目的:探讨多模态MRI联合PET代谢参数在颞叶癫痫(TLE)双病理(DP)诊断中的应用价值及对术后预后的预测作用。
方法:我们回顾性回顾了2016年1月至2021年12月在我们医院接受手术的50例TLE-DP患者,并收集了人口统计学,临床特征,视频脑电图(v-EEG),神经影像学,和手术数据。在至少12个月的定期随访期间收集癫痫发作结果数据,并使用Engel评分进行分级。Fisher精确检验用于比较各种诊断方式的DP检出率的差异。进行单因素和多因素分析以探讨预测手术后癫痫发作结果的预后因素。
结果:在50名患者中,20是男性。中位年龄为30岁,首次发作的中位年龄为14岁,中位持续时间为10年。基于体素的形态计量学-PET统计参数标测-PET/MRI(VBM-PSPM-PET/MRI)检出率最高,其次是PET/MRI,VBM分析,和PET-SPM。无论随访时间如何,v-EEG,PET,图像后处理方法,在Kaplan-Meier分析中使用对数秩检验,VBM-PSPM-PET/MRI与癫痫发作结果具有统计学相关性。多因素分析显示VBM-PSPM-PET/MRI是TLE-DP的独立预测因子(风险比(HR)=15.674,95%CI=0.002~0.122,P<0.001)。
结论:我们的研究表明,VBM-PSPM-PET/MRI在TLE-DP患者中具有最高的检测价值,并且可以为接受手术的患者提供独立的预后信息。这种方法在选择接受手术治疗的患者的候选人和进行预后分层方面具有最大的潜力。
OBJECTIVE: To investigate the application value of multimodal MRI combined with PET metabolic parameters in detecting temporal lobe epilepsy (TLE) with dual pathology (DP) and the prediction effect of post-surgical outcomes in these patients.
METHODS: We retrospectively reviewed 50 patients with TLE-DP who underwent surgery at our hospital between January 2016 and December 2021 and collected the demographics, clinical characteristics, video-electroencephalography (v-EEG), neuroimaging, and surgical data. Seizure outcome data were collected during a regular follow-up of at least 12 months and were graded using Engel scores. Fisher\'s exact test was used to compare the differences in DP detection rates of various diagnostic modalities. Univariate and multivariate analyses were performed to explore the prognostic factors for predicting seizure outcomes post-surgery.
RESULTS: Of the 50 patients, 20 were males. The median age was 30, the median age at first seizure was 14, and the median duration was ten years. Voxel-based morphometry-PET statistical parametric mapping-PET/MRI (VBM-PSPM-PET/MRI) had the highest detection rate, followed by PET/MRI, VBM analysis, and PET-SPM. Regardless of follow-up duration, v-EEG, PET, image post-processing methods, and VBM-PSPM-PET/MRI statistically correlated with seizure outcomes using the log-rank test in the Kaplan-Meier analysis. Multivariate analysis showed that VBM-PSPM-PET/MRI was an independent predictor of TLE-DP (hazard ratio (HR) = 15.674, 95 % CI = 0.002-0.122, P < 0.00 1).
CONCLUSIONS: Our study illustrates that VBM-PSPM-PET/MRI has the highest detection value in patients with TLE-DP and can provide independent prognostic information for patients who undergo surgery. This approach has the most substantial potential for the selection of candidates for patients who undergo surgical treatment and for prognostic stratification.