正电子发射计算机断层成像/磁共振成像融合技术在提高儿童结构相关难治性癫痫致痫灶检出率的应用  

Application of positron emission computed tomography /magnetic resonance imaging coregistration in improving epileptic foci detection rate of structural intractable epilepsy in children

作　　者：刘明[1,2] 季涛云[1,2] 叶锦棠[1,3] 范岩[1,4] 刘晓燕[1,2] 王爽[1,2] 吴晔[1,2] 刘庆祝[1] 王若凡[1,2] 王文[1] 程伟科[1] 姜玉武[1,2] 蔡立新[1] Liu Ming;Ji Taoyun;Ye Jintang;Fan Yan;Liu Xiaoyan;Wang Shuang;Wu Ye;Liu Qingzhu;Wang Ruofan;Wang Wen;Cheng Weike;Jiang Yuwu;Cai Lixin(Department of Children Epilepsy Center,Peking University First Hospital,Beijing 100034,China;Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;Department of Radiology,Peking University First Hospital,Beijing 100034,China;Department of Nuclear Medicine,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院儿童癫痫中心,100034 [2]北京大学第一医院儿科,100034 [3]北京大学第一医院放射科,100034 [4]北京大学第一医院核医学科,100034

出　　处：《中华实用儿科临床杂志》2018年第23期1815-1819,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家重点研发计划(2016YFC1306201);北京大学第一医院交叉临床研究专项课题(2017CR23).

摘　　要：目的 探讨磁共振成像(MRI)、正电子发射计算机断层成像(PET)和PET/MRI融合技术在儿童难治性癫痫致痫区的检出情况.方法 回顾性分析2015年9月至2016年3月于北京大学第一医院儿童癫痫中心行癫痫切除手术的难治性癫痫患儿资料.收集患儿基本临床资料、手术和预后随访资料、发作间期和发作期脑电图、MRI、PET、PET/MRI融合等信息.与癫痫术前评估团队确定的致痫区对比,评估 MRI、PET和PET/MRI融合技术对癫痫定位的准确性.根据随访≥1年无发作患者,分别计算MRI、PET和PET/MRI融合技术对癫痫灶检出的敏感度、特异度、阳性预测值和阴性预测值.结果 (1)共收集62例,男30例,女32例.平均起病年龄为2.50岁(2 d^11.70岁),平均手术年龄5.10岁(0.75~15.60岁).(2)62例手术方式和预后:局灶/单脑叶切除32例(占51.6%),多脑叶切除16例(占25.8%),半球离断14例(占22.6%).术后随访≥1年,Engel Ⅰ级占91.9%(57/62例),Engel Ⅱ~Ⅳ级分别为1例、3例和1例.(3)与术前评估团队确定的致痫区相比,MRI一致性为64.5%(40/62例),PET一致性为72.5%(45/62例),PET/MRI融合技术一致性为85.5%(53/62例),三者比较差异有统计学意义(χ2=7.25,P=0.03).(4)Engel Ⅰ级患者计算结果显示, MRI的敏感度为66. 7%,特异度为60.0%;PET的敏感度为75.4%,特异度为60.0%;PET/MRI融合技术的敏感度为85. 9%,特异度为80.0%.(5)对11例病理结果为局灶性皮质发育不良的"阴性MRI"进行二次阅读, 9例发现有轻微异常.结论 PET/MRI融合能提高儿童难治性癫痫的病灶检出率.Objective To study the predictive value of magnetic resonance imaging (MRI),positron emission computed tomography (PET)and PET/MRI coregistration in intractable epilepsy of children.Methods A retrospec-tively analysis was performed based on the surgery data at the Department of Children Epilepsy Center of Peking Univer-sity First Hospital from September 2015 to March 2016.The clinical data,surgery and follow-up study data,interictal and ictal electroencephalogram,MRI,PET and PET/MRI coregistration data were collected.By comparison with the epi-leptogenic zone designed by pre-surgical workup,the accuracy of MRI,PET and PET/MRI coregistration in detecting lesion was assessed.In the patients who had no seizure during≥1 year follow-up,their sensitivity,specificity,positive predictive value,negative predictive value of MRI,PET and PET/MRI coregistration were calculated.Results (1)A total of 62 patients underwent surgery,30 boys and 32 girls. The average age on epilepsy onset was 2. 50 years (2 days-11.70 years),and average age on surgery was 5.10 years old(0.75-15.60 years old).(2)Surgical treat-ment of 62 cases included the resection of the focal or lobar (32 cases,51.6%),and the multilobar (16 cases, 25. 8%).Hemispherotomy was done in 14 cases (22.6%).During ≥1 year follow-up,seizure outcome was Engel class Ⅰ in 57 cases (91.9%)out of the 62 patients,Engel classⅡto Engel classⅣin 1 case,3 cases,and 1 case, respectively.(3)Referred to epileptogenic zone designed by presurgical workup,MRI represented 64.5%(40/62 ca-ses)results with accordance,PET and PET/MRI coregistration was 72.5%(45/62 cases)and 85.5%(53/62 cases), respectively,and the difference was significant(χ2=7.25,P=0.03).(4)Based on the patients of Engel class Ⅰ, their sensitivity and specificity were 66.7%,60.0% in MRI,75.4%,60.0% in PET %,and 85.9%,80.0% in PET/MRI coregistration,respectively.(5)There were 11 "non-lesion" cases of all focal cortical dysplasia in patholo-gy,and subtle structural abnormalities were de tected in 9 cases by review

关 键 词：难治性癫痫 磁共振成像 正电子发射计算机断层成像 正电子发射计算机断层成像/磁共振成像融合技术 致痫区 

分 类 号：R742.1[医药卫生—神经病学与精神病学]