, Oliveira E, Rosado P. Relative localizing value of amygdalo-hippocampal MR biometry in temporal lobe epilepsy[J]. Epilepsy Res, 2006, 69(2): 147-164.
[5]Park SA, Kim GS, Lee SK, et al． Interictal epileptiform discharges relate to 1H-MRS-detected metabolic abnormalities in mesial temporal lobe epilepsy[J]. Epilepsia, 2002, 43(11): 1385-1389．
[6]Smith JK, Castillo M, Kwock L． MR spectroscopy of brain tumors[J]． Magn Reson Imaging Clin N Am, 2003, 11(3): 415-429．
[7]Garcia M, Huppertz HJ, Ziyeh S, et al. Valproate-induced metabolic changes in patients with epilepsy: assessment with 1H-MRS[J]. Epilepsia, 2009, 50(3): 486-492.
[8]Van der Hel WS, Van Eijsden P, Bos IW, et al. In vivo MRS and histochemistry of status epilepticus-induced hippocampal pathology in a juvenile model of temporal lobe epilepsy[J]. NMR Biomed, 2013, 26(2): 132-140.
[9]Engel J Jr． Update on surgical treatment of the epilepsies[J]． Neurology, 1993, 43(8): 1612-1617．
[10]Chandra PS, Vaghania G, Bal CS, et al． Role of concordance between ictal-subtracted SPECT and PET in predicting long-term outcomes after epilepsy surgery[J]. Epilepsy Res, 2014, 108(10): 1782-1789.
[11]Won HJ, Chang KH, Cheon JE, et al． Comparison of MR imaging with PET and ictal SPECT in 118 patients with intractable epilepsy[J]． AJNR, 1999, 20(4): 593-599．
2016, Vol. 27 
