Abstract：
OBJECTIVE: Although commonly used in the evaluation of patients for epilepsy surgery, the association between the detection of localizing 18fluorine fluorodeoxyglucose PET (18F-FDG-PET) hypometabolism and epilepsy surgery outcome is uncertain. We conducted a systematic review and meta-analysis to determine whether localizing 18F-FDG-PET hypometabolism is associated with favorable outcome after epilepsy surgery.
METHODS: A systematic literature search was undertaken. Eligible publications included evaluation with 18F-FDG-PET before epilepsy surgery, with ≥10 participants, and those that reported surgical outcome at ≥12 months. Random-effects meta-analysis was used to calculate the odds of achieving a favorable outcome, defined as Engel class I, International League Against Epilepsy class 1-2, or seizure-free, with localizing 18F-FDG-PET hypometabolism, defined as concordant with the epilepsy surgery resection zone. Meta-regression was used to characterize sources of heterogeneity.
RESULTS: The database search identified 8,916 studies, of which 98 were included (total patients n = 4,104). Localizing 18F-FDG-PET hypometabolism was associated with favorable outcome after epilepsy surgery for all patients with odds ratio (OR) 2.68 (95% CI 2.08-3.45). Subgroup analysis yielded similar findings for those with (OR 2.64, 95% CI 1.54-4.52) and without epileptogenic lesion detected on MRI (OR 2.49, 95% CI 1.80-3.44). Concordance with EEG (OR 2.34, 95% CI 1.43-3.83), MRI (OR 1.69, 95% CI 1.19-2.40), and triple concordance with both (OR 2.20, 95% CI 1.32-3.64) was associated with higher odds of favorable outcome. By contrast, diffuse 18F-FDG-PET hypometabolism was associated with worse outcomes compared with focal hypometabolism (OR 0.34, 95% CI 0.22-0.54).
CONCLUSIONS: Localizing 18F-FDG-PET hypometabolism is associated with favorable outcome after epilepsy surgery, irrespective of the presence of an epileptogenic lesion on MRI. The extent of 18F-FDG-PET hypometabolism provides additional information, with diffuse hypometabolism associated with worse surgical outcome than focal 18F-FDG-PET hypometabolism. These findings support the incorporation of 18F-FDG-PET into routine noninvasive investigations for patients being evaluated for epilepsy surgery to improve epileptogenic zone localization and to aid patient selection for surgery.
METHODS: A systematic literature search was undertaken. Eligible publications included evaluation with 18F-FDG-PET before epilepsy surgery, with ≥10 participants, and those that reported surgical outcome at ≥12 months. Random-effects meta-analysis was used to calculate the odds of achieving a favorable outcome, defined as Engel class I, International League Against Epilepsy class 1-2, or seizure-free, with localizing 18F-FDG-PET hypometabolism, defined as concordant with the epilepsy surgery resection zone. Meta-regression was used to characterize sources of heterogeneity.
RESULTS: The database search identified 8,916 studies, of which 98 were included (total patients n = 4,104). Localizing 18F-FDG-PET hypometabolism was associated with favorable outcome after epilepsy surgery for all patients with odds ratio (OR) 2.68 (95% CI 2.08-3.45). Subgroup analysis yielded similar findings for those with (OR 2.64, 95% CI 1.54-4.52) and without epileptogenic lesion detected on MRI (OR 2.49, 95% CI 1.80-3.44). Concordance with EEG (OR 2.34, 95% CI 1.43-3.83), MRI (OR 1.69, 95% CI 1.19-2.40), and triple concordance with both (OR 2.20, 95% CI 1.32-3.64) was associated with higher odds of favorable outcome. By contrast, diffuse 18F-FDG-PET hypometabolism was associated with worse outcomes compared with focal hypometabolism (OR 0.34, 95% CI 0.22-0.54).
CONCLUSIONS: Localizing 18F-FDG-PET hypometabolism is associated with favorable outcome after epilepsy surgery, irrespective of the presence of an epileptogenic lesion on MRI. The extent of 18F-FDG-PET hypometabolism provides additional information, with diffuse hypometabolism associated with worse surgical outcome than focal 18F-FDG-PET hypometabolism. These findings support the incorporation of 18F-FDG-PET into routine noninvasive investigations for patients being evaluated for epilepsy surgery to improve epileptogenic zone localization and to aid patient selection for surgery.
摘要：
目的：虽然通常用于评估癫痫手术患者，定位18氟脱氧葡萄糖PET(18F-FDG-PET)代谢异常检测与癫痫手术结局之间的关联尚不确定.我们进行了系统评价和荟萃分析，以确定定位18F-FDG-PET低代谢是否与癫痫手术后的良好结局相关。
方法：进行了系统的文献检索。符合条件的出版物包括在癫痫手术前使用18F-FDG-PET进行评估，参与者≥10人，和那些在≥12个月时报告手术结果的患者。随机效应荟萃分析用于计算获得有利结果的几率，定义为恩格尔一级，国际抗癫痫联赛1-2级，或无癫痫发作，与局部18F-FDG-PET低代谢，定义为与癫痫手术切除区一致。使用元回归来表征异质性的来源。
结果：数据库搜索确定了8,916项研究，其中98例纳入（总患者n=4,104）。对于所有比值比（OR）为2.68（95％CI2.08-3.45）的患者，定位18F-FDG-PET低代谢与癫痫手术后的良好预后相关。对于在MRI上检测到有（OR2.64，95％CI1.54-4.52）和没有癫痫性病变的患者（OR2.49，95％CI1.80-3.44），亚组分析产生了相似的发现。与脑电图的一致性（OR2.34，95%CI1.43-3.83），MRI（OR1.69，95%CI1.19-2.40），与两者的三重一致性(OR2.20,95%CI1.32-3.64)与较高的有利结局几率相关。相比之下,与局灶性低代谢相比,弥漫性18F-FDG-PET低代谢与较差的预后相关(OR0.34,95%CI0.22-0.54).
结论：定位18F-FDG-PET低代谢与癫痫手术后的良好结局相关，无论MRI上是否存在癫痫性病变。18F-FDG-PET低代谢的程度提供了额外的信息，与局灶性18F-FDG-PET低代谢相比，弥漫性低代谢与较差的手术结果相关。这些发现支持将18F-FDG-PET纳入接受癫痫手术评估的患者的常规无创检查中，以改善癫痫发生区定位并帮助患者选择手术。
方法：进行了系统的文献检索。符合条件的出版物包括在癫痫手术前使用18F-FDG-PET进行评估，参与者≥10人，和那些在≥12个月时报告手术结果的患者。随机效应荟萃分析用于计算获得有利结果的几率，定义为恩格尔一级，国际抗癫痫联赛1-2级，或无癫痫发作，与局部18F-FDG-PET低代谢，定义为与癫痫手术切除区一致。使用元回归来表征异质性的来源。
结果：数据库搜索确定了8,916项研究，其中98例纳入（总患者n=4,104）。对于所有比值比（OR）为2.68（95％CI2.08-3.45）的患者，定位18F-FDG-PET低代谢与癫痫手术后的良好预后相关。对于在MRI上检测到有（OR2.64，95％CI1.54-4.52）和没有癫痫性病变的患者（OR2.49，95％CI1.80-3.44），亚组分析产生了相似的发现。与脑电图的一致性（OR2.34，95%CI1.43-3.83），MRI（OR1.69，95%CI1.19-2.40），与两者的三重一致性(OR2.20,95%CI1.32-3.64)与较高的有利结局几率相关。相比之下,与局灶性低代谢相比,弥漫性18F-FDG-PET低代谢与较差的预后相关(OR0.34,95%CI0.22-0.54).
结论：定位18F-FDG-PET低代谢与癫痫手术后的良好结局相关，无论MRI上是否存在癫痫性病变。18F-FDG-PET低代谢的程度提供了额外的信息，与局灶性18F-FDG-PET低代谢相比，弥漫性低代谢与较差的手术结果相关。这些发现支持将18F-FDG-PET纳入接受癫痫手术评估的患者的常规无创检查中，以改善癫痫发生区定位并帮助患者选择手术。
