正电子发射计算机体层成像-CT与静息态功能MRI在颞叶癫痫定侧中的价值  

Comparative study of resting-state functional MRI and positron emission tomography-CT in the localization of temporal lobe epileptic focus

作　　者：赵春雷[1] 陈自谦[1] 王志敏[1] 钱根年[1] 倪萍[1] 陶超超[1] 

机构地区：[1]南京军区福州总医院医学影像科,350025

出　　处：《中华放射学杂志》2013年第3期211-215,共5页Chinese Journal of Radiology

基　　金：南京军区重大课题资助项目（092029）;福建省科学发展计划重点资助项目（2009Y0037）;福建省自然科学基金资助项目（2009J01187）

摘　　要：目的评价PET—CT与静息态功能MRI在颞叶癫痫定侧诊断中的价值。方法对将接受手术治疗的17例难治性癫痫患者行PET-CT与静息态功能MRI检查，同时选择性别、年龄相匹配的17名健康志愿者作为对照组。利用统计参数图（SPM）5后处理软件对所采集静息态功能MRI图像进行分析，测量全脑和双侧海马ReHo值。利用目测分析法及不对称指数分析PET—CT所得图像，测量双侧海马标准化摄取值（SUV）。利用配对样本t检验分析双侧颞叶SUV、ReHo值，利用ROC曲线界定出诊断颞叶癫痫的最佳临界值。利用Pearson相关分析判断双侧海马SUV与ReHo值的相关性。利用Kappa一致性检验，分析两者诊断结果的一致性。并将诊断结果与对照组和术后病理结果进行对比分析，评价2种方法在颞叶癫痫定侧诊断中的价值。结果17例患者PET—CT图像均有颞叶局限性或广泛性代谢减低，其中12例患者能够明确定侧，与术后病理结果对照诊断准确率为70．6％；17例患者行静息态功能MRI检查，11例表现为单侧ReHo值减低，能明确定侧，准确率为64．7％。两种检查方法联合应用可将诊断准确率提高到76．5％（13／17）。颞叶癫痫组患侧海马ReHo值（0．34±0．12）明显低于正常对照组海马ReHo值（0．46±0．07），2者差异有统计学意义（t=3．230，P=0．003），当ReHo值为0．36时，对颞叶癫痫诊断的敏感度为88．2％，特异度为94．1％；17例患者患侧SUV（4．17±0．63）与健侧SUV（4．77±0．56）间差异有统计学意义（t=2．930，P=0．006），当SUV为4．23时，对颞叶癫痫的诊断敏感度为88．2％，特异度为64．7％。2种检查方法在病灶检出率上有存在一致性，但一致性不高（Kappa值为0．49），患侧SUV与ReHo值之间无相关性（r=0．280，P=0．314）。结论PET—CT与静息态功能MRI多模态功能与代谢成像可提高颞叶癫痫定侧的诊断准确�Objective To evaluate the efficacy of PET-CT brain imaging and resting-state fMRI in preoperative localization of temporal lobe epileptic （ TLE ） focus. Methods PET-CT and resting-state fMRI were performed in 17 patients with refractory TLE, who then underwent surgical treatment. Seventeen healthy volunteers matched with gender and age were recruited as the control group. The resting-state fMRI images were post processed by SPM5 software. Regional homogeneity（ReHo） values of the whole brain and bilateral hippocampus were obtained and analyzed. PET-CT images were analyzed by visual analysis method and asymmetry index method and the standardized uptake value （SUV）of bilateral hippoeampus were obtained. The ReHo values and SUV of the bilateral hippocampus were compared by two independent samples t-test, and analyzed by receiver operating characteristic curve （ROC） for optimized diagnostic threshold. Pearson correlation analysis was employed for evaluating the correlation between the SUV and ReHo values of bilateral hippocampus. The consistency between the diagnostic accuracy of PET-CT andresting-state fMRI was assessed by Kappa consistency test. The outcome of the patient group was compared with that of the control group, and with the pathological results, to evaluate the diagnostic value of the two modalities for preoperative localization of temporal lobe epileptic focus. Results Regional or comprehensive low metabolism of ^18F-FDG in temporal lobes was presented in all 17 patients, and 11 patients out of 17 showed lateral decreased ReHo value. The diagnostic accuracy of the two examinations was 70. 6% （12/17） and 64. 7% （11/17） for PET-CT and resting-state fMRI respectively compared with pathological results,and could be increased to 76. 5% （13/17） when the two methods were combined for diagnosis. The ReHo values of the TLE group （0. 34 ± 0. 12）were significantly lower than those of the control group （0. 46 ± 0. 07） （t =3. 230,P =0. 003）. The sensitivity and specificity of

关 键 词：癫痫 颞叶 磁共振成像 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R742.1[医药卫生—神经病学与精神病学]