Wyniki kliniczne dynamicznego badania PET z fluordezoksyglukazą w ogniskowej epilepsji: wczesne badanie obserwacyjne
Clinical outcomes of dynamic [F]-FDG PET in focal epilepsy: a prospective early observational study
W skrócie
Badanie sprawdzało, czy nowa technika obrazowania mózgu (dynamiczne PET) może lepiej pomóc w znalezieniu miejsca pochodzenia napadów epilepsji u pacjentów, którzy nie reagują na leki. Okazało się, że ta metoda wskazała prawidłowe miejsce do operacji u 88% pacjentów, którzy po zabiegu zaprzestali mieć napady, nawet w przypadkach, gdy tradycyjne badania MRI były niepomocne. Wyniki sugerują, że dynamiczne PET może być użytecznym narzędziem do planowania operacji u pacjentów z opornymi na leki napadami epilepsji.
Oryginalny abstract (angielski)
BACKGROUND AND PURPOSE: Standard static 18F-fluorodeoxyglucose PET (sPET) frequently registers normal metabolism in patients with focal drug-resistant epilepsy (DRE), limiting its utility for identifying the epileptogenic zone (EZ) for epilepsy surgery. Dynamic FDG-PET (dPET), which quantifies the rate of glucose uptake rather than its static concentration, may offer improved sensitivity. This early phase, prospective, observational study evaluated the concordance between dPET-defined hypokinetic regions and surgical outcomes in patients with focal DRE. MATERIALS AND METHODS: Thirty-one adult patients with focal DRE underwent dPET along with standard pre-surgical evaluations. Whole-brain kinetic maps were segmented into 36 regions of interest and converted to intrasubject z-score maps; regions with kinetic values at least 1.67 standard deviations below the whole-brain mean were considered hypokinetic. Surgical decision-making proceeded independently of dPET findings. The primary outcome was observed agreement between the region of lowest kinetic z-score and the EZ, assessed by 6 month post-surgical seizure outcome. RESULTS: Twenty-nine of 31 patients (94%) had at least one region exceeding the hypokinetic threshold, most commonly in mesial temporal structures. Ten patients underwent resective surgery; 8 achieved freedom from disabling seizures at 6 months. Among the 8 seizure-free, 7 (88%) had a dPET hypokinetic region concordant with the surgical EZ, including cases with normal MRI or dual pathology. dPET findings did not coincide with the surgical target in the 2 patients with non-seizure-free outcomes. CONCLUSIONS: These findings suggest that dPET, by capturing metabolic rate rather than concentration, can identify regions that correspond to the EZ with a high degree of concordance in surgically confirmed cases, including many with nonlocalizing structural imaging. While this early phase study is not powered to establish diagnostic accuracy, the results support further investigation of dPET as a noninvasive adjunct for presurgical localization in focal drug-resistant epilepsy.