PET结合视频脑电图对MRI阴性难治性癫痫致痫灶的术前定位  

Positron emission tomography plus VEEG in the localization of epileptic foci in negative-MRI interact epilepsy

作　　者：白新苹[1] 杨卫东[1] 陈旨娟[1] 王增光[1] 刘阳[1] 张广健[1] 毓青 蔡莉 

机构地区：[1]天津医科大学总医院功能神经外科,300052 [2]神经内科 [3]核医学中心

出　　处：《中华医学杂志》2012年第9期600-603,共4页National Medical Journal of China

基　　金：天津市科委科学基金（06VFJMJC07900）

摘　　要：目的评价正电子发射计算机断层（PET）在MRI阴性致痫灶定位诊断中的意义。方法对61例癫痫患者行头MRI、视频脑电图（VEEG）和发作间期”F-FDG联合13N-NH，·H2O—PET检查，将MRI阴性手术患者术前定位与术后疗效比较，并对MRI阳性与MRI阴性两组问PET、VEEG结果进行比较。结果Mill阴性组26例，阳性组35例；VEEG定位致痫灶提示：脑区性12例，多脑区性16例，半球性13例，不能定位20例；PET显像61例均有异常改变：脑区性23例，多脑区性28例，半球性5例，不能定位6例。17例MRI阴性患者术后Engels标准达Ⅰ-Ⅱ级的12例占70．59％，对两组间PET、VEEG定位分别进行比较，差异均无统计学意义；分别对两组的PET与VEEG比较，差异均有统计学意义。结论PET是一种对致痫灶定位敏感性、准确性较高的功能影像检查技术，特别在MRI阴性时，PET是定位致痫灶必不可少的检查手段。Objective To explore the application value of positron emission tomography （PET） in the localization of magnetic resonance imaging （MRI） -negative epileptogenic focus. Methods Brain images of is fluoro-2-deoxy-D-glucose （ is F-FDG） and 13 N_NH3 . H2 O-PET, MRI and video electroencephalography （VEEG） were obtained in 65 patients. Preoperative and postoperative localizations were compared in MRI- negative patients. And the results of PET and VEEG were compared between the MRI-positive and MRI- negative groups. Results MRI scans were normal in 26 cases and abnormal in 35 cases. Sixty-one patients had interictal epileptiform discharge on VEEG （brain regions, n = 12; multiple brain areas, n = 16; hemisphere, n- 13; unspecified location, n = 20） and interictal PET imaging （brain regions, rt = 23; multiple brain areas, n = 28 ; hemisphere, n = 5 ; unspecified location, = 6 ）. And 17 MRI-negative patients underwent operations and 12 of them reached the Engels Ⅰ - Ⅱ level standard. Both PET and VEEG were compared between the MRI-positive and MRI-negative groups. No significant differences existed between two group （ P 〈 0. 05 ）. A comparison of PET and VEEG showed statistical significance in two group （P 〉 0.05 ）. Conclusion PET imaging is both sensitive and effective in the detection and localization of epileptogenic loci. Especially for MRI-negative eases, it is an indispensable tool of localizing epileptogenie foci.

关 键 词：癫痫 定位 正电子发射断层显像 脑电描记术 核磁共振成像 

分 类 号：R742.1[医药卫生—神经病学与精神病学]