一体化18F-FDG PET/MRI多模态分子影像在癫痫精准定位中的应用价值  

Clinical value of simultaneous 18F-FDG PET/MR molecular imaging in localizing seizure foci in epilepsy patients

作　　者：张淼[1] 黄鹏[1] 占世坤[2] 孟宏平 黄新韵 林晓珠[1] 张一帆[1] 曹春燕[2] 孙伯民[2] 李彪[1] 刘伟[2] ZHANG Miao;HUANG Peng;ZHAN Shikun;MENG Hongping;HUANG Xinyun;LIN Xiaozhu;ZHANG Yifan;CAOChunyan;SUN Biao;LI Biao;LIU Wei(Department of Nuclear Medicine,Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Department of Functional Neurosurgery,Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)

机构地区：[1]上海交通大学医学院附属瑞金医院核医学科,上海200025 [2]上海交通大学医学院附属瑞金医院功能神经外科,上海200025

出　　处：《诊断学理论与实践》2019年第3期271-277,共7页Journal of Diagnostics Concepts & Practice

基　　金：上海市申康促进医院临床技能与临床创新能力三年行动计划(16CR3110B)

摘　　要：目的:探讨一体化18F-FDG PET/MRI(以下简化为PET/MRI)检查在癫痫精准定位中的应用价值。方法:入组25例药物难治型癫痫患者,在术前发作间期行颅脑一体化PET/MRI检查,并在检查完成1个月内通过立体定向脑电图(stereot-actic electroencephalography, SEEG)或手术病理检查明确致癫痫灶。以SEEG及手术病理方法为金标准,对单一MRI形态学、PET形态分析法、PET/MRI融合成像3种方法检出、定位致痫灶的灵敏度和特异度进行对照研究;通过MI Neurology软件对致癫痫灶与正常PET/MRI脑代谢数据库进行配准比对,获得各脑区的标准差(standard deviation, SD)值,对比病变部位与对侧正常对照脑区SD值、平均标准化摄取值(mean standardized uptake value, SUVmean)值的差异。结果:单一MRI形态学方法定位致癫痫灶的灵敏度为37.5%(9/24),特异度为100%(4/4),有15处致痫灶单一MRI形态学无法显示,其中14例病灶无结构异常,因而MRI无法显示。单一PET形态学方法确诊16处癫痫灶。结合PET(包括半定量PET)进行PET/MRI融合成像,可以检出12处MRI阴性病例,PET/MRI检查定位致癲痫灶的灵敏度为91.6%(22/24),明显高于单一MRI形态学(P<0.05)。PET/MRI融合成像减少了1例PET假阳性诊断,其成像特异度为100%,同时MRI可以清晰显示解剖结构,为手术提供精准定位。致癫痫灶SD值为-6.16±2.26,健侧SD值为-0.72±0.89,致癫痫灶的SD值明显低于健侧对照区(P<0.01)。结论:一体化PET/MRI检查充分融合了2种显像方法的优势,对于无结构异常的致痫灶,结合PET(包括定量PET)可以发现MRI检查阴性的病灶,而MRI分辨率高,可清晰显示解剖结构,PET/MRI同机可对病灶的部位和范围进行精准定位,并可以进行功能融合成像,为手术方案制定提供了有力信息,在癫痫个体化精准医疗中显示出巨大应用潜力。Objective: To analyze the clinical value of simultaneous 18F-FDG PET/MR imaging(PET/MRI) in precise localization of epileptogenic lesion. Methods: Twenty-five patients with drug-refractory epilepsy were enrolled.All patients underwent simultaneous PET/MR during the interval of epilepsy. The epileptogenic foci were identified by stereo-tactic electroencephalography(SEEG) or surgical pathology in all patients within one month after PET/MRI. The sensitivity and specificity of three imaging modalities including single MRI, single PET and PET/MRI in localizing epileptogenic foci were compared. The standard deviation(SD) values of each brain region were assessed by matching the epileptogenic foci with the normal PET/MR brain metabolic database by MI Neurology software. The differences of SD values and mean standardized uptake value mean(SUVmean) between the lesions and the oppositesite brain regions were compared.Results: The sensitivity and specificity of single MRI in locating epileptogenic focus were 37.5%(9/24) and 100%(4/4),respectively. There were 15 epileptogenic focus which could not be displayed by single MR, among which there were fourteen focus with no structure abnormal. PET/MRI can detected twelve of these fourteen lesions and the sensitivity of PET/MRI in localizing epileptogenic foci was 91.6%(22/24), which was significantly higher than that of single MRI( P<0.05). The specificity of PET/MRI was 100%. The combination of PET and MRI reduced false-positive diagnosis. At the same time, MRI could provide a very clear anatomical structure and help foraccurate localization. The SD value of epileptogenic foci was-6.16+2.26 and that of opposite healthy side was-0.72+0.89. The SD value of epileptogenic lesion was significantly lower than that of control area(P <0.01). Conclusions: Simultaneous PET/MRI fully combines the advantages of two imaging methods. For the nonstructural abnormal epileptogenic foci, combined MRI with PET(including quantitative PET) can detect the MRI-negative foci, and with the high resoluti

关 键 词：一体化PET/MRI 18F-FDG 癫痫 数据库 定量分析 

分 类 号：R816[医药卫生—放射医学]