基于一体化PET-MRI动态局部一致性及葡萄糖代谢预测MRI阴性难治性颞叶癫痫患者手术预后  

Prediction of surgical outcomes in MRI-negative refractory temporal lobe epilepsy patients using integrated PET-MRI dynamic regional homogeneity and glucose metabolism

作　　者：胡杰[1] 王静娟 王振明 崔碧霄[1] 许潇尹 杨宏伟 卢洁[1] Hu Jie;Wang Jingjuan;Wang Zhenming;Cui Bixiao;Xu Xiaoyin;Yang Hongwei;Lu Jie(Department of Radiology and Nuclear Medicine,Xuanwu Hospital,Capital Medical University,Beijing Key Laboratory of MRI and Brain Informatics,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院放射与核医学科、磁共振成像脑信息学北京市重点实验室,北京100053

出　　处：《中华放射学杂志》2025年第2期160-167,共8页Chinese Journal of Radiology

基　　金：国家重点研发计划(2022YFC2406900)。

摘　　要：目的:基于静息态PET-MRI探讨MRI阴性难治性颞叶癫痫(TLE)患者静息态局部一致性(ReHo)、动态局部一致性(dReHo)及葡萄糖代谢改变及其预测手术预后效能。方法:该研究为横断面研究。回顾性分析2016至2020年在首都医科大学宣武医院接受诊治的30例MRI阴性难治性TLE患者(病例组)和30名正常对照者(对照组)的临床和影像资料。所有MRI阴性难治性TLE患者接受手术治疗,并根据术后Engel分级分为预后良好亚组(EngelⅠ级,16例)及预后不良亚组(EngelⅡ~Ⅳ级,14例)。采用方差分析比较3组间静息态ReHo、dReHo、葡萄糖代谢(SUVR值)差异。采用Spearman相关分析差异脑区静息态ReHo、dReHo、SUVR值与Engel分级的相关性。基于差异脑区静息态ReHo、dReHo及葡萄糖代谢值,采用支持向量机对预后良好及预后不良患者进行分类预测,以受试者操作特征曲线和曲线下面积(AUC)分析预测效能。结果:MRI阴性难治性TLE患者预后良好亚组、预后不良亚组及对照组dReHo差异脑区位于右侧颞中回颞极、右侧梭状回、右侧岛盖部额下回、左侧楔叶、右内侧和旁扣带脑回、右侧顶上回;静态ReHo差异脑区主要位于双侧颞下回、顶上回及右侧额下回、左内侧额上回、左侧额中回、右侧缘上回;SUVR值差异显著脑区为患侧上、中、下颞叶,内嗅皮层及颞极区域。MRI阴性TLE患者的右侧颞中回颞极dReHo值与Engel分级呈正相关(r=0.421,P=0.020)。基于dReHo联合SUVR值的支持向量机模型分类预后良好、预后不良患者的AUC为0.825、准确度达73.3%。结论:MRI阴性难治性TLE患者dReHo异常区域主要位于病灶对侧默认模式网络区域,与Engel分级有关,结合葡萄糖代谢值,能够预测MRI阴性颞叶癫痫患者术后预后。Objective To investigate alterations in static regional homogeneity(ReHo)and dynamic regional homogeneity(dReHo)and glucose metabolism in MRI-negative refractory temporal lobe epilepsy(TLE)patients using resting-state PET-MRI,and to evaluate their efficacy in predicting surgical outcomes.Methods This study was a cross-sectional design.A retrospective analysis was conducted on the clinical and imaging data of 30 patients with MRI-negative refractory TLE(patient group)treated at Xuanwu Hospital,Capital Medical University,between 2016 and 2020,and data from 30 healthy controls(control group).All MRI-negative refractory TLE patients underwent surgical treatment and were further divided into a good prognosis subgroup(Engel Class I,16 cases)and a poor prognosis subgroup(Engel ClassⅡ-Ⅳ,14 cases)based on postoperative Engel classification.Analysis of variance was used to compare differences in static ReHo,dReHo,and glucose metabolism(SUVR)among the three groups.The correlation of static ReHo,dReHo,and SUVR values of differential brain regions with Engel grading was analyzed using Spearman.A support vector machine(SVM)model was constructed using the static ReHo,dReHo,and SUVR values from these differential regions to classify and predict patient prognosis.The predictive performance was evaluated using receiver operating characteristic curves and the area under the curve(AUC).Results Differential dReHo regions among the good prognosis subgroup,poor prognosis subgroup,and control group were located in the right lateral middle temporal gyrus temporal pole,the right fusiform gyrus,the right insula subfrontal gyrus,the left cuneate lobe,the right medial and paracortical cingulate gyrus,and the right supraparietal gyrus;the differential static ReHo regions were primarily found in the bilateral inferior temporal gyrus,the supraparietal gyrus,and the right subfrontal gyrus,the left medial supraparietal gyrus,the left median frontal gyrus,and the right marginal supraparietal gyrus;SUVR differences were in the affected superior

关 键 词：癫痫 颞叶 磁共振成像 正电子发射断层显像术 动态局部一致性 Engel分级 

分 类 号：R74[医药卫生—神经病学与精神病学]