MRI与^(18)F-FDG PET对难治性颞叶癫痫定侧诊断价值  

An investigation on the clinical application of MRI and ^(18)F-FDG PET in the localization of intractable temporal lobe epilepsy

作　　者：赵春雷[1] 陈自谦[1] 钱根年[1] 付丽媛[1] 杨忠东[1] 王楷堂[1] 

机构地区：[1]南京军区福州总医院医学影像中心,福州350025

出　　处：《功能与分子医学影像学（电子版）》2016年第1期14-18,共5页Functional and Molecular Medical Imaging(Electronic Edition)

基　　金：福建省科技计划重点项目(2016I0010);全军医药卫生科研基金项目(MS132)

摘　　要：目的探讨18F-FDG PET脑代谢显像与MRI对颞叶癫痫致痫灶定侧诊断价值。方法 对78例资料完整的难治性颞叶癫痫(TLE)患者进行回顾性分析,以病理结果为金标准,对其常规MRI、MRS、18F-FDG PET检查及三者联合诊断在TLE定侧上的检出准确率进行比较、分析,以评价其价值。结果 本组78例难治性TLE患者均行前述三种检查,经统计学分析,致痫灶侧NAA/(Cho+Cr)及SUVmean低于健侧,三种检查定侧检出准确率分别为33.33﹪(26/78)、58.97﹪(46/78)及85.89﹪(67/78),三者联合诊断准确率为89.74﹪(70/78)(χ2 = 73.090,P < 0.001),采用分割χ2进一步两两比较,对P值进行校正,以0.008为标准,结果常规MRI与MRS(χ2 = 10.317, P = 0.001)、18F-FDG PET(χ2 = 44.758, P < 0.001)、三者联合(χ2 = 52.433, P < 0.001)差异均有统计学意义;MRS与18F-FDG PET(χ2 = 14.158, P < 0.001)、三者联合(χ2 = 19.366, P <0.001)差异均有统计学意义。结论 MRS对颞叶癫痫致痫灶定侧检出准确率明显高于常规MRI,在癫痫影像诊断时可先利用MRI进行诊断,同时行MRS检查,若仍无法准确定位,有条件者可进行18F-FDG PET检查,三者联合应用可显著提高其检出准确率。Objective To investigate the feasibility of using 18F-FDG PET and MRI in the localization of temporal lobe epileptic focus.Methods A retrospective study was carried out on 78 patients diagnosed with TLE.Conventional MRI,MRS and 18F-FDG PET brain imaging were all acquired in these patients.Using pathological results as the gold standard,the accuracies of these three methods,and a combination of all three,were compared.Results We found the ratio of NAA /（Cho＋Cr）and SUVmean was lower than that of the healthy side.The accuracy of these three kinds examinations and combined application of these three methods in localization of temporal lobe epileptic focus were 33.33﹪（26/78）,58.97﹪（46/78）,85.89﹪（67/78）and 89.74﹪（70/78）respectively.With chi-square test,we found the overall difference of the data was of statistically significant（χ2 = 73.090,P〈0.001）.Then further analysis was done by using the chi-square decomposition with the P value corrected to 0.008.As a result,we found the difference between conventional MRI and MRS,18F-FDG PET imaging,combined application was statistically significant（χ2 was 10.317,44.758,52.433,respectively and P = 0.001,P〈0.001,P〈0.001,respectively）.The difference between MRS and 18F-FDG PET,combined application was statistically significant（χ2 was 14.158,19.366,respectively and P values are both less than 0.01）.There was no significant difference between 18F-FDG PET and the combined application.Conclusion MRI can be used in the clinical diagnosis of epilepsy,but the conventional MRI and MRS examination should be carried out at the same time,because the accuracy of MRS was significantly higher than that of conventional MRI.18F-FDG PET test should be performed if the results from MRI and MRS are inconclusive and patient are willing to accept the additional test.The combination of the three methods in localization of temporal lobe epileptic focus can significantly improve the diagnostic accuracy of intractable temporal lobe epilepsy.

关 键 词：正电子 发射 计算机断层扫描 磁共振 波谱 癫痫 定位 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R817.4[医药卫生—临床医学] R445.2