目的:通过磁共振成像(MRI)准确检测局灶性皮质发育不良(FCD)在癫痫的术前评估中起着关键作用。多模态成像的整合在诊断FCD和设计有效的手术策略方面都显示出重要的价值。这项研究旨在通过结合正电子发射断层扫描(PET)分析来增强MRI后处理。我们试图比较各种图像后处理方法在MRI阴性FCD患者中的诊断功效。
方法:在这项回顾性调查中,我们收集了一组术前MRI结果阴性的患者.对T1加权的体积序列进行形态分析程序(MAP)和复合参数图(CPM)后处理技术。我们独立地将来自各种方法的图像与PET扫描共配准。随后对对齐进行了评估,其相关性与术后癫痫发作结局相关。
结果:共有41名患者被纳入研究。在PET-MAP(p=0.0189)和PET-CPM(p=0.00041)组中,与非重叠组相比,重叠组与更好的术后结局显著相关.在PET中(p=0.234),CPM(p=0.686)和MAP(p=0.672),重叠结局和无癫痫结局之间无统计学意义.单独使用CPM的灵敏度优于MAP(0.65对0.46)。PET-CPM的使用表现出优异的灵敏度(0.96),阳性预测值(0.83),和阴性预测值(0.91),而MAP表现出优异的特异性(0.71)。
结论:我们的研究结果表明,与MAP相比,CPM在检测潜在FCD病变的敏感性方面具有优势,特别是当它与PET联合用于MRI阴性癫痫患者的诊断时。此外,我们证实了将代谢成像(PET)与来自结构成像(MAP或CPM)的定量图协同作用,可增强对细微癫痫发生区(EZs)的识别的优越性.这项研究有助于阐明综合多模式技术在提高我们查明癫痫病例中难以捉摸的病理特征的能力方面的潜力。
OBJECTIVE: Accurate detection of focal cortical dysplasia (FCD) through magnetic resonance imaging (MRI) plays a pivotal role in the preoperative assessment of epilepsy. The integration of multimodal imaging has demonstrated substantial value in both diagnosing FCD and devising effective surgical strategies. This study aimed to enhance MRI post-processing by incorporating positron emission tomography (PET) analysis. We sought to compare the diagnostic efficacy of diverse image post-processing methodologies in patients presenting MRI-negative FCD.
METHODS: In this retrospective investigation, we assembled a cohort of patients with negative preoperative MRI results. T1-weighted volumetric sequences were subjected to morphometric analysis program (MAP) and composite parametric map (CPM) post-processing techniques. We independently co-registered images derived from various methods with PET scans. The alignment was subsequently evaluated, and its correlation was correlated with postoperative seizure outcomes.
RESULTS: A total of 41 patients were enrolled in the study. In the PET-MAP(p = 0.0189) and PET-CPM(p = 0.00041) groups, compared with the non-overlap group, the overlap group significantly associated with better postoperative outcomes. In PET(p = 0.234), CPM(p = 0.686) and MAP(p = 0.672), there is no statistical significance between overlap and seizure-free outcomes. The sensitivity of using the CPM alone outperformed the MAP (0.65 vs 0.46). The use of PET-CPM demonstrated superior sensitivity (0.96), positive predictive value (0.83), and negative predictive value (0.91), whereas the MAP displayed superior specificity (0.71).
CONCLUSIONS: Our findings suggested a superiority in sensitivity of CPM in detecting potential FCD lesions compared to MAP, especially when it is used in combination with PET for diagnosis of MRI-negative epilepsy patients. Moreover, we confirmed the superiority of synergizing metabolic imaging (PET) with quantitative maps derived from structural imaging (MAP or CPM) to enhance the identification of subtle epileptogenic zones (EZs). This study serves to illuminate the potential of integrated multimodal techniques in advancing our capability to pinpoint elusive pathological features in epilepsy cases.