有效控制与控制不佳的MRI阴性的GTCS病人发作间期SPECT对照研究  

Control Study of Cerebral Perfusion in Effectively Treated and Incompletely Controlled Patients with Idiopathic Generalized Tonic Clonic Seizure

作　　者：侯敏侯敏 王开颜[2] 刘兴党[1] 朱汇庆[1] 

机构地区：[1]复旦大学附属华山医院核医学科 [2]复旦大学附属华山医院神经内科,200040

出　　处：《中国医学计算机成像杂志》2004年第6期413-416,共4页Chinese Computed Medical Imaging

摘　　要：目的利用单光子发射计算机断层摄影(SPECT)半定量分析有效控制与控制不良的MRI阴性的全面性强直阵挛发作癫(GTCS)病人的局部脑血流差异,探讨脑血流灌注与其预后的关系。材料和方法对29例有效控制的和12例控制不佳的MRI阴性的GTCS病人进行发作间期99mTc-ECD-SPECT脑血灌流显像,10例年龄匹配的健康人作对照,用感兴趣区(ROI)的不对称指数(%AI)进行半定量分析。将SPECT分析结果与病人的临床表现与EEG相比较。结果①控制不佳组与有效控制组在丘脑和基底节区的%AI存在显著性差异(P<0.05);②控制不佳组SPECT脑显像的异常率(83.3%,10/12)明显高于有效控制组的异常率(17.2%,5/29),两组具有显著性差异(P<0.01);而两组病人的EEG异常率分别为58.3%、44.8%(7/12、13/29),无显著性差异(P>0.05)。结论控制不佳的MRI阴性的GTCS病人往往存在发作间期的低血流灌注脑区,提示癫的难治性;而控制良好的病人多无明显异常发现,可能预后较好。Purpose:In order to explore the relation between epileptic patients’prognosis and their cerebral perˉfusion,we study the cerebral perfusion of both effectively treated and incompletely controlled patients with idiopathic generalized tonic clonic seizure(GTCS)by 99m Tc-ethyl cysteinates dimmer(ECD)SPECT.Materials and Methods:Interictal SPECT was performed on29effectively treated idiopathic GTCS patients and12incomplete controlled idiopathic GTCS patients.SPECT was semi-quantitatively analyzed using a region of interest analysis(ROI),and an asymmetry index(AI)was measured from the ratio of two symmetrical ROIs.The SPECT findings were compared with seizure frequency and EEG.Results:①rCBF decreased in basal ganglia and thalamus of incompletely controlled patients with idioˉpathic GTCS compared to that of effectively treated ones(P<0.05).②The abnormal rate of SPECT in incompletely controlled patients was higher than that of effectively treated ones(P<0.01),while there was no significant difference in EEG between two groups.Conclusion:Most incompletely controlled patients with GTCS can be found regional hypoperfusion in brain by SPECT,which may stand for reˉfractory to treatment by AEDs,while effectively treated ones usually have no abnormal finding,perhaps indicating a good prognosis.

关 键 词：全面性强直阵挛发作癫痫 脑血流灌注 有效控制 控制不佳 单光子发射计算机断层摄影 

分 类 号：R817.4[医药卫生—影像医学与核医学]