Intertechnique Agreement in Epilepsy Imaging

Year 2019, Volume: 13 Issue: 4, 292 - 301, 30.07.2019

Altan Güneş Dilek Yalnızoğlu Ceren Günbey Bilge Volkan Salancı Figen Söylemezoğlu Burçak Biginer Eser Lay Ergün Güzide Turanlı Belkıs Erbaş Meral Topçu Serap Saygı Kader Karli Oğuz

https://doi.org/10.12956/tchd.541114

Abstract

Aim:To
analyze seizure semiology,
scalp video-electroencephalography,magnetic resonance imaging (MRI) and
18F-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) findings in
patients with medically refractory epilepsy,to assess the concordance rate (CR)
between clinical-electroencephalography findings (CEF) and neuroimaging studies
(NS) for localizing epileptogenic foci.

Material
and methods:This retrospective study included
108 consecutive patients (male/female=59/49;mean age=26.6±10.5 years) who were
classified according to CEF (either temporal or extra-temporal lobe epilepsy
[TLE]) between January 2011 and January 2017.Statistical analysis was performed
using a t, Mann-Whitney U, McNemar,
or χ² tests.

Results:Fifty-six patients had TLE (M/F=30/26,mean
age=30.1±8.9 years) and 52 had extra-TLE (M/F=29/23,mean age=22.8±10.9 years) according
to CEF.12/108 patients (M/F=6/6,mean age=28.7±10.2 years) underwent epilepsy
surgery and the mean postoperative follow-up period was 32 months.The
highest CR between CEF and NS (76%) was found in patients with non-hippocampal
sclerosis abnormality in TLE group.In patients with malformations of cortical
development on MRI,the CR (84.2%)
between CEF and MRI was better than those between CEF and FDG-PET (52.6%) (P=0.010).The
CR between CEF and NS for TLE (48.2%) was better than for extra-TLE (9.6%) (P<0.001).No
significant difference was found in the localization of the epileptogenic focus
between MRI and FDG-PET according to the seizure outcome of patients (P=1).

Conclusions:FDG-PET
may not help in revealing epileptic region in cases with abnormal MRI
especially in malformations of cortical development.The highest CR between CEF
and NS is found in TLE patients with findings inconclusive of hippocampal
sclerosis.With low CR between CEF and NS in extra-TLE,meticulous use of
multiple modalities is necessary for accurate pre-surgical evaluation.

Keywords

Medically refractory epilepsy, Magnetic resonance imaging

Epilepsi görüntülemesinde Modaliteler Arası Uyum

Abstract

Amaç: Medikal tedaviye
dirençli epilepsi hastalarında nöbet semiyolojisi, skalp-video elektroensefalografi,
manyetik rezonans görüntülüme (MRG) ve 18-floro-2-deoksi-glukoz
pozitron emisyon tomografi (FDG-PET) bulgularının değerlendirilmesi,
epileptojenik odağı lokalize etmede klinik-elektroensefalografi bulguları ile nörogörüntüleme
yöntemleri arasındaki uyumun değerlendirilmesi amaçlandı.

Gereç ve Yöntemler: Retrospektif olan çalışmamız
hastane etik kuru onayı alınarak yapıldı. Çalışmaya, Ocak 2011 ile Ocak 2017
tarihleri arasında, klinik-elektroensefalografi
bulgularına göre temporal (30 erkek, 26 kız, ortalama yaş 30,1±8,9 yıl) ve
ekstra-temporal lob epilepsi (29 erkek, 23 kız, ortalama yaş 22,8±10,9 yıl) gruplarına
ayrılan ardışık 108 hasta (59 erkek, 49 kız, ortalama yaş 26,6±10,5 yıl) dahil
edildi. Kategorik-sayısal değişkenler t, Mann-Whitney U, McNemar veya Ki-kare testi
ile analiz edildi.

Bulgular: Çalışmaya dahil edilen 108 hastanın 12’si (6 erkek, 6 kız, ortalama yaş 28,7±10,2 yıl) epilepsi
cerrahisi geçirdi ve bu hastaların operasyon sonrası ortalama takip süresi 32
aydı. Klinik-elektroensefalografi
bulguları ile nörogörüntüleme yöntemleri arasında en yüksek uyum (%76)
hippokampal skleroz dışı anormallikler sahip temporal lob epilepsili hastalarda
saptandı. MRG’de kortikal gelişimsel anormalliklere sahip hastalardaki, klinik-
elektroensefalografi bulguları ile MRG arasındaki uyum (%84,2), klinik-elektroensefalografi
bulguları ile FDG-PET arasındaki uyumdan (%52,6) yüksekti (p=0,010). Temporal lob
epilepsilerindeki klinik-elektroensefalografi
bulguları ile nörogörüntüleme yöntemleri arasındaki uyum (%48,2),
ekstra-temporal lob epilepsilerine (%9,6) göre daha yüksekti (p<0,001). Opere olan
hastaların takiplerine göre MRG ile FDG-PET arasında epileptojenik odağı
lokalize etmede anlamlı farklılık saptanmadı (p=1).

Sonuç: FDG-PET
epileptojenik odağın lokalize edilmesinde, özellikle MRG’de kortikal gelişimsel
anormalliklerin saptandığı hastalarda yardımcı olamayabilir. Klinik-elektroensefalografi
bulguları ile nörogörüntüleme yöntemleri arasındaki en yüksek uyum hippokampal
skleroz dışı anormalliklere sahip temporal lob epilepsili hastalarda saptandı. Ekstra-temporal
lob epilepsilerindeki klinik-elektroensefalografi bulguları ile
nörogörüntüleme yöntemleri arasındaki düşük uyum, ekstra-temporal lob
epilepsilerinin cerrahi öncesi değerlendirilmesinde, farklı
yöntemlerin kullanılmasını gerektirmektedir.

Keywords

Epilepsi, Manyetik rezonans görüntüleme

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