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Quantitative positron emission tomography-guided magnetic resonance imaging postprocessing in magnetic resonance imaging-negative epilepsies

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机构: [1]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China [2]Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA [3]Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan [4]Department of Nuclear Medicine, Cleveland Clinic, Cleveland, OH, USA [5]Imaging Institute, Cleveland Clinic, Cleveland, OH, USA [6]Department of Pathology, Cleveland Clinic, Cleveland, OH, USA [7]Department of Pediatric Neurology, Helsinki University Hospital, Helsinki, Finland [8]Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA [9]Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
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关键词: focal cortical dysplasia MRI postprocessing MRI-negative epilepsy presurgical evaluation quantitative positron emission tomography

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Objective: Detection of focal cortical dysplasia (FCD) is of paramount importance in epilepsy presurgical evaluation. Our study aims at utilizing quantitative positron emission tomography (QPET) analysis to complement magnetic resonance imaging (MRI) postprocessing by a morphometric analysis program (MAP) to facilitate automated identification of subtle FCD. Methods: We retrospectively included a consecutive cohort of surgical patients who had a negative preoperative MRI by radiology report. MAP was performed on T1-weighted volumetric sequence and QPET was performed on PET/computed tomographic data, both with comparison to scanner-specific normal databases. Concordance between MAP and QPET was assessed at a lobar level, and the significance of concordant QPET-MAP(+) abnormalities was confirmed by postresective seizure outcome and histopathology. QPET thresholds of standard deviations (SDs) of -1, -2, -3, and -4 were evaluated to identify the optimal threshold for QPET-MAP analysis. Results: A total of 104 patients were included. When QPET thresholds of SD = -1, -2, and -3 were used, complete resection of the QPET-MAP(+) region was significantly associated with seizure-free outcome when compared with the partial resection group (P = 0.023, P < 0.001, P = 0.006) or the no resection group (P = 0.002, P < 0.001, P = 0.001). The SD threshold of -2 showed the best combination of positive rate (55%), sensitivity (0.68), specificity (0.88), positive predictive value (0.88), and negative predictive value (0.69). Surgical pathology of the resected QPET-MAP(+) areas revealed mainly FCD type L Multiple QPETMAP(+) regions were present in 12% of the patients at SD = -2. Significance: Our study demonstrates a practical and effective approach to combine quantitative analyses of functional (QPET) and structural (MAP) imaging data to improve identification of subtle epileptic abnormalities. This approach can he readily adopted by epilepsy centers to improve postresective seizure outcomes for patients without apparent lesions on MRI.

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出版当年[2017]版:
大类 | 2 区 医学
小类 | 2 区 临床神经病学
最新[2023]版:
大类 | 1 区 医学
小类 | 2 区 临床神经病学
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出版当年[2016]版:
Q1 CLINICAL NEUROLOGY
最新[2023]版:
Q1 CLINICAL NEUROLOGY

影响因子: 最新[2023版] 最新五年平均 出版当年[2016版] 出版当年五年平均 出版前一年[2015版] 出版后一年[2017版]

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第一作者机构: [1]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China [2]Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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通讯机构: [*1]Cleveland Clinic Epilepsy Center, Cleveland, OH, USA.
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