Value of 18F-FDG PET with Cortex ID Analysis in the Localization of Epileptic Foci Caused by Focal Cortical Dysplasia

doi:10.12114/j.issn.1007-9572.2018.00.317

Abstract

Abstract: Background　Focal cortical dysplasia（FCD）frequently is associated with medically intractable epilepsy，surgical resection of epileptogenic foci is the main treatment method，and its efficacy and long-term prognosis are closely related to the accurate localization of epileptogenic foci.PET brain imaging plays an important role in the localization of epileptogenic focus.However，PET brain imaging in tradition relied on visual analysis，which was greatly influenced by subjective factors of physicians.Objective　To evaluate the clinical value of 18F-FDG PET with Cortex ID analysis for the preoperative localization of epileptic FCD．Methods　From Hebei General Hospital，34 cases of focal epilepsy were enrolled in this retrospective study from February 2013 to June 2017.All of them received surgical treatment，and postoperative pathological examination detected that the cause of focal epilepsy was FCD.All of the cases underwent 18F-FDG interictal brain PET imaging before surgery.Both visual analysis and Cortex ID analysis were used to analyze the PET images，and the accuracies of imaging results analyzed by these two methods were evaluated by comparing with the findings of postoperative pathological examination.Results　All the cases were found with a total of 41 FCD-induced epileptic foci by pathological examination，but with 29，34 by visual analysis and Cortex ID analysis of the 18F-FDG PET images，respectively.The accuracy of visual analysis and Cortex ID analysis of the images was 70.7%（29/41），82.9%（34/41），respectively，showed no significant difference（χ2=0.191，P=0.295），and demonstrating a fair diagnostic consistency（Kappa=0.396，P=0.007）．Conclusion　The rates of detection of FCD-induced epileptic foci by 18F-FDG PET with visual analysis and Cortex ID analysis were not significantly different and showing a fair consistency in the diagnostic results.Cortex ID analysis method has good repeatability and little subjective influence.

Key words: Epilepsy, Positron-emission tomography and computed tomography, Focal cortical dysplasia, Epileptic focus, Brain glucose metabolism, Cortex ID

摘要： 背景　局灶性脑皮质发育不良（FCD）的治疗主要依靠外科切除致痫灶，其疗效及远期预后与致痫灶的准确定位密切相关。正电子发射断层扫描（PET）脑显像在致痫灶定位诊断中具有优势。既往采用PET脑显像依靠视觉分析法进行诊断，受医师主观因素影响大。目的　探讨Cortex ID分析法用于18F-脱氧葡萄糖（FDG）PET脑显像术前定位FCD致痫灶的临床应用价值。方法　回顾性分析2013年2月—2017年6月就诊于河北省人民医院并行手术治疗的局灶性癫痫患者34例，经术后病理检查证实为FCD所致癫痫。术前均行发作间期18F-FDG PET脑显像，分别采用视觉分析法和Cortex ID分析法进行术前致痫灶定位，以术后病理检查结果为金标准，比较两种方法对FCD致痫灶的诊断价值。结果　34例FCD患者依据金标准证实有41个FCD致痫灶，视觉分析法对FCD致痫灶的检出率为70.7%（29/41），Cortex ID分析法对FCD致痫灶的检出率为82.9%（34/41）；两种方法对FCD致痫灶的检出率比较，差异无统计学意义（χ2=0.191，P=0.295）。两种方法对FCD致痫灶的诊断具有一致性（Kappa=0.396，P=0.007）。结论　Cortex ID分析法与视觉分析法对FCD致痫灶检出率无显著差异，两种方法诊断FCD致痫灶一致性一般。Cortex ID分析法重复性好，受主观影响小。

关键词: 癫痫, 正电子发射断层扫描及电脑断层扫描, 局灶性脑皮质发育不良, 致痫灶, 脑葡萄糖代谢, Cortex ID

WEI Qiang,CHENG Jie,TIAN Congna, et al. Value of 18F-FDG PET with Cortex ID Analysis in the Localization of Epileptic Foci Caused by Focal Cortical Dysplasia　[J]. Chinese General Practice, 2019, 22(3): 341-346. DOI: 10.12114/j.issn.1007-9572.2018.00.317.
魏强,程洁,田丛娜等. Cortex ID分析法用于18F-FDG PET脑显像术前定位局灶性脑皮质发育不良致痫灶的临床价值分析[J]. 中国全科医学, 2019, 22(3): 341-346. DOI: 10.12114/j.issn.1007-9572.2018.00.317.

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