Fluorodeoxyglucose F18

氟脱氧葡萄糖 F18
  • 文章类型: Journal Article
    使用放射性标记的成纤维细胞活化蛋白抑制剂(FAPI)的PET/CT是肿瘤学中一种有前途的诊断工具,特别是当观察到未增加和/或生理高[18F]FDG摄取(如在肝实质中)时。我们旨在回顾使用放射性标记的FAPI的PET/CT在原发性和/或转移性肝脏病变中的作用,并将它们的性能与更多的“传统”放射性药物进行比较。应用了基于术语“FAPI”AND(“肝”或“肝”)的搜索算法,最后一次更新是在2024年1月1日。在检索到的177篇文章中,全面分析了76项研究,这些研究报告了放射性标记的FAPIPET/CT在至少一名患有原发性或转移性肝病灶的患者中的诊断应用。尽管在临床条件和/或研究方法上存在一些异质性,具有放射性标记的FAPI的PET/CT在常见的原发性肝脏恶性肿瘤(肝癌,肝内胆管癌)和肝转移(主要来自胃肠道和肺)。在原发性和转移性肝脏病变中发现FAPI比[18F]FDG更高的肿瘤背景比,由于较低的背景活动。尽管临床证据有限,放射性标记的FAPI可用于评估FAPI衍生的治疗剂如[177Lu]Lu-FAPI的适用性和有效性。然而,未来需要对更广泛的人群进行前瞻性研究,以证实其优异的表现。
    PET/CT using radiolabeled fibroblast activation protein inhibitors (FAPIs) is a promising diagnostic tool in oncology, especially when non-increased and/or physiologically high [18F]FDG uptake (as in liver parenchyma) is observed. We aimed to review the role of PET/CT using radiolabeled FAPIs in primary and/or metastatic liver lesions, and to compare their performances with more \"conventional\" radiopharmaceuticals. A search algorithm based on the terms \"FAPI\" AND (\"hepatic\" OR \"liver\") was applied, with the last update on 1st January 2024. Out of 177 articles retrieved, 76 studies reporting on the diagnostic application of radiolabeled FAPI PET/CT in at least one patient harboring primary or metastatic liver lesion(s) were fully analyzed. Although there was some heterogeneity in clinical conditions and/or study methodology, PET/CT with radiolabeled FAPIs showed an excellent performance in common primary liver malignancies (hepatocarcinoma, intrahepatic cholangiocarcinoma) and liver metastases (mostly from the gastrointestinal tract and lungs). A higher tumor-to-background ratio for FAPIs than for [18F]FDG was found in primary and metastatic liver lesions, due to lower background activity. Despite limited clinical evidence, radiolabeled FAPIs may be used to assess the suitability and effectiveness of FAPI-derived therapeutic agents such as [177Lu]Lu-FAPI. However, future prospective research on a wider population is needed to confirm the excellent performance.
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  • 文章类型: Journal Article
    在过去的十年里,几种策略彻底改变了皮肤黑色素瘤(CM)患者的临床管理,包括免疫治疗和靶向酪氨酸激酶抑制剂(TKI)治疗。的确,免疫检查点抑制剂(ICIs),单独或组合,代表没有可操作突变的晚期疾病患者的护理标准。值得注意的是,BRAF与MEK抑制剂的组合代表了用于显示BRAF突变的疾病的治疗标准。同时,FDGPET/CT已成为皮肤黑色素瘤患者常规分期和评估的一部分。使用FDGPET/CT测量来预测对ICI治疗和/或目标治疗的反应越来越有兴趣。虽然诸如标准化摄取值(SUV)之类的半定量值在预测结果方面受到限制,新的措施,包括肿瘤代谢体积,全病变糖酵解和影像组学作为核医学潜在的成像生物标志物似乎很有希望.这次审查的目的,由跨学科专家组编写,是评估目前关于可以改善CM结果的影像组学方法的文献。
    Over the past decade, several strategies have revolutionized the clinical management of patients with cutaneous melanoma (CM), including immunotherapy and targeted tyrosine kinase inhibitor (TKI)-based therapies. Indeed, immune checkpoint inhibitors (ICIs), alone or in combination, represent the standard of care for patients with advanced disease without an actionable mutation. Notably BRAF combined with MEK inhibitors represent the therapeutic standard for disease disclosing BRAF mutation. At the same time, FDG PET/CT has become part of the routine staging and evaluation of patients with cutaneous melanoma. There is growing interest in using FDG PET/CT measurements to predict response to ICI therapy and/or target therapy. While semiquantitative values such as standardized uptake value (SUV) are limited for predicting outcome, new measures including tumor metabolic volume, total lesion glycolysis and radiomics seem promising as potential imaging biomarkers for nuclear medicine. The aim of this review, prepared by an interdisciplinary group of experts, is to take stock of the current literature on radiomics approaches that could improve outcomes in CM.
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  • 文章类型: Journal Article
    CAR-T细胞疗法,也称为嵌合抗原受体T细胞疗法,是免疫治疗非霍奇金淋巴瘤(NHL)领域的一种新方法。在接受CAR-T细胞治疗的患者中,氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描([18F]FDGPET/CT)在追踪治疗反应和评估免疫治疗的整体疗效方面发挥着关键作用。这项研究的目的是对旨在通过[18F]FDGPET/CT评估和预测接受CAR-T细胞治疗的NHL患者毒性的研究文献进行系统综述。两名研究人员询问了PubMed/MEDLINE和Cochrane中央对照试验注册(CENTRAL)数据库,以寻求涉及在接受CAR-T细胞治疗的淋巴瘤患者中使用[18F]FDGPET/CT的研究。全面的计算机文献检索允许纳入11项研究。通过使用第2版“诊断准确性研究质量评估”工具(QUADAS-2),系统评价中纳入的研究的偏倚风险评分为低。目前的文献强调[18F]FDGPET/CT在评估和预测接受CAR-T细胞治疗的NHL患者的毒性中的作用。强调CAR-T细胞疗法研究的演变性质。需要更多的研究来增加文献中收集的证据。
    CAR-T-cell therapy, also referred to as chimeric antigen receptor T-cell therapy, is a novel method in the field of immunotherapy for the treatment of non-Hodgkin\'s lymphoma (NHL). In patients receiving CAR-T-cell therapy, fluorodeoxyglucose Positron Emission Tomography/Computer Tomography ([18F]FDG PET/CT) plays a critical role in tracking treatment response and evaluating the immunotherapy\'s overall efficacy. The aim of this study is to provide a systematic review of the literature on the studies aiming to assess and predict toxicity by means of [18F]FDG PET/CT in patients with NHL receiving CAR-T-cell therapy. PubMed/MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were interrogated by two investigators to seek studies involving the use of [18F]FDG PET/CT in patients with lymphoma undergoing CAR-T-cell therapy. The comprehensive computer literature search allowed 11 studies to be included. The risk of bias for the studies included in the systematic review was scored as low by using version 2 of the \"Quality Assessment of Diagnostic Accuracy Studies\" tool (QUADAS-2). The current literature emphasizes the role of [18F]FDG PET/CT in assessing and predicting toxicity in patients with NHL receiving CAR-T-cell therapy, highlighting the evolving nature of research in CAR-T-cell therapy. Additional studies are warranted to increase the collected evidence in the literature.
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  • 文章类型: Journal Article
    目的:系统评价现有证据,使用18F-FDGPET/CT分析风湿性多肌痛(PMR)或巨细胞动脉炎(GCA)患者颅外大血管血管炎(LVV)的患病率。
    方法:检索PubMed和EMBASE,并由两名评审员筛选结果。使用改良版本的纽卡斯尔-渥太华量表评估研究质量。使用I2统计量和Q检验评估研究之间的异质性。按疾病类型进行了进一步的亚组分析,学习质量,和18F-FDGPET/CT摄取标准。通过漏斗图和Egger检验评估发表偏倚。
    结果:确定了268种出版物,其中17项符合选择标准,并纳入荟萃分析.通过18F-FDGPET/CT检查,颅外LVV的总体合并患病率为54.5%[95%CI:42.6%至66.1%]。GCA患者的患病率明显高于PMR患者(60.1%vs.41.8%,p=0.006)。同样,偏倚风险较低的研究报告颅外LVV患病率较高(61.1%vs.46.9%;p=0.010)。未观察到发表偏倚。
    结论:18F-FDGPET/CT检查可用于检测颅外LVV,PMR或GCA患者。这种参与在GCA患者中更为常见,并且可能根据研究的质量而有所不同。
    OBJECTIVE: Systematic review of current evidence to analyze the prevalence of extracranial large vessel vasculitis (LVV) using 18F-FDG PET/CT in patients with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA).
    METHODS: PubMed and EMBASE were searched and the results were screened by two reviewers. Study quality was assessed using a modified version of the Newcastle-Ottawa scale. Heterogeneity between studies was assessed using the I2 statistic and the Q test. Further subgroup analyses were performed by disease type, study quality, and 18F-FDG PET/CT uptake criteria. Publication bias was assessed by funnel plot and Egger\'s test.
    RESULTS: 268 publications were identified, of which 17 met the selection criteria and were included in the meta-analysis. The overall pooled prevalence of extracranial LVV by 18F-FDG PET/CT was 54.5% [95% CI: 42.6%-66.1%]. In patients with GCA the prevalence was significantly higher than in patients with PMR (60.1% vs. 41.8%, P = 0.006). Likewise, studies with a lower risk of bias reported a higher prevalence of extracranial LVV (61.1% vs. 46.9%; P = 0.010). No publication bias was observed.
    CONCLUSIONS: The 18F-FDG PET/CT test may be useful in the detection of extracranial LVV, both in patients with PMR or GCA. Such involvement is more frequent in patients with GCA, and may vary depending on the quality of the studies.
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  • 文章类型: Journal Article
    背景:原发性中枢神经系统淋巴瘤(PCNSL)是一种罕见的结外非霍奇金淋巴瘤,预后不良。18F-氟代脱氧葡萄糖正电子发射断层扫描(PET)/磁共振(MR)结合了PET和MR的优点。这项研究的目的是通过荟萃分析评估PET/MR诊断PCNSL的有效性。
    方法:万方数据库,SinoMed,中国国家知识基础设施,Cochrane图书馆,从数据库开始到2024年10月,将搜索PubMed和Embase有关PET/MRI在PCNSL诊断中的候选研究。将应用以下关键字:“原发性中枢神经系统淋巴瘤”,“原发性脑内淋巴瘤”,“正电子发射断层扫描磁共振”和“PET-MR”。符合纳入标准的研究将被纳入。没有完全真正积极的研究,假阳性,假阴性和真阴性值;以英语和中文以外的语言报告的研究;会议摘要全文不可用,病例报告将被排除。诊断准确性研究的质量评估将用于评估研究质量。将使用STATA软件(V.15.0)和Meta-Disc软件(V.1.4)进行荟萃分析。当异质性明显时,亚组分析将用于研究异质性的起源。分析的稳健性将通过敏感性分析进行检查。
    背景:这项研究基于公共数据库,不需要道德批准。在完成本系统评价和荟萃分析后,结果将寻求在同行评审的期刊上发表。
    CRD42023472570。
    BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin\'s lymphoma with poor prognosis. 18F-flourodeoxyglucose positron emission tomography (PET)/magnetic resonance (MR) combines the advantages of PET and MR. The aim of this study is to evaluate the validity of PET/MR for the diagnosis of PCNSL by means of a meta-analysis.
    METHODS: Wanfang Database, SinoMed, China National Knowledge Infrastructure, the Cochrane Library, PubMed and Embase will be searched for candidate studies about PET/MRI in PCNSL diagnosis from database inception to October 2024. The following keywords will be applied: \"Primary central nervous system lymphoma\", \"Primary intracerebral lymphoma\", \"Positron Emission Tomography Magnetic Resonance\" and \"PET-MR\". Studies meeting the inclusion criteria will be included. Studies without full true positive, false positive, false negative and true negative values; studies reported in languages other than English and Chinese; conference abstracts not available in full text and case reports will be excluded. Quality Assessment of Diagnostic Accuracy Studies will be used to evaluate the study quality. The STATA software (V.15.0) and Meta-Disc software (V.1.4) will be used to carry out meta-analysis. When heterogeneity is evident, subgroup analysis will be used to investigate the origin of heterogeneity. The robustness of the analysis will be checked with sensitivity analysis.
    BACKGROUND: This research is based on public databases and does not require ethical approval. The results will seek publication in a peer-reviewed journal after the completion of this systematic review and meta-analysis.
    UNASSIGNED: CRD42023472570.
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  • 文章类型: Case Reports
    背景:为了证明和分析18F-FDG正电子发射断层扫描/计算机断层扫描(PET/CT)在这种罕见的中性基底细胞癌综合征(NBCCS)中的发现。
    方法:一名71岁左侧浸润性乳腺癌患者接受激素治疗6个月,并接受18F-FDGPET/CT检查以评估疗效。18F-FDGPET/CT显示治疗后改善和其他意外发现,包括皮肤上有18F-FDG摄取的多个结节,双侧肋骨囊性病变的骨扩张,异位钙化和右输尿管扩张。她没有已知的家族史。然后,患者接受了所有皮肤结节的手术切除,术后病理为多发性基底细胞癌。最后,对NBCCS进行综合诊断。患者仍在随访中。此外,我们从文献中总结了18F-FDGPET/CT的报告病例(n=3)。
    结论:由于不同的诊断和治疗结果,在18F-FDGPET/CT上识别该综合征很重要。
    BACKGROUND: To demonstrate and analyze the 18F-FDG positron emission tomography/computed tomography (PET/CT) findings in this rare nevoid basal cell carcinoma syndrome (NBCCS).
    METHODS: A 71-year-old woman with the left invasive breast cancer was treated with hormone therapy for six months and underwent the 18F-FDG PET/CT examination for efficacy evaluation. 18F-FDG PET/CT revealed the improvement after treatment and other unexpected findings, including multiple nodules on the skin with 18F-FDG uptake, bone expansion of cystic lesions in the bilateral ribs, ectopic calcifications and dilated right ureter. She had no known family history. Then, the patient underwent surgical excision of the all skin nodules and the postoperative pathology were multiple basal cell carcinomas. Finally, the comprehensive diagnosis of NBCCS was made. The patient was still in follow-up. Additionally, we have summarized the reported cases (n = 3) with 18F-FDG PET/CT from the literature.
    CONCLUSIONS: It is important to recognize this syndrome on 18F-FDG PET/CT because of different diagnoses and therapeutic consequences.
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  • 文章类型: Journal Article
    正电子发射断层扫描(PET)和计算机断层扫描(CT)已发展成为肿瘤学领域的关键诊断方式。随着其在暂存和就绪可用性方面的应用越来越多,对于致力于放射肿瘤学家来说,对分子成像的整合有一个完整的分析和理解变得势在必行,这对辐射规划有帮助,同时也承认其可能的局限性和挑战。一个重要的障碍在于用于诊断和治疗癌症的肿瘤特异性b分子的合成和设计。辐射在医学生物化学和生物技术中的应用,包括诊断,治疗,和控制生物系统,被封装在总称“核医学”下。值得注意的是,各种放射性同位素在药剂学中的应用受到了极大的关注,特别是在药物输送系统领域,DNA,和显像剂。本文提供了对新技术PET和CT的使用的全面综述,这些新技术具有目前正在开发或在临床实践中使用的主要正电子发射放射性药物,并将其整合到成像和放射治疗中。
    Positron emission tomography (PET) and computed tomography (CT) have evolved as a pivotal diagnostic modality in the field of oncology. With its increasing application in staging and ready availability, it becomes imperative for committed radiation oncologists to possess a complete analysis and understanding of integration of molecular imaging, which can be helpful for radiation planning, while also acknowledging its possible limitations and challenges. A significant obstacle lies in the synthesis and design of tumor-specific bmolecules for diagnosing and treating cancer. The utilization of radiation in medical biochemistry and biotechnology, encompassing diagnosis, therapy, and control of biological systems, is encapsulated under the umbrella term \"nuclear medicine\". Notably, the application of various radioisotopes in pharmaceutics has garnered significant attention, particularly in the realm of delivery systems for drugs, DNA, and imaging agents. The present article provides a comprehensive review of use of novel techniques PET and CT with major positron-emitting radiopharmaceuticals currently in progress or utilized in clinical practice with their integration into imaging and radiation therapy.
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  • 文章类型: Systematic Review
    目的:我们的研究旨在比较镓-68-成纤维细胞活化蛋白抑制剂(68Ga-FAPI)正电子发射断层扫描/计算机断层扫描(PET/CT)和氟-18-氟脱氧葡萄糖(18F-FDG)PET/CT在胃肿瘤原发灶和转移灶中的应用,以确定优越的诊断工具。
    方法:系统搜索,截至2023年3月31日,整个PubMed,Embase,和CochraneLibrary数据库使用了特定于数据的布尔逻辑策略。对胃癌病灶中68Ga-FAPI和18F-FDGPET/CT的敏感性(SEN)和特异性(SPE)进行评估。使用QUADAS-2评估研究质量,并通过Begg和Egger测试检查发表偏倚。
    结果:在五项研究中,分析涉及141例胃肿瘤患者和2753例转移灶,总体研究质量令人满意,没有明显的发表偏倚。患者水平数据显示,68Ga-FAPI的组合SEN为0.95(95%CI:0.90-0.98),18F-FDG的组合SEN为0.84(95%CI:0.77-0.89)。在病变级别,68Ga-FAPI的合并SENs为0.91(95%CI:0.84-0.96),18F-FDG的合并SENs为0.72(95%CI:0.63-0.80).68Ga-FAPI检测淋巴结转移的合并SEN为0.78(95%CI:0.74-0.82),18F-FDG为0.35(95%CI:0.30-0.39),合并的SPE值为0.99(95%CI:0.98-0.99)和0.97(95%CI:0.96-0.98),分别。为了检测远处转移,68Ga-FAPI和18F-FDG的合并SEN值分别为0.97(95%CI:0.96-0.98)和0.69(95%CI:0.66-0.72),合并的SPE值为0.86(95%CI:0.82-0.89)和0.64(95%CI:0.59-0.68),分别。
    结论:这项荟萃分析得出结论,在评估原发性胃肿瘤方面,68Ga-FAPIPET/CT比18F-FDGPET/CT更敏感,淋巴结,和远处转移,但淋巴结转移的特异性差异无统计学意义。
    OBJECTIVE: Our study aims to head to head compare the application of gallium-68-fibroblast activation protein inhibitor (68Ga-FAPI) positron emission tomography/computed tomography (PET/CT) and fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT in primary and metastatic lesions of gastric tumor to determine the superior diagnostic tool.
    METHODS: A systematic search, up to March 31, 2023, across PubMed, Embase, and Cochrane Library databases utilized a data-specific Boolean logic strategy. Sensitivity (SEN) and specificity (SPE) evaluations of 68Ga-FAPI and 18F-FDG PET/CT in gastric cancer lesions were conducted. The quality of the studies was assessed using QUADAS-2, and publication bias was examined through Begg and Egger tests.
    RESULTS: Analysis involved 141 gastric tumor patients and 2753 metastatic lesions in five studies, with overall satisfactory study quality and no apparent publication bias. Patient-level data showed a combined SEN of 0.95 (95% CI: 0.90-0.98) for 68Ga-FAPI and 0.84 (95% CI: 0.77-0.89) for 18F-FDG. At the lesion level, combined SEN were 0.91 (95% CI: 0.84-0.96) for 68Ga-FAPI and 0.72 (95% CI: 0.63-0.80) for 18F-FDG. The pooled SEN for detecting lymph node metastases was 0.78 (95% CI: 0.74-0.82) for 68Ga-FAPI and 0.35 (95% CI: 0.30-0.39) for 18F-FDG, with pooled SPE values of 0.99 (95% CI: 0.98-0.99) and 0.97 (95% CI: 0.96-0.98), respectively. For detecting distant metastases, pooled SEN values were 0.97 (95% CI: 0.96-0.98) and 0.69 (95% CI: 0.66-0.72) for 68Ga-FAPI and 18F-FDG, with pooled SPE values of 0.86 (95% CI: 0.82-0.89) and 0.64 (95% CI: 0.59-0.68), respectively.
    CONCLUSIONS: This meta-analysis concluded that 68Ga-FAPI PET/CT was significantly more sensitive than 18F-FDG PET/CT in assessing primary gastric tumors, lymph nodes, and distant metastases, but the difference in the specificity of lymph node metastasis was not significant.
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  • 文章类型: Review
    Rosai-Dorfman病(RDD)是一种罕见的非朗格汉斯细胞组织细胞增生症,其特征是巨大的淋巴结病和系统性结外病变。我们介绍了一名28岁女性的病例,她的右眼复发性视力模糊3个月。在演讲前十年,她的左眼出现了失明和萎缩。她随后出现头痛,发烧,和精神状态受损。头颅磁共振成像提示肥厚性硬脑膜炎(HP),和18F-氟-2-脱氧-2-d-葡萄糖(FDG)正电子发射断层扫描/计算机断层扫描显示,左侧硬脑膜吸收了大量FDG。自身免疫测试显示抗核反应升高,反SS-A,和抗SS-B抗体水平。萎缩性眼球的切开活检显示RDD具有明显的多克隆浆细胞增多症。患者被诊断为RDD并伴有多系统受累,包括干燥综合征(SS),全葡萄膜炎,和HP。用甲基强的松龙治疗数周导致显著改善。这是首例报告的RDD,伴有SS并伴有全葡萄膜炎和HP。尽管RDD很少在年轻患者中被诊断出,跨学科合作对于防止延迟诊断至关重要。
    Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis characterized by massive lymphadenopathy and systemic extranodal lesions. We present the case of a 28-year-old woman who presented with recurrent blurred vision in her right eye for 3 months. She developed blindness and atrophy in her left eye a decade prior to presentation. She subsequently developed headache, fever, and impaired mental status. Cranial magnetic resonance imaging indicated hypertrophic pachymeningitis (HP), and 18F-fluoro-2-deoxy-2-d-glucose (FDG) positron emission tomography/computed tomography revealed significant FDG uptake in the left dura mater. Autoimmune testing revealed elevated anti-nuclear, anti-SS-A, and anti-SS-B antibody levels. Incisional biopsy of the atrophic eyeball revealed RDD with marked polyclonal plasmacytosis. The patient was diagnosed with RDD accompanied by multisystem involvement, including Sjögren\'s syndrome (SS), panuveitis, and HP. Treatment with methylprednisolone for several weeks resulted in significant improvement. This is the first reported case of RDD presenting with SS in combination with panuveitis and HP. Although RDD is rarely diagnosed in young patients, interdisciplinary collaboration is essential to prevent a delayed diagnosis.
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  • 文章类型: Meta-Analysis
    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。
    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.
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