难治性颞叶癫痫的分子影像学研究与病理对照  

Comparison of molecular imaging with postoperational pathology in temporal lobe epilepsy

作　　者：张海琴[1] 关乐[1] 李坤成[2] 王志群[2] 崔春蕾[1] 李则[1] 张人玲[1] 

机构地区：[1]首都医科大学宣武医院核医学科,北京100053 [2]首都医科大学宣武医院放射科,北京100053

出　　处：《医学影像学杂志》2012年第4期509-513,共5页Journal of Medical Imaging

摘　　要：目的:对照难治性颞叶癫痫(TLE)手术病理资料,探讨联合单光子发射计算机断层(SPECT)和质子磁共振波谱(1 H-MRS)两种分子影像学技术对TLE定位的临床价值。方法:选择29例经手术病理证实的单侧TLE。所有患者术前均行SPECT发作间期脑血流(CBF)灌注显像、常规磁共振(MRI)扫描和1 H-MRS成像。将两种分子影像学技术,发作间期CBF灌注显像和1 H-MRS,对TLE的定位表现与病理结果进行对比分析。结果:病理改变最常见的是海马硬化和皮质发育不良,共27例(93.10%),此两种改变伴随出现于16例中(55.17%)。对于双重病理TLE,MRI、SPECT定位阳性率均为100%(16/16),MRS为87.50%(14/16)。对于单纯性海马硬化,MRI为阴性,SPECT仅为14.29%(1/7),而MRS高达57.14%(4/7)。对于单纯性皮质发育不全,MRS为阴性,MRI为50.00%(2/4),而SPECT高达75.00%(3/4)。联合应用SPECT和MRS对TLE定位率高达86.20%(25/29),尤其是对MRI阴性的患者,两种技术联合能发现54.55%(6/11)TLE的致痫灶。结论:联合SPECT发作间期脑血流灌注显像和1 H-MRS两种分子影像学技术能为难治性TLE提供更为全面和准确的定位诊断信息,可进一步提高定位MRI阴性TLE患者致痫灶的比例。Objective：To evaluate the epilepsy focus location diagnostic value of single photon emission computed tomo- graphy （SPECT） and proton magnetic resonance spectroscopy （1^H-MRS） in the patients with temporal lobe epilepsy （TLE）. by comparing the results of the postoperational pathology. Methods： Twenty-nine selected patients with unilateral TLE verified by operation and pathology were studied. All of them had been performed SPECT interictal cerebral blood flow （CBF） perfusion imaging, routine magnetic resonance imaging （MRI） and 1H-MRS before the operation. The value of the location diagnosis in epilepsy t＇ocus of two molecular imaging methods, interictal CBF per{us/on imaging and 1^ H- MRS. were compared. Results：The most common histologic abnormalities were hippocampal sclerosis and malformation of cortical development （MCD） （27, 93. 10%0）, and they appeared in the same specimen most o{ time （16, 55. 17%）. For this kind of case, location accuracy rate of MR1 and SPECT was 100.00%（16/16）, and MRS was 87.50%（14/16）. For pure hippocampal sclerosis, MRI was negative, location accuracy rate of SPECT was 14.29%（1/？） and MRS reached to 57.14 % （4/7）. For pure MCD, MRS was negative, location accuracy rate of MRI was 50.00 % （2/4） and SPECT reached to 75.00%（3/4）. The accuracy rate reached to 86.20Yz0 （25/29） when SPECT and 1^ H-MRS were combined, and 54.55%（6/11） of patients with negative MRI showed positive SPECT and/or 1^ H-MRS. Conclusion： The combination of SPECT interictal CBF perfusion imaging and 1 H-MRS can provide more general information for the location of TLE patients and can improve the accuracy rate of location for TLE with negative MR1.

关 键 词：颞叶癫痫 病理特点 单光子发射计算机断层 磁共振成像 磁共振波谱学 定位诊断 

分 类 号：R814.42[医药卫生—影像医学与核医学]