Epilepsi görüntülemesinde Modaliteler Arası Uyum

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 χ 2 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.