脑代谢显像与脑血流灌注显像在难治性癫痫发作不同时期中的定位应用  

Application of cerebral metabolism imaging and cerebral blood flow perfusion imaging in localization of refractory epilepsy at different stages

作　　者：陆玲玲 胡永全[1] Lu Lingling;Hu Yongquan(Department of Nucleal Medicine,Bengbu Medical College First Affiliated Hospital,Beng Bu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院核医学科,蚌埠233000

出　　处：《中国临床实用医学》2022年第5期36-40,共5页China Clinical Practical Medicine

基　　金：蚌埠医学院科技重点项目(2021byzd038)。

摘　　要：目的探讨发作间期18F-脱氧葡萄糖(18F-FDG)正电子发射型断层扫描仪(PET)/电子计算机断层扫描(CT)及联合发作期18F-FDG PET/CT、发作期^(99m)Tc-双半胱乙酯(^(99m)Tc-ECD)单光子发射型计算机断层扫描仪(SPECT)/CT在难治性癫痫致痫灶定位中的诊断价值。方法本研究为回顾性研究, 选取2017年3月至2022年1月于蚌埠医学院第一附属医院行手术治疗的61例难治性癫痫患者, 男36例, 女25例, 年龄(32.46±11.01)岁, 年龄范围为18~58岁。所有患者均行发作间期18F-FDG PET/CT脑代谢显像且均为阳性表现, 对18F-FDG PET/CT显像结果表现为多灶改变而不能准确定位者行发作期18F-FDG PET/CT显像或发作期^(99m)Tc-ECD SPECT/CT显像, 评估发作间期18F-FDG PET/CT显像及联合发作期18F-FDG PET/CT显像或^(99m)Tc-ECD SPECT/CT显像在难治性癫痫致痫灶中的定位诊断价值。结果 61例患者中23例(37.7%)在18F-FDG PET/CT中表现为单发病灶, 38例(62.3%)在18F-FDG PET/CT中表现为多发病灶或弥漫性改变无法准确定位, 其中12例行发作期18F-FDG PET/CT显像, 9例(75.0%)转化为单发病灶;26例行发作期^(99m)Tc-ECD SPECT/CT显像, 20例(76.9%)转化为单发性局限性血流灌注增高区。61例患者经发作间期18F-FDG PET/CT联合发作期18F-FDG PET/CT或^(99m)Tc-ECD SPECT/CT显像最终准确定位致痫灶52例, 准确度为85.2%。结论发作间期PET/CT显像表现为单发病灶的难治性癫痫患者, 致痫灶定位准确;发作间期PET/CT显像表现为多发病灶而无法准确定位的患者, 可加行发作期SPECT/CT显像或发作期PET/CT显像, 联合应用优势互补, 可显著提高对癫痫致痫灶的定位准确度。Objective To investigate the diagnostic value of 18F-deoxyglucose positron emission computed tomography/computed tomography(18F-FDG PET/CT),combined 18F-FDG PET/CT and ^(99m)TC-ethyl cysteinate dimer single photon emission computed tomography/computed tomography(^(99m) TC-ECD SPECT/CT)in refractory epilepsy.Methods This study was a retrospective study,61 patients with intractable epilepsy,36 males and 25 females,who underwent surgical in Bengbu Medical College First Affiliated Hospital between March 2017 and January 2022,the age was(32.46±11.01)years old,ranging from 18 to 58 years old.All patients underwent interictal 18F-FDG PET/CT brain metabolism imaging and all were positive,18F-FDG PET/CT or ^(99m)Tc-ECD SPECT/CT in ictal phase were performed in patients with multifocal lesions that could not be located accurately,to evaluate the diagnostic value of interictal 18F-FDG PET/CT imaging and combined 18F-FDG PET/CT imaging or ^(99m)Tc-ECD SPECT/CT imaging in localizing intractable epileptic foci.Results Of the 61 patients,23 patients(37.7%)presented as single lesions on 18F-FDG PET/CT,and 38 patients(62.3%)presented as multiple lesions or diffuse lesions that could not be accurately localized on 18F-FDG PET/CT.18F-FDG PET/CT imaging during seizure was performed in 12 patients,9 patients(75.0%)of them transformed into single lesion,and ^(99m)Tc-ECD SPECT/CT imaging during seizure in 26 patients,20 patients(76.9%)transformed into single localized hyperperfushion area.In 61 patients,interictal 18F-FDG PET/CT combined with ictal 18F-FDG PET/CT or ^(99m)Tc-ECD SPECT/CT imaging was used to accurately localize the epileptogenic focus in 52 patients(85.2%).Conclusions Interictal PET/CT imaging showed a single focus of intractable epilepsy patients,epileptogenic focus accurate location;For the patients whose PET/CT imaging showed multiple lesions and could not be accurately located,SPECT/CT imaging or PET/CT imaging could be added during the period of attack.The combined application of complementary advantages could sig

关 键 词：癫痫 正电子发射断层显像术 单光子发射计算机断层显像 术前定位 

分 类 号：R742.1[医药卫生—神经病学与精神病学]