PET脑显像在癫痫患者致痫灶定位中的价值  

PET cerebral imaging in focus localization of epilepsy

作　　者：秦杰[1] 孔令山[1] 谢明萱[1] 梁丽[1] 崔斌[1] 王剑超[2] 黄清海[2] 

机构地区：[1]第二军医大学长海医院PET中心,上海200433 [2]第二军医大学长海医院脑外科,上海200433

出　　处：《中国医学影像技术》2005年第7期1075-1077,共3页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨^(18)F-脱氧葡萄糖(^(18)F-FDG)正电子发射计算机断层(PET)脑显像在各类癫痫患者致痫灶定位中的价值。方法对65例癫痫患者于发作间期行^(18)F-FDG PET脑显像,将其定位结果与头皮脑电图(EEG)、CT或MRI结果进行比较,并对其中14例定位后接受手术或放射治疗患者的预后情况进行分析。结果65例患者中,56例(86%)患者发作间期PET图像上可见皮层局限性低代谢灶,4例(6%)可见皮层局限性高代谢灶,其余5例(8%)未见异常代谢灶。在PET图像呈典型低代谢表现的56例患者中,PET定位结果与EEG定侧(判定左右半球)或定位(判定具体脑叶)结果相符者40例(71%),EEG呈弥漫性异常者(无法定位)10例(18%),EEG检查未见异常者1例(2%),另5例(9%)PET定位结果与EEG定位结果不符。该56例患者中,44例(79%)CT或MRI检查阴性,12例(21%)CT或MRI检查阳性,后者中有11例PET定位结果与CT或MRI定位结果相符。明确致痫灶后接受手术或放射治疗的14例患者,平均随访2年,9例(64%)术后未再有癫痫发作或有不同程度的缓解。结论对于头皮EEG无法准确定位和CT、MRI检查阴性的癫痫患者,^(18)F-FDGPET脑显像可替代部分侵入性EEG检查用于致痫灶定位,而不同的PET定位图形对患者手术方案的选择也有重要指导意义。Objective To discuss the clinical value of 18 F -Fluorodeoxyglucose ( 18 F -FDG) PET cerebral imaging in focus localization of patients with all kinds of epilepsies. Methods Sixty-five patients of epilepsies were studied with interictal 18 F -FDG PET cerebral imaging, and all of them had scalp EEG, CT or MRI results for comparison. Fourteen patients with definite foci after PET imaging underwent surgeries or radiotherapies, whose prognosis were followed up and analyzed. Results In interictal PET images, 56 patients (86%) showed focal hypometabolism, 4 patients (6%) showed focal hypermetabolism and rest 5 patients (8%) had negative results. In 56 patients with typical results of hypometabolism, 40 patients (71%) had coincidence of localization results between PET and EEG, 10 patients (18%) with diffuse epileptic discharge and 1 patient (2%) with negative result of EEG, 5 patients (9%) had different localization results of PET and EEG. Also in these 56 patients, 44 patients (79%) had negative results and 12 patients (21%) had positive results of CT or MRI. Eleven of the latter group had coincidence of localization results between PET and CT (or MRI). Fourteen patients who underwent surgeries or radiotherapies were followed up for av. Two years, and 9 patients (64%) were free from seizures or had partial remissions. Conclusion Instead of some invasive EEG, 18 F -FDG PET cerebral imaging can give important information for focus localization of epilepsy with negative results of scalp EEG, CT and MRI. Its figures also can guide the choice of surgical operations.

关 键 词：癫痫 正电子发射计算机断层显像 ^18F-脱氧葡萄糖 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R445.6[医药卫生—临床医学]