urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.25694/URMJ.2019.03.17urmj-505Research ArticleПСИХИАТРИЯПЭт/кт с 18F-FDG в уточняющей диагностике эпилепсииUtility of 18F-FDG PET/CT in the diagnostics of EpilepsyАретинскийАлександр ВитальевичAretinskiyA. V.are-tinskyi@gmail.comЖиляковА. В.ZhilyakovA. V.noemail@neicon.ruАретинскийВ. Б.AretinskiyV. B.noemail@neicon.ruШершеверА. С.ShersheverA. S.noemail@neicon.ruИсуповА. Б.IsupovA. B.noemail@neicon.ruШориковЕ. В.ShorikovE. V.noemail@neicon.ruЦентр ядерной медицины ООО «ПЭТ-Технолоджи»Russian Federation«Областной специализированный центр медицинской реабилитации “Озеро Чусовское”»Russian FederationФГБОУ ВО «Уральский государственный медицинский университет» Минздрава РоссииRussian Federation201914042021032529Copyright © Аретинский А.В., Жиляков А.В., Аретинский В.Б., Шершевер А.С., Исупов А.Б., Шориков Е.В., 20212021Аретинский А.В., Жиляков А.В., Аретинский В.Б., Шершевер А.С., Исупов А.Б., Шориков Е.В.Aretinskiy A.V., Zhilyakov A.V., Aretinskiy V.B., Shershever A.S., Isupov A.B., Shorikov E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/505

Определение локализации эпилептогенных очагов при диагностике эпилепсии является важным шагом, направленным на выбор тактики и улучшение результатов лечения. В настоящее время для диагностики эпилепсии чаще всего применяется ЭЭГ (электроэнцефа-лография), магнитно-резонансная томография (МРТ) и, в меньшей степени, однофотонная эмиссионная компьютерная томография (ОФЭКТ). Чувствительность экстракраниальной ЭЭГ не превышает 56%, а при внутрикраниальном ЭЭГ высок риск осложнений. Несмотря на то что диагностическая ценность МРТ достаточно высока, у ряда пациентов (в особенности с фармакорезистентной эпилепсией) не удается выявить морфологические изменения. Одним из наиболее перспективных методов на сегодняшний день является диагностика с помощью позитронной эмиссионной томографии, совмещенной с компьютерной томогра-фией (ПЭТ/КТ), с использованием 18-фтордезоксиглюкозы (18F-FDG) в качестве радиотрей-сера. В данной статье систематизирован обзор литературы по данной проблеме за последние годы. Приводятся данные об информативности и диагностической ценности ПЭТ/КТ с 18F-FDG у пациентов с эпилепсией.

Detecting the localization of epileptogenic focuses (seizure lateralization) in cases of epilepsy is an important diagnostic step aimed at choosing tactics and improving treatment outcomes. Currently, EEG (electroencephalography), magnetic resonance imaging (MRI) and, to a lesser extent, single photon emission computed tomography (SPECT) are most commonly used to diagnose epilepsy. The sensitivity of extracranial EEG does not exceed 56%, while at intracranial EEG the risk of complica-tions is high. Despite the fact that the diagnostic value of MRI is quite high, in a number of patients (especially with pharmacoresistant epilepsy), it is not possible to detect morphological changes. One of the most promising methods today is diagnostics using positron emission tomography, combined with computed tomography (PET/CT), using 18-fluorodeoxyglucose (18F-FDG) as a radiotracer. This article is a review of the literature on this issue in recent years. Data on informativity and diag-nostic value of PET / CT with 18F-FDG in patients with epilepsy are presented.

эпилепсияпозитронно эмиссионная томографиясовмещенная с компьютерной томографией18-фтордезоксиглюкозамагнитно-резонансная томография (МРТ)электроэнцефалография (ЭЭГ)epilepsypositron emission tomography/computed tomography18F-fluoro-2-deoxy-D-glucosemagnetic resonance imaging (MRI)electroencephalography (EEG)ReferencesMarina Hodolic, Raffi Topakian, Robert Pichler. 18F-fluorodeoxyglucose and 18F-flumazenil positron emission tomography in patients with refractory epilepsy. Radiology and Oncology. Volume 50, Issue 3. 2016; 247-253Marina Hodolic, Raffi Topakian, Robert Pichler. 18F-fluorodeoxyglucose and 18F-flumazenil positron emission tomography in patients with refractory epilepsy. Radiology and Oncology. Volume 50, Issue 3. 2016; 247-253Ismet Sarikaya. PET studies in epilepsy. Am J Nucl Med Mol Imaging. 2015; 5(5): 416-430Ismet Sarikaya. PET studies in epilepsy. Am J Nucl Med Mol Imaging. 2015; 5(5): 416-430Devous MD Sr, Thisted RA, Morgan GF, Leroy RF, Rowe CC. SPECT brain imaging in epilepsy: a metaanalysis. J Nucl Med. 1999; 285-293Devous MD Sr, Thisted RA, Morgan GF, Leroy RF, Rowe CC. SPECT brain imaging in epilepsy: a metaanalysis. J Nucl Med. 1999; 285-293Аретинский А.В., Терновой С.К. ПЭТ/КТ с 18F-FDG в уточняющей диагностике рака тела матки. REJR 2018; 8(3): 20-29.Аретинский А.В., Терновой С.К. ПЭТ/КТ с 18F-FDG в уточняющей диагностике рака тела матки. REJR 2018; 8(3): 20-29.Society of Nuclear Medicine Procedure Guideline for FDG PET Brain Imaging Version 1.0. approved February 8, 2009; 1-11.Society of Nuclear Medicine Procedure Guideline for FDG PET Brain Imaging Version 1.0. approved February 8, 2009; 1-11.Franck Semah, Gregory Petyt. Clinical applications of PET/CT in neurology. Principles and Practice of PET/ CT. 2017; 159-161Franck Semah, Gregory Petyt. Clinical applications of PET/CT in neurology. Principles and Practice of PET/ CT. 2017; 159-161Stanescu L, Ishak GE, Khanna PC, Biyyam DR, Shaw DW, Parisi MT. FDG PET of the brain in pediatric patients: imaging spectrum with MR imaging correlation. Radiographics. 2013;1279-1303Stanescu L, Ishak GE, Khanna PC, Biyyam DR, Shaw DW, Parisi MT. FDG PET of the brain in pediatric patients: imaging spectrum with MR imaging correlation. Radiographics. 2013;1279-1303Chugani HT, Phelps ME. Imaging human brain development with positron emission tomography. J Nucl Med. 1991;23-26Chugani HT, Phelps ME. Imaging human brain development with positron emission tomography. J Nucl Med. 1991;23-26Herholz K, Salmon E, Perani D, Baron JC, Holthoff V, Frölich L, et al. Discrimination between Alzheimer dementia and controls by automated analysis of multicenter FDG PET. Neuroimage. 2002; 302-316Herholz K, Salmon E, Perani D, Baron JC, Holthoff V, Frölich L, et al. Discrimination between Alzheimer dementia and controls by automated analysis of multicenter FDG PET. Neuroimage. 2002; 302-316Won HJ, Chang KH, Cheon JE, Kim HD, Lee DS, Han MH, et al. Comparison of MR imaging with PET and ictal SPECT in 118 patients with intractable epilepsy. AJNR Am J Neuroradiol. 1999; 593-599Won HJ, Chang KH, Cheon JE, Kim HD, Lee DS, Han MH, et al. Comparison of MR imaging with PET and ictal SPECT in 118 patients with intractable epilepsy. AJNR Am J Neuroradiol. 1999; 593-599Kim YK, Lee DS, Lee SK, Chung CK, Chung JK, Lee MC. (18)F-FDG PET in localization of frontal lobe epilepsy: comparison of visual and SPM analysis. J Nucl Med. 2002; 1167-74Kim YK, Lee DS, Lee SK, Chung CK, Chung JK, Lee MC. (18)F-FDG PET in localization of frontal lobe epilepsy: comparison of visual and SPM analysis. J Nucl Med. 2002; 1167-74Gok B, Jallo G, Hayeri R, Wahl R, Aygun N. The evaluation of FDG-PET imaging for epileptogenic focus localization in patients with MRI positive and MRI negative temporal lobe epilepsy. Neuroradiology. 2013; 541-50Gok B, Jallo G, Hayeri R, Wahl R, Aygun N. The evaluation of FDG-PET imaging for epileptogenic focus localization in patients with MRI positive and MRI negative temporal lobe epilepsy. Neuroradiology. 2013; 541-50Rathore C, Dickson JC, Teotonio R, Ell P, Duncan JS. The utility of 18F-fluorodeoxyglucose PET (FDG PET) in epilepsy surgery. Epilepsy Res. 2014;1306-1314Rathore C, Dickson JC, Teotonio R, Ell P, Duncan JS. The utility of 18F-fluorodeoxyglucose PET (FDG PET) in epilepsy surgery. Epilepsy Res. 2014;1306-1314Da Silva EA, Chugani DC, Muzik O, Chugani HT. Identification of frontal lobe epileptic foci in children using positron emission tomography. Epilepsia. 1997,2006; 1198-1208Da Silva EA, Chugani DC, Muzik O, Chugani HT. Identification of frontal lobe epileptic foci in children using positron emission tomography. Epilepsia. 1997,2006; 1198-1208Buch K, Blumenfeld H, Spencer S, Novotny E, Zubal IG. Evaluating the accuracy of perfusion/metabolism (SPET/PET) ratio in seizure localization. Eur J Nucl Med Mol Imaging. 2008; 579-588Buch K, Blumenfeld H, Spencer S, Novotny E, Zubal IG. Evaluating the accuracy of perfusion/metabolism (SPET/PET) ratio in seizure localization. Eur J Nucl Med Mol Imaging. 2008; 579-588Hassan Kassema, Fahd El Shiekhb, Ahmed Wafaiec, Sherif Abdelfattahc, Hussein Farghalyd, Lamia Afifie. Presurgical evaluation of refractory temporal lobe epilepsy: Comparison of MR imaging, PET and ictal SPECT in localization of the epileptogenic substrate. The Egyptian Journal of Radiology and Nuclear Medicine Volume 44, Issue 3, 2013; 641-649Hassan Kassema, Fahd El Shiekhb, Ahmed Wafaiec, Sherif Abdelfattahc, Hussein Farghalyd, Lamia Afifie. Presurgical evaluation of refractory temporal lobe epilepsy: Comparison of MR imaging, PET and ictal SPECT in localization of the epileptogenic substrate. The Egyptian Journal of Radiology and Nuclear Medicine Volume 44, Issue 3, 2013; 641-649Masaki Iwasaki, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga. Non-invasive Evaluation for Epilepsy Surgery. Neurol Med Chir (Tokyo). 2016; 632-640Masaki Iwasaki, Kazutaka Jin, Nobukazu Nakasato, Teiji Tominaga. Non-invasive Evaluation for Epilepsy Surgery. Neurol Med Chir (Tokyo). 2016; 632-640Gokdemir S1, Halac M, Albayram S, Oz B, Yeni N, Uzan M, Ozkara C. Contribution of FDG-PET in epilepsy surgery: consistency and postoperative results compared with magnetic resonance imaging and electroencephalography. Turk Neurosurg. 2015; 53-57Gokdemir S1, Halac M, Albayram S, Oz B, Yeni N, Uzan M, Ozkara C. Contribution of FDG-PET in epilepsy surgery: consistency and postoperative results compared with magnetic resonance imaging and electroencephalography. Turk Neurosurg. 2015; 53-57Willmann O, Wennberg R, May T, Woermann FG, Pohlmann-Eden B. The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy A meta-analysis. Seizure. 2007; 509-520Willmann O, Wennberg R, May T, Woermann FG, Pohlmann-Eden B. The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy A meta-analysis. Seizure. 2007; 509-520Leiderman DB, Albert P, Balish M, Bromfield E, Theodore WH. The dynamics of metabolic change following seizures as measured by positron emission tomography with fludeoxyglucose F 18. Arch Neurol. 1994; 932-936Leiderman DB, Albert P, Balish M, Bromfield E, Theodore WH. The dynamics of metabolic change following seizures as measured by positron emission tomography with fludeoxyglucose F 18. Arch Neurol. 1994; 932-936Choi JY, Kim SJ, Hong SB, Seo DW, Hong SC, Kim BT, et al. Extratemporal hypometabolism on FDG PET in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy. Eur J Nucl Med Mol Imaging. 2003; 581-587Choi JY, Kim SJ, Hong SB, Seo DW, Hong SC, Kim BT, et al. Extratemporal hypometabolism on FDG PET in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy. Eur J Nucl Med Mol Imaging. 2003; 581-587

The authors declare that there are no conflicts of interest present.