The Application Value Of ¹⁸F-FDG PET/CT Brain Metabolism Imaging In The Surgical Operation Of Refractory Epilepsy

Part ⅠThe value of 18F-FDG PET/CT brain Metabolism Imaging in preoperative localization of epileptic foci and operative decision-making in Refractory EpilepsyObjective:To explore the application value of ¹⁸F-FDG PET/CT brain metabolism imagingin preoperative localization of epileptic foci and surgical decision-making of refractory epilepsy.Methods:A total of 69 refractory epilepsy patients in our hospital from January 2010 to September 2016 were evaluated retrospectively.They all underwent ¹⁸F-FDG PET/CT to scan brain glucose metabolism.Regarding video electroencephalogram or intraoperative cortical electroencephalogram as gold standard,we evaluated the application value of ¹⁸F-FDG PET/CT of brain in preoperative localization of epileptic foci and surgical decision making of refractory epilepsy.On the other hand,we compared its application value in the surgical operation of refractory epilepsy with MRI.Results:Of the 69 patients,53manifested as positive in ¹⁸F-FDG PET/CT imaging while 16 were defined as negative.The positive lesions in ¹⁸F-FDG PET/CT were consistent with the epileptic foci which were localized by electroencephalogram in 48 patients and partial epileptogenic foci were detected in 3 patients.The concordance of¹⁸F-FDG PET/CT and electroencephalogram in localization of epileptic foci was 73.9%（51/69）.Of the 69 patients,43 were considered as positive in MRI,accurately localization of epileptogenic foci in 38 patients and partial epileptogenic foci were detected in 3 patients,and MRI findings were concordant 59.4%（51/69）with electroencephalogram.The concordance of ¹⁸F-FDG PET/CT and MRI was76.8%（53/69）.The difference was significant by chi 2 test for paired design when P=0.021﹤0.05,the difference is statistically significant.In Kappa consistency test,kappa was 0.466,according to the three-level classification proposed by Fleiss.Of the 53 patients which showed positive in ¹⁸F-FDG PET/CT imaging,46 have drawn up correct operation plan according to it,including 35 cases of surgical patients and11 case who were excluded from surgery.In the 48 cases showing positive MRI findings,43 have made correct surgery program which comprised of 30 patients eligible for surgery and 8 cases excluded from surgery.Combining the two imaging methods,there were 53 case defined as positive which manifested as positive in at least one of the two imaging and correct operation plans were made in 38 cases eligible for surgery and 15 cases excluded from surgery.Conclusions:Comparing with MRI,¹⁸F-FDG PET/CT of brain showed high consistency with electroencephalogram in localization of epileptic foci.Combination of the two imaging can not only improve the preoperative localization of epileptic foci but help clinician choose patients eligible for surgery and exclude those not eligible.Part ⅡThe relevance between the characteristics of ¹⁸F-FDG PET/CT brain metabolism imaging and the postoperative prognosis in intractable EpilepsyObjective:To summarize the correlation between imaging findings in ¹⁸F-FDG PET/CT of refractory epilepsy patients and their curative effect,so that we can select patients eligible for surgery and eliminate those not eligible and evaluate the postoperative efficacy.Methods:We retrospectively analyzed 53 refractory epilepsy patients who admitted to our hospital from January 2010 to December2015.They all manifested as positive in ¹⁸F-FDG PET/CT of brain and were treated with operation subsequently.These patients were divided into good postoperative efficacy group（32）and bad postoperative efficacy group（21）.Then we analyzed three influence factors including the distribution（Unilateral hemisphere of brain/Bilateral cerebral hemisphere）,the range and the location of lesions by logistic regression statistical analysis and summarized the correlation between imaging findings in ¹⁸F-FDG PET/CT of refractory epilepsy patients and their curative effect.Results:Univariate analysis showed that the distribution of lesions and the range of lesions in ¹⁸F-FDG PET/CT were statistically significant different while the location of lesions had no statistical difference.Further logistic regression analysis was made on the distribution of lesions and the range of lesions,the results showed that there was a strong correlation between the range of lesions and the postoperative efficacy but the distribution of lesions was not relevant to the curative effect.Conclusions:Focal lesions in ¹⁸F-FDG PET/CT was a positive factor for favorable postoperative efficacy and can provide patients with important consulting information on surgical decision making.