Rasmussen脑炎患者的18F-脱氧葡萄糖PET的表现特点  

Manifestations of 18F-fluorodeoxyglucose positron emission tomography in Rasmussen encephalitis

作　　者：王海祥[1] 张玮[1] 陈述花[1] 梅曦[1] 刘晓飞[2] 王志忠[2] 栾国明[1] 刘兴洲[1] 

机构地区：[1]北京三博脑科医院(首都医科大学第十一临床医学院)癫痫中心,100093 [2]解放军第309医院核医学科

出　　处：《中华神经外科杂志》2014年第8期796-799,共4页Chinese Journal of Neurosurgery

基　　金：国家临床重点专科建设项目（SG2011-02-2-7）;北京市自然科学基金（7122088）

摘　　要：目的 总结Rasmussen脑炎患者18F-脱氧葡萄糖（18F-FDG） PET的代谢改变特点及其在Rasmussen脑炎诊断治疗中的价值.方法 回顾性分析手术治疗且经病理证实为Rasmussen脑炎的13例患者的临床资料及PET检查结果,并将PET的异常代谢区与MRI病灶进行对比评价.结果 PET的异常代谢改变分为低代谢、高代谢及混合型代谢异常（同时具有低代谢及高代谢改变）.7例只表现为低代谢,6例表现为混合性代谢异常.3例为发作期PET,10例为间歇期PET.13例均有低代谢异常改变,其中11例的低代谢改变范围超过3个脑叶.低代谢改变最常受累的脑叶是颞叶（12/13）、额叶（9/13）及岛叶（8/13）.6例有高代谢改变的病例中,2例涉及中央区,2例涉及颞叶,1例涉及额叶、岛叶,1例涉及顶枕叶.与MRI有异常信号的病灶进行对比,低代谢区与病灶并不一致.相反,在6例有高代谢改变的病例中,PET高代谢区在MRI相应部位均能发现病灶.结论 Rasmussen脑炎的PET表现特点是单侧半球弥漫性低代谢以及在低代谢背景上出现高代谢的混合型代谢异常,最常受累的代谢异常脑区是颞叶、额叶及岛叶,其特点均支持Rasmussen脑炎的诊断.高代谢区与MRI有异常信号病灶的一致性提示该区是炎症活动或致痫灶,这对选择脑活检部位提供帮助.Objective To summarize the characteristics of the metabolic changes detected by 18F-fluorodeoxyglucose （FDG） positron emission tomography （PET） in patients suffering from Rasmussen encephalitis （RE） and to study the roles of 18F-FDG PET in the clinical diagnosis.Methods The clinical data and PET images of 13 patients who had underwent resection and been pathologically confirmed as RE from 2008 to 2013 were retrospectively analyzed,and the abnormally metabolic region identified by PET and lesions＇ locations identified by MRI were compared and evaluated respectively.Results The metabolism level of PET was categorized as hypometabolism,hypermetabolism and hybrid metabolic abnormalities （showing both hypometabolism and hypermetabolism）.In the thirteen patients,seven of them manifested only hypometabolism,and six hybrid metabolic abnormalities.Three patients underwent ictal PET and ten underwent interictal PET.Hypometabolism was detected in all of the thirteen patients,and in 11 patients more than three lobes were involved.The regions involved most were temporal lobe （12/13）,frontal lobe （9/13）,and insula lobe （8/13）.In the six patients with hypermetabolism,central region was involved in two patients,temporal lobe in two,frontal and insular lobe in one,and parietal and occipital lobe in one.After comparasion with MRI lesions,it was found that the hypometabolic regions were inconsistent with those lesions＇ locations detected by MRI.On the contrary,in the six patients with hypermetabolic regions,the MRI lesions＇ locations were found as being corresponding to the hypermetabolic regions.Conclusions The characteristic manifestation on PET imaging in RE is unilaterally diffuse hypometabolism or hybrid metabolic abnormalities with hypermetabolism on diffuse hypometabolic background.The most involved regions of metabolic abnormalities were temporal lobe,frontal lobe and insular lobe.All the characteristics could support the diagnosis of RE.The consistency between hypermetabolic regions and MR

关 键 词：正电子发射断层显像术 RASMUSSEN脑炎 癫痫 

分 类 号：R742.9[医药卫生—神经病学与精神病学]