一侧小脑发作间期低代谢在癫痫术前评估中的定侧价值  

The lateralization value of interictal cerebellar hypometabolism in epileptic presurgical assessment

作　　者：高曲文[1] 黎振声[1] 王欣璐[2] 林健[1] 郭晓绯[1] 欧阳习[2] 齐自娟 彭凯润[1] 王伟[1,3] GAO Quwen;LI Zhensheng;WANG Xinlu;LIN Jian;GUO Xiaofei;OUYANG Xi;QI Zijuan;PENG Kairun;WANG Wei(Department of Epilepsy,Guangzhou General Hospital of PLA,Guangzhou 510010,China)

机构地区：[1]广州军区广州总医院癫痫科,广州510010 [2]广州军区广州总医院核医学科PET/CT中心,广州510010 [3]中山大学附属第二医院神经外科,广州510120

出　　处：《实用医学杂志》2018年第15期2544-2547,共4页The Journal of Practical Medicine

摘　　要：目的明确一侧小脑发作间期低代谢的致痫区定侧价值。方法收集2013-2015年行致痫灶切除、随访1年以上、疗效达到EngelⅠ级的癫痫患者术前PET/CT,目测法与半定量法检测小脑代谢并分析其与致痫灶的侧别关系,致痫灶定侧以手术切除病灶侧为准。结果共入组44例患者,致痫灶对侧小脑半球代谢较同侧更低者17例(38.6%)。如以一侧小脑低代谢为定侧依据,则其敏感性为38.6%。38例示致痫灶同侧大脑半球低代谢,即本研究中PET/CT的定侧价值为86.4%,另外6例示双侧大脑半球低代谢,其中3例致痫灶对侧小脑半球代谢较同侧更低。如果加上小脑的定侧,则PET/CT总致痫灶定侧价值由86.4%提高至93.2%。半定量法显示致痫灶同侧小脑半球代谢较对侧高(x>0),双侧小脑半球代谢不对称指数差异有统计学意义(P=0.002)。结论一侧小脑发作间期不对称性低代谢往往提示致痫灶位于对侧大脑半球。Objective To explore the lateralizing value of cerebellar hypometabolism in epileptic presurgical assessment.Methods The patients who underwent epileptic surgery between 2013 and 2015 and were followed up for at least one year and had an effect of Engel classⅠwere enrolled in this study.The side of epileptogenic zone(EZ)was determined to be ipsilateral to the resected area.We studied the correlation between EZ and cerebellar metabolism by visual examination and semi-quantitative analyses which was performed by using standardized uptake value(SUV)to calculate asymmetrical index(AI)of metabolism distribution.Results Forty-four patients were enrolled.By visual examination,17(38.6%)patients were found lower metabolism in cerebellar hemisphere contralateral to EZ.If unilateral cerebellar hypometabolism was used to lateralize EZ,the sensitivity was 38.6%.Otherwise,38 of 44 patients demonstrated cerebral hypometabolism ipsilateral to EZ,and the lateralizing value of interictal PET/CT was 86.4%.6 of 44 patients demonstrated bilateral cerebral hypometabolism,3 of the 6 patients showed more conspicuous hypometabolism in cerebellar hemisphere contralateral to EZ.With addition of lateralizing role of cerebellum,the total lateralization value of PET/CT increased from 86.4%to 93.2%(41/44).By semiquantitative analyses of SUV,AI of bilateral cerebellar hemisphere showed significant difference(P=0.002).Conclusion Unilateral cerebellar hypometabolism on interictal PET/CT may indicate EZ locating contralateral cerebral hemisphere.

关 键 词：癫痫 PET/CT 小脑 致痫灶 定侧 

分 类 号：R651.1[医药卫生—外科学]