Brain 18F-fluorodeoxyglucose positron emission tomography: An efficient tool at the initial diagnosis of nonlesional late onset epilepsy

IF 6.6 1区医学 Q1 CLINICAL NEUROLOGY Epilepsia Pub Date : 2025-02-26 DOI:10.1111/epi.18328

Salomé Puisieux, Sébastien Heyer, Natacha Forthoffer, Matthieu Doyen, Louise Tyvaert, Antoine Verger

{"title":"Brain 18F-fluorodeoxyglucose positron emission tomography: An efficient tool at the initial diagnosis of nonlesional late onset epilepsy","authors":"Salomé Puisieux, Sébastien Heyer, Natacha Forthoffer, Matthieu Doyen, Louise Tyvaert, Antoine Verger","doi":"10.1111/epi.18328","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>This study evaluates the diagnostic performance and prognostic value of brain <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG) positron emission tomography (PET) at the initial diagnosis of patients with nonlesional late onset epilepsy (NLLOE).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In this cohort study at the University Hospital of Nancy, France, newly diagnosed NLLOE patients, >50 years old, were consecutively included from June 2017 to January 2021 and systematically underwent brain <sup>18</sup>F-FDG PET. They were categorized into four presumed etiological NLLOE subtypes: neurodegenerative subtype (NDS; patients with a diagnosis of neurodegenerative disease), microvascular subtype (MVS; patients with ≥3 cardiovascular risk factors and ≥2 vascular lesions on magnetic resonance imaging), inflammatory subtype (IFS; patients meeting international criteria for encephalitis), and unlabeled subtype (ULS). A systematic patient follow-up (at least 2 years) allowed assessment of cognitive outcomes under antiseizure medication by comparing for each patient the proportion of preserved/altered scores between initial and second neuropsychological assessment. Brain <sup>18</sup>F-FDG PET was analyzed using a combined visual and semiquantitative approach at the individual level.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Eighty-seven patients were included (NDS, <i>n</i> = 18; MVS, <i>n</i> = 22; IFS, <i>n</i> = 7; ULS, <i>n</i> = 40). A normal <sup>18</sup>F-FDG PET was observed in 46% of patients, with the final diagnosis of 88% of these patients excluding a neurodegenerative or inflammatory disorder. <sup>18</sup>F-FDG PET had a negative predictive value of 94% for a cognitive decline at follow-up, similar for the overall population (<i>n</i> = 71) and the ULS population (<i>n</i> = 32). Moreover, a PET hypometabolic pattern suggestive of a neurodegenerative disorder was indicative of cognitive decline at follow-up in 74% of cases.</p>\n </section>\n \n <section>\n \n <h3> Significance</h3>\n \n <p><sup>18</sup>F-FDG PET as part of the initial diagnosis of NLLOE patients may have a significant impact on both NLLOE diagnosis and cognitive prognosis. For almost half of NLLOE patients, a normal <sup>18</sup>F-FDG PET could help to exclude neurodegenerative and inflammatory epilepsy etiologies as well as future cognitive decline.</p>\n </section>\n </div>","PeriodicalId":11768,"journal":{"name":"Epilepsia","volume":"66 6","pages":"2066-2078"},"PeriodicalIF":6.6000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/epi.18328","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Epilepsia","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/epi.18328","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

This study evaluates the diagnostic performance and prognostic value of brain ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) at the initial diagnosis of patients with nonlesional late onset epilepsy (NLLOE).

Methods

In this cohort study at the University Hospital of Nancy, France, newly diagnosed NLLOE patients, >50 years old, were consecutively included from June 2017 to January 2021 and systematically underwent brain ¹⁸F-FDG PET. They were categorized into four presumed etiological NLLOE subtypes: neurodegenerative subtype (NDS; patients with a diagnosis of neurodegenerative disease), microvascular subtype (MVS; patients with ≥3 cardiovascular risk factors and ≥2 vascular lesions on magnetic resonance imaging), inflammatory subtype (IFS; patients meeting international criteria for encephalitis), and unlabeled subtype (ULS). A systematic patient follow-up (at least 2 years) allowed assessment of cognitive outcomes under antiseizure medication by comparing for each patient the proportion of preserved/altered scores between initial and second neuropsychological assessment. Brain ¹⁸F-FDG PET was analyzed using a combined visual and semiquantitative approach at the individual level.

Results

Eighty-seven patients were included (NDS, n = 18; MVS, n = 22; IFS, n = 7; ULS, n = 40). A normal ¹⁸F-FDG PET was observed in 46% of patients, with the final diagnosis of 88% of these patients excluding a neurodegenerative or inflammatory disorder. ¹⁸F-FDG PET had a negative predictive value of 94% for a cognitive decline at follow-up, similar for the overall population (n = 71) and the ULS population (n = 32). Moreover, a PET hypometabolic pattern suggestive of a neurodegenerative disorder was indicative of cognitive decline at follow-up in 74% of cases.

Significance

¹⁸F-FDG PET as part of the initial diagnosis of NLLOE patients may have a significant impact on both NLLOE diagnosis and cognitive prognosis. For almost half of NLLOE patients, a normal ¹⁸F-FDG PET could help to exclude neurodegenerative and inflammatory epilepsy etiologies as well as future cognitive decline.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

脑18f -氟脱氧葡萄糖正电子发射断层扫描：一个有效的工具，在非病变性晚发性癫痫的初步诊断。

目的：探讨脑18f -氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）在非病变性晚发型癫痫（NLLOE）患者初诊断中的诊断价值。方法：在法国南希大学医院的队列研究中，于2017年6月至2021年1月连续纳入新诊断的NLLOE患者，年龄50岁，并系统地进行了脑部18F-FDG PET检查。他们被分为四种假定的病因性NLLOE亚型：神经退行性亚型(NDS；诊断为神经退行性疾病的患者)，微血管亚型(MVS；磁共振成像显示心血管危险因素≥3个，血管病变≥2个)，炎症亚型(IFS；符合脑炎国际标准的患者)和未标记亚型（ULS）。系统的患者随访（至少2年）通过比较每个患者在初次和第二次神经心理学评估中保留/改变评分的比例来评估抗癫痫药物治疗下的认知结果。脑18F-FDG PET在个体水平上采用视觉和半定量相结合的方法进行分析。结果：纳入87例患者(NDS, n = 18；MVS, n = 22；IFS, n = 7；ULS, n = 40)。46%的患者18F-FDG PET正常，88%的患者最终诊断排除了神经退行性或炎症性疾病。18F-FDG PET对随访时认知能力下降的阴性预测值为94%，对总体人群（n = 71）和ULS人群（n = 32）的预测相似。此外，在随访中，提示神经退行性疾病的PET低代谢模式表明74%的病例认知能力下降。意义：18F-FDG PET作为NLLOE患者初始诊断的一部分，可能对NLLOE的诊断和认知预后都有显著影响。对于几乎一半的NLLOE患者，正常的18F-FDG PET可以帮助排除神经退行性和炎症性癫痫病因以及未来的认知能力下降。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Epilepsia 医学-临床神经学

CiteScore

10.90

自引率

10.70%

发文量

319

审稿时长

2-4 weeks

期刊介绍： Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.